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Aljafen BN, Alneseyan R, Muayqil T, Alkhateeb MO, Aldosari MM, Alsermani A, Alnakhli L, Althomali R, Alnami R, Alqahtani R, Ibrahim L, Babtain F. Evaluating the prevalence and risk factors for depression in patients with temporal lobe epilepsy with hippocampal sclerosis: A cross-sectional multicenter study. Epilepsy Behav 2024; 154:109782. [PMID: 38636108 DOI: 10.1016/j.yebeh.2024.109782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Epilepsy frequently accompanies Major Depressive Disorder (MDD). Notably, people with temporal lobe epilepsy and hippocampal sclerosis may face an increased susceptibility to MDD, as evidence indicates the involvement of the limbic system in the development of emotional symptoms. OBJECTIVES To determine the prevalence and predictors of depression in temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) and compare them to those of other epilepsy types. METHODS A sample of 293 epilepsy patients, including 159 non-TLE-HS and 134 TLE-HS, were recruited from three hospitals. Of these, 215 completed a two-section electronic survey. The first section collected demographic and epilepsy data, while the second used the Arabic version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). RESULTS Of 215 patients, 104 (48%) had TLE-HS-38 with right TLE-HS (37%), 56 with left TLE-HS (54%), and 10 with bilateral TLE-HS (10%). The prevalence and severity of depression was assessed with an NDDI-E score of 15 or higher identified 35 patients (16%) with MDD. Valproic acid and lamotrigine were associated with higher NDDI-E scores. No such associations were found for levetiracetam or carbamazepine. Polytherapy in TLE-HS showed a significant correlation with daily poor concentration. CONCLUSION We explored the differences in depression prevalence between TLE-HS and other epilepsy types and concluded they are minimal but slightly higher in TLE-HS. Predictors of depression such as seizure frequency and disease duration influenced MDD prevalence in TLE-HS. Lamotrigine and valproate were linked to higher NDDI-E scores.
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Affiliation(s)
- Bandar N Aljafen
- Neurology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Ruwa Alneseyan
- Neurology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Taim Muayqil
- Neurology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mashael O Alkhateeb
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Alfasial University, Riyadh, Saudi Arabia
| | - Mubarak M Aldosari
- Epilepsy Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Aya Alsermani
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Lujain Alnakhli
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Renad Althomali
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Razan Alnami
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Ruba Alqahtani
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Lama Ibrahim
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Fawzi Babtain
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Ierusalimsky NV, Karimova ED, Samotaeva IS, Luzin RV, Zinchuk MS, Rider FK, Guekht AB. [Structural brain changes in patients with temporal lobe epilepsy and comorbid depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:83-89. [PMID: 37796072 DOI: 10.17116/jnevro202312309183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To assess the morphological features of the brain structures in patients with temporal lobe epilepsy and comorbid depression. MATERIAL AND METHODS From 1 January 2017 to 31 December 2020, we studied 80 patients with temporal lobe epilepsy (aged 18-60 years, 38 of whom had comorbid depression) and 48 healthy subjects of comparable age. Magnetic resonance imaging (MRI) of the brain was performed using the epilepsy protocol in a scanner with a magnetic field strength of 1.5 T. Focal temporal lobe epilepsy was diagnosed by neurologists (epileptologists) specialising in epilepsy according to the International League Against Epilepsy (ILAE) classification of epilepsy. Psychiatrists assessed the presence and severity of depressive disorders by clinical interview and by participants' scores on the Beck Depression Inventory (BDI-II). MRI data were processed using FreeSurfer 6.0 software to determine volumes of subcortical structures and thicknesses of cortical structures. At the group level, analysis of covariance with Holm-Bonferroni correction was used as the statistical method. RESULTS Morphometric analysis revealed a significant decrease in the volume of the thalamus bilaterally and the brain stem and an increase in the volume of the choroid plexus in the left hemisphere, as well as a significant decrease in the thickness of the entorhinal cortex, temporal pole and isthmus of the cingulate gyrus in the left hemisphere and middle temporal gyrus and inferior temporal gyrus in the right hemisphere in patients with epilepsy compared to healthy controls. No association was found between the presence of depression and significant structural changes on MRI. CONCLUSION The data obtained suggest an effect of temporal lobe epilepsy, but not comorbid depression, on the morphology of brain structures.
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Affiliation(s)
- N V Ierusalimsky
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - E D Karimova
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - I S Samotaeva
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - R V Luzin
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - M S Zinchuk
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - F K Rider
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - A B Guekht
- Scientific and Practical Psychoneurological Center, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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Kanner AM, Irving LT, Cajigas I, Saporta A, Cordeiro JG, Ribot R, Velez-Ruiz N, Detyniecki K, Melo-Bicchi M, Rey G, Palomeque M, King-Aponte T, Theodotou C, Ivan ME, Jagid JR. Long-term seizure and psychiatric outcomes following laser ablation of mesial temporal structures. Epilepsia 2022; 63:812-823. [PMID: 35137956 DOI: 10.1111/epi.17183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Postsurgical seizure outcome following laser interstitial thermal therapy (LiTT) for the management of drug-resistant mesial temporal lobe epilepsy (MTLE) has been limited to 2 years. Furthermore, its impact on presurgical mood and anxiety disorders has not been investigated. The objectives of this study were (1) to identify seizure outcome changes over a period ranging from 18 to 81 months; (2) to investigate the seizure-free rate in the last follow-up year; (3) to identify the variables associated with seizure freedom; and (4) to identify the impact of LiTT on presurgical mood and anxiety disorders. METHODS Medical records of all patients who underwent LiTT for MTLE from 2013 to 2019 at the University of Miami Comprehensive Epilepsy Center were retrospectively reviewed. Demographic, epilepsy-related, cognitive, psychiatric, and LiTT-related data were compared between seizure-free (Engel Class I) and non-seizure-free (Engel Class II + III + IV) patients. Statistical analyses included univariate and multivariate stepwise logistic regression analyses. RESULTS Forty-eight patients (mean age = 43 ± 14.2 years, range = 21-78) were followed for a mean period of 50 ± 20.7 months (range = 18-81); 29 (60.4%) achieved an Engel Class I outcome, whereas 11 (22.9%) had one to three seizures/year. Seizure-freedom rate decreased from 77.8% to 50% among patients with 24- and >61-month follow-up periods, respectively. In the last follow-up year, 83% of all patients were seizure-free. Seizure freedom was associated with having mesial temporal sclerosis (MTS), no presurgical focal to bilateral tonic-clonic seizures, and no psychopathology in the last follow-up year. Presurgical mood and/or anxiety disorder were identified in 30 patients (62.5%) and remitted after LiTT in 19 (62%). SIGNIFICANCE LiTT appears to be a safe and effective surgical option for treatment-resistant MTLE, particularly among patients with MTS. Remission of presurgical mood and anxiety disorders can also result from LiTT.
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Affiliation(s)
- Andres M Kanner
- Epilepsy Division, Departments of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Le Treice Irving
- Epilepsy Division, Departments of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Iahn Cajigas
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Anita Saporta
- Epilepsy Division, Departments of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | | | - Ramses Ribot
- Epilepsy Division, Departments of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Naymee Velez-Ruiz
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Kamil Detyniecki
- Epilepsy Division, Departments of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Manuel Melo-Bicchi
- Epilepsy Division, Departments of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Gustavo Rey
- Epilepsy Division, Departments of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Maru Palomeque
- Epilepsy Division, Departments of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Tricia King-Aponte
- Epilepsy Division, Departments of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Christian Theodotou
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jonathan R Jagid
- Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Bidirectional Relations Among Depression, Migraine, and Epilepsy: Do They Have an Impact on Their Response to Treatment? Curr Top Behav Neurosci 2021; 55:251-265. [PMID: 34964936 DOI: 10.1007/7854_2021_286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The evaluation and treatment of patients with epilepsy is not limited to the type of epilepsy, but it must incorporate the common comorbid neurologic, psychiatric, and medical disorders, as the latter can bare an impact on the course and response to treatment of the seizure disorder and vice versa. In this article we review the bidirectional relations among epilepsy and two of its most common comorbidities, mood disorders and migraine and examine the implications of these relations on the selection of therapies of these three disorders and their response to treatment. We also review the most salient common pathogenic mechanisms that may explain such relations.
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de Figueiredo NSV, Gaça LB, Assunção-Leme IB, Mazetto L, Garcia MTFC, Sandim GB, Alonso NB, Centeno RS, Filho GMDA, Jackowski AP, Júnior HC, Yacubian EMT. A pioneering FreeSurfer volumetric study of a series of patients with mesial temporal lobe epilepsy and hippocampal sclerosis with comorbid depression. Psychiatry Res Neuroimaging 2021; 311:111281. [PMID: 33836383 DOI: 10.1016/j.pscychresns.2021.111281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
Depression is the most frequent psychiatric comorbidity in patients with mesial temporal lobe epilepsy (MTLE) and hippocampal sclerosis (HS). This study aimed to confirm whether patients with comorbid depression have different volumetric patterns on magnetic resonance imaging, analysing the influence of HS sides. Psychiatrists conducted semi-structured interviews with 75 patients, who were divided into non-depression group (NDG, n = 52) and depression group (DG, n = 23), and compared with 98 controls. The FreeSurfer software was used in the volumetric analysis of the estimated total intracranial volume (eTIV), bilateral cortical and subcortical regions of interest (ROIs), and for presence of left (L-, n = 41) or right (R-, n = 34) MTLE-HS. Twenty-three (30.7%) patients had depression, of whom 14 (34.1%) had l-MTLE-HS and 9 (26.5%) had R-MTLE-HS. No difference was observed between DG and NDG vs. controls in terms of eTIV and cortical ROIs, regardless of the severity of depression. In patients with l-MTLE-HS, the eTIV in the DG was reduced in comparison with that in the NDG and control group, with a small effect size. Hippocampal reduction occurred ipsilateral to HS in the l-MTLE-HS and R-MTLE-HS subgroups when DG and NDG were compared with controls, as expected according to Enhancing Neuro Imaging Genetics through Meta-Analysis (2018).
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Affiliation(s)
- Nathália Stela Visoná de Figueiredo
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 650, 1st floor. Postal number: 04039-002 Vila Clementino, São Paulo, Brazil.
| | - Larissa Botelho Gaça
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 650, 1st floor. Postal number: 04039-002 Vila Clementino, São Paulo, Brazil
| | - Idaiane Batista Assunção-Leme
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 669, 3rd floor. Postal number: 04039-032 Vila Clementino, São Paulo, Brazil
| | - Lenon Mazetto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 650, 1st floor. Postal number: 04039-002 Vila Clementino, São Paulo, Brazil
| | - Maria Teresa Fernandes Castilho Garcia
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 650, 1st floor. Postal number: 04039-002 Vila Clementino, São Paulo, Brazil
| | - Gabriel Barbosa Sandim
- Departament of Diagnosis by Imaging, Universidade Federal de São Paulo (UNIFESP), Napoleão de Barros Street, 800. Postal number: 04024-002 Vila Clementino, São Paulo, Brazil
| | - Neide Barreira Alonso
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 650, 1st floor. Postal number: 04039-002 Vila Clementino, São Paulo, Brazil
| | - Ricardo Silva Centeno
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 650, 1st floor. Postal number: 04039-002 Vila Clementino, São Paulo, Brazil
| | - Gerardo Maria de Araújo Filho
- Department of Psychiatry and Medical Psychology, Faculdade de Medicina de São José do Rio Preto (FAMERP), Brigadeiro Faria Lima Avenue, 5416. Postal number: 15090-000 Vila São José, São José do Rio Preto, Brazil
| | - Andrea Parolin Jackowski
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 669, 3rd floor. Postal number: 04039-032 Vila Clementino, São Paulo, Brazil
| | - Henrique Carrete Júnior
- Departament of Diagnosis by Imaging, Universidade Federal de São Paulo (UNIFESP), Napoleão de Barros Street, 800. Postal number: 04024-002 Vila Clementino, São Paulo, Brazil
| | - Elza Márcia Targas Yacubian
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 650, 1st floor. Postal number: 04039-002 Vila Clementino, São Paulo, Brazil
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Qin Y, Tong X, Li W, Zhang L, Zhang Y, Li X, Yang J, Qin K, Lei D, Gong Q, Zhou D, An D. Divergent Anatomical Correlates and Functional Network Connectivity Patterns in Temporal Lobe Epilepsy with and Without Depression. Brain Topogr 2021; 34:525-536. [PMID: 33973138 DOI: 10.1007/s10548-021-00848-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/05/2021] [Indexed: 02/05/2023]
Abstract
Epilepsy and depression were proposed to facilitate each other reciprocally through common neurobiological anomalies, especially the prefrontal-limbic-subcortical abnormalities. Yet neuroimaging patterns of higher-order cognitive networks and neuroanatomical correlates were rarely compared in temporal lobe epilepsy patients with (TLE-D) and without depression (TLE-N). We collected T1-weighted structural and resting-state functional MRI data from 20 TLE-D, 31 TLE-N and 20 healthy controls (HCs) and performed analyses including hippocampal volume (HCV), cortical thickness, gray matter volume (GMV) and whole-brain functional network connectivity (FNC) across three groups. Imaging differences were related to clinical and psychological measurements. TLE-D demonstrated disrupted functional role of subcortical (SUB) and higher-order cognitive networks compared to TLE-N and HCs. In TLE-D, GMV in the right supplementary motor area (SMA) and FNC between the dorsal attention (DAN) and SUB were attenuated compared to TLE-N and HCs, FNC between SUB and the visual network (VIS) decreased compared to HCs. GMV in the right SMA was negatively correlated with depression severity and some symptoms. Combined, explicit emotion regulation may be impaired in TLE-D. Meanwhile, compared to HCs, TLE-N showed smaller HCVs, TLE-D and TLE-N showed smaller GMV in the medial orbital frontal gyrus and right hippocampus and hippocampal gyrus, possibly implying predisposition of epileptic activities to co-morbid depression. Our findings suggest distinct anatomical and FNC patterns in TLE-D and TLE-N. More than prefrontal-limbic-subcortical anomalies, disrupted higher-order cognitive network may contribute to depression in TLE, providing new potential treatment targets for depression and calling attention to relation between cognitive dysfunction and co-morbid depression.
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Affiliation(s)
- Yingjie Qin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Tong
- Department of Neurology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Le Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yingying Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiuli Li
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kun Qin
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Du Lei
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiyong Gong
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Dongmei An
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Elkommos S, Mula M. A systematic review of neuroimaging studies of depression in adults with epilepsy. Epilepsy Behav 2021; 115:107695. [PMID: 33348194 DOI: 10.1016/j.yebeh.2020.107695] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Depression is a relatively common comorbidity in people with epilepsy with a lifetime history identified in 1 in 4 individuals. In this paper, we aimed to provide a systematic review of structural and functional brain region-specific group differences of adults with epilepsy and depression and to discuss existing evidence as compared to that in people with depression. METHODS We undertook a systematic review of neuroimaging studies of depression in adults with epilepsy through MEDLINE/PubMed, Embase and PsycInfo searches until June 2020. RESULTS A total of 44 studies were included in the qualitative synthesis: 21 on structural neuroimaging, 9 on functional, and 14 on pharmaco/metabolic neuroimaging. Almost all studies focused on temporal lobe epilepsy (TLE). Patterns of changes in the hippocampi and subcortical structures seem to be different from those reported in depression outside epilepsy. Cortical changes are grossly similar as well as the lack of any laterality effect. Serotonin dysfunction seems to be due to different mechanisms with reduced synaptic availability for depression in epilepsy as compared to reduced 5HT1 receptor density outside epilepsy. Depressive symptoms seem to correlate with a dysfunction in temporolimbic structures contralateral to the epileptogenic zone especially in patients with de novo postsurgical depression. CONCLUSIONS Depression, at least in TLE, seems to be associated with a different pattern of brain changes as compared to major depression, potentially supporting the notion of phenomenological peculiarities of depression in epilepsy.
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Affiliation(s)
- Samia Elkommos
- Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Institute of Medical and Biomedical Education, St George's University of London, United Kingdom.
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Reh R, Williams LJ, Todd RM, Ward LM. Warped rhythms: Epileptic activity during critical periods disrupts the development of neural networks for human communication. Behav Brain Res 2020; 399:113016. [PMID: 33212087 DOI: 10.1016/j.bbr.2020.113016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/27/2022]
Abstract
It is well established that temporal lobe epilepsy-the most common and well-studied form of epilepsy-can impair communication by disrupting social-emotional and language functions. In pediatric epilepsy, where seizures co-occur with the development of critical brain networks, age of onset matters: The earlier in life seizures begin, the worse the disruption in network establishment, resulting in academic hardship and social isolation. Yet, little is known about the processes by which epileptic activity disrupts developing human brain networks. Here we take a synthetic perspective-reviewing a range of research spanning studies on molecular and oscillatory processes to those on the development of large-scale functional networks-in support of a novel model of how such networks can be disrupted by epilepsy. We seek to bridge the gap between research on molecular processes, on the development of human brain circuitry, and on clinical outcomes to propose a model of how epileptic activity disrupts brain development.
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Affiliation(s)
- Rebecca Reh
- University of British Columbia, Department of Psychology, 2136 West Mall, Vancouver BC V6T 1Z4, Canada
| | - Lynne J Williams
- BC Children's Hospital MRI Research Facility, 4480 Oak Street, Vancouver, BC V6H 0B3, Canada
| | - Rebecca M Todd
- University of British Columbia, Department of Psychology, 2136 West Mall, Vancouver BC V6T 1Z4, Canada; University of British Columbia, Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Lawrence M Ward
- University of British Columbia, Department of Psychology, 2136 West Mall, Vancouver BC V6T 1Z4, Canada; University of British Columbia, Djavad Mowafaghian Centre for Brain Health, 2215 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
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Why does depression worsen progression and treatment response in the most frequent neurological disorders? Implications for clinical practice. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2018.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Alcántara Montero A, Sánchez Carnerero C. ¿Por qué la depresión empeora el curso y la respuesta al tratamiento en los trastornos neurológicos más frecuentes? Implicaciones en la práctica clínica. Neurologia 2020; 35:338-340. [DOI: 10.1016/j.nrl.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/11/2018] [Indexed: 12/21/2022] Open
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Morningstar M, Hung A, Mattson WI, Gedela S, Ostendorf AP, Nelson EE. Internalizing symptoms in intractable pediatric epilepsy: Structural and functional brain correlates. Epilepsy Behav 2020; 103:106845. [PMID: 31882324 DOI: 10.1016/j.yebeh.2019.106845] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 01/09/2023]
Abstract
Internalizing disorders (i.e., depression and anxiety) are common comorbidities in people with epilepsy. In adults with epilepsy, comorbid depression or anxiety is associated with worse seizure control and reduced quality of life, and may be linked to specific neural biomarkers. Less is known about brain correlates of internalizing symptoms in pediatric populations. In the current study, we performed a retrospective analysis of 45 youth between the ages of 6 and 18 years old with intractable epilepsy. Individuals were evaluated for internalizing symptoms on the Child Behavior Checklist (CBCL) and underwent magnetic resonance (MR) and fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging as part of the clinical evaluation for surgical treatment of epilepsy. Forty-two percent of patients experienced clinically significant internalizing symptoms based on parent report. Compared with individuals who scored in the normal range, youth with clinical levels of internalizing problems showed overall reductions in cortex volume, as well as widespread reductions in cortical thickness and functional activation in the bilateral occipital/parietal lobe, left temporal regions, and left inferior frontal cortex on MR and PET scans. There were no group differences in amygdala or hippocampus volumes, nor other patient- or illness-related variables such as age, sex, or the type, lateralization, or duration of epilepsy. Results suggest that high rates of internalizing disorders are present in youth with refractory epilepsy. Multifocal reductions in cortical thickness and function may be nonspecific risk factors for clinically meaningful internalizing symptoms in youth with chronic epilepsy. As such, the presence of broad cortical thinning and reduced glucose uptake upon radiological examination may warrant more focused clinical evaluation of psychological symptoms.
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Affiliation(s)
- Michele Morningstar
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America.
| | - Andy Hung
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Whitney I Mattson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Satyanarayana Gedela
- Department of Pediatrics and Neurology, Emory University College of Medicine, Atlanta, GA, United States of America
| | - Adam P Ostendorf
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America; Department of Neurology, Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Eric E Nelson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America
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Nogueira MH, Pimentel da Silva LR, Vasques Moreira JC, de Rezende TJR, Zanão TA, de Campos BM, Yasuda CL, Cendes F. Major Depressive Disorder Associated With Reduced Cortical Thickness in Women With Temporal Lobe Epilepsy. Front Neurol 2020; 10:1398. [PMID: 32010051 PMCID: PMC6979005 DOI: 10.3389/fneur.2019.01398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Major Depressive Disorder (MDD) is highly prevalent in patients with mesial temporal lobe epilepsy (MTLE), especially in women, carrying significant morbidity. This study aimed to investigate the cortical thickness (CT) abnormalities associated with MDD in women with MTLE and hippocampal atrophy (HA). Also, we investigated the impact of MDD upon the volumes of the hippocampus and amygdala in these patients. Methods: We included 50 women with MTLE and HA (20 left, LMTLE; 30 right, RMTLE), 41 healthy women in the control group, and 15 women with MDD without epilepsy. MTLE patients were subdivided into three groups: MTLE-without-MDD (23 MTLE patients without MDD), MTLE-mild-MDD (nine MTLE patients with mild symptoms of MDD), and MTLE-severe-MDD (18 MTLE patients with moderate to severe symptoms of MDD). The five groups were balanced for age (p = 0.56). All participants had high-resolution 3D T1-weighted images in a 3T scanner. We used FreeSurfer 6.0 for volumetry and CT parcellation. All participants were submitted to a clinical psychological evaluation through the Structured Clinical Interview for DSM-IV (SCID-IV) and completed the Beck Depression Inventory (BDI-II). Results: We identified a smaller ipsilateral amygdala volume (p = 0.04) in the MTLE-severe-MDD group when compared to the control group. Our results presented a reduced ipsilateral lateral orbitofrontal cortex (p = 0.02) in the MTLE-severe-MDD in comparison to the MTLE-mild-MDD group. We also identified a thinner ipsilateral fusiform gyrus (p < 0.01) in the MTLE-severe-MDD compared to both MTLE-without-MDD and control groups. A reduced CT of the contralateral superior frontal gyrus (p = 0.02) was observed in the MTLE-severe-MDD in comparison to the MTLE-mild-MDD group. Conclusions: The identification of areas with reduced CT and atrophy of the ipsilateral amygdala in women with MTLE and MDD suggest that the cortical thinning in the network of the paralimbic system is related to the co-occurrence and intensity of depressive symptoms in this group.
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Affiliation(s)
- Mateus Henrique Nogueira
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil.,The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil
| | - Luciana Ramalho Pimentel da Silva
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil.,The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil
| | - José Carlos Vasques Moreira
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil.,The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil
| | - Thiago Junqueira Ribeiro de Rezende
- The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil.,Laboratory of Medical Physics, University of Campinas - UNICAMP, Campinas, Brazil
| | - Tamires Araújo Zanão
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil.,The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil
| | - Brunno Machado de Campos
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil.,The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil
| | - Clarissa Lin Yasuda
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil.,The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil
| | - Fernando Cendes
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil.,The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil
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Zapata Barco AM, Restrepo-Martínez M, Restrepo D. Depression in People with Epilepsy. What is the Connection? REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:53-61. [PMID: 32081210 DOI: 10.1016/j.rcp.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/25/2017] [Accepted: 10/22/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Depression is the most common psychiatric comorbidity in people with epilepsy. It worsens the prognosis and quality of life of these patients. Despite this, depression is poorly diagnosed and when the treatment is given, it is frequently suboptimal. OBJECTIVE To perform a narrative review of the medical literature, seeking to collect useful information regarding the relationship between epilepsy and depression. RESULTS Narrative reviews, systematic reviews, meta-analyses, clinical trials, and follow-up studies were identified in English and Spanish with no time limit, including epidemiological, clinical, associated factors, etiological explanations, diagnostic and therapeutic approaches to comorbid depression in epilepsy. CONCLUSION The relationship between epilepsy and depression is complex. The available scientific evidence suggests the possibility of a bidirectional relationship that could be explained from common aetiopathogenic mechanisms. Despite the high prevalence of depression in epileptic patients, this mental disorder continues to be poorly identified by clinicians. To improve this, we have easy-to-apply instruments that routinely screen this patient population and contribute substantially to making the problem more visible and seek to improve the quality of life for this population.
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Abstract
Psychiatric illnesses, including depression and anxiety, are highly comorbid with epilepsy (for review see Josephson and Jetté (Int Rev Psychiatry 29:409-424, 2017), Salpekar and Mula (Epilepsy Behav 98:293-297, 2019)). Psychiatric comorbidities negatively impact the quality of life of patients (Johnson et al., Epilepsia 45:544-550, 2004; Cramer et al., Epilepsy Behav 4:515-521, 2003) and present a significant challenge to treating patients with epilepsy (Hitiris et al., Epilepsy Res 75:192-196, 2007; Petrovski et al., Neurology 75:1015-1021, 2010; Fazel et al., Lancet 382:1646-1654, 2013) (for review see Kanner (Seizure 49:79-82, 2017)). It has long been acknowledged that there is an association between psychiatric illnesses and epilepsy. Hippocrates, in the fourth-fifth century B.C., considered epilepsy and melancholia to be closely related in which he writes that "melancholics ordinarily become epileptics, and epileptics, melancholics" (Lewis, J Ment Sci 80:1-42, 1934). The Babylonians also recognized the frequency of psychosis in patients with epilepsy (Reynolds and Kinnier Wilson, Epilepsia 49:1488-1490, 2008). Despite the fact that the relationship between psychiatric comorbidities and epilepsy has been recognized for thousands of years, psychiatric illnesses in people with epilepsy still commonly go undiagnosed and untreated (Hermann et al., Epilepsia 41(Suppl 2):S31-S41, 2000) and systematic research in this area is still lacking (Devinsky, Epilepsy Behav 4(Suppl 4):S2-S10, 2003). Thus, although it is clear that these are not new issues, there is a need for improvements in the screening and management of patients with psychiatric comorbidities in epilepsy (Lopez et al., Epilepsy Behav 98:302-305, 2019) and progress is needed to understand the underlying neurobiology contributing to these comorbid conditions. To that end, this chapter will raise awareness regarding the scope of the problem as it relates to comorbid psychiatric illnesses and epilepsy and review our current understanding of the potential mechanisms contributing to these comorbidities, focusing on both basic science and clinical research findings.
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Miller M, Hogue O, Hogan T, Busch RM. Naming decline after epilepsy surgery is associated with subjective language complaints. Epilepsy Behav 2019; 99:106484. [PMID: 31477537 DOI: 10.1016/j.yebeh.2019.106484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This retrospective, observational study investigated the relationship between objective naming decline and patient report of subjective decline in language functioning following epilepsy surgery. The role of depression in this relationship was also examined. METHODS A total of 429 adults with pharmacoresistant epilepsy completed the Boston Naming Test (BNT) and Memory Assessment Clinics Self-Rating Scale (MAC-S) before and after resective surgery. Multiple regression analyses were used to examine the relationship between objective naming decline and subjective language functioning, while controlling for the confounding effect of depression. RESULTS Individuals who experienced moderate to severe naming decline (≥11 raw points on BNT) following surgery reported a decline in subjective language functioning (p < .001) and endorsed problems with word-retrieval as well as more general semantic abilities. Those who experienced mild naming decline (5-10 raw points) also reported an increase in subjective language problems (p = .006). Complaints in this group were less severe than in those with more marked naming declines and were primarily related to word-retrieval. Both of these relationships remained significant after controlling for the confounding effect of depression (p < .005-.014). CONCLUSIONS Individuals with epilepsy who experience naming decline following surgery perceive these declines in their daily life, regardless of whether or not they are depressed. Findings support the utilization of risk models to predict naming outcome and the importance of counseling patients regarding the risk for naming decline following surgery.
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Affiliation(s)
- Margaret Miller
- Epilepsy Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Thomas Hogan
- Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
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Gonçalves EB, de Oliveira Cardoso TAM, Yasuda CL, Cendes F. Depressive disorders in patients with pharmaco-resistant mesial temporal lobe epilepsy. J Int Med Res 2018; 46:752-760. [PMID: 29239239 PMCID: PMC5971495 DOI: 10.1177/0300060517717825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 06/07/2017] [Indexed: 01/06/2023] Open
Abstract
Objectives To assess depressive disorders in patients with mesial temporal lobe epilepsy (MTLE) refractory to medical treatment. Methods Adult patients with refractory MTLE completed two questionnaires (Mini International Neuropsychiatric Interview (MINI) and the Beck Depression Inventory (BDI) had a semi-structured psychiatric interview and a high resolution MRI scan. For complete neuropsychiatric diagnosis, as per International Classification of Diseases (ICD-10), the results were combined with clinical history and additional information from the patients' family. Results Of the 40 patients identified for this case series study which took place from 2008-2012, 31 (77.5%) had a depressive disorder: 14 had dysthymia, 11 had recurrent depressive disorder and 6 had bipolar disorder. Of the nine patients without a firm diagnosis of mood disorder, seven had isolated symptoms of depression or anxiety and two presented with mixed depression/anxiety symptoms. Only 8/31 (25.8%) patients were receiving antidepressant treatment. There was no association between BDI scores and seizure frequency. No significant difference was found between patients with and without depression and the presence or laterality of HA. Conclusions Depressive disorders are common, underdiagnosed and undertreated in patients with refractory MTLE.
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Affiliation(s)
| | | | - Clarissa Lin Yasuda
- Department of Neurology, University of Campinas – UNICAMP, Campinas, Sao Paulo, Brazil
| | - Fernando Cendes
- Department of Neurology, University of Campinas – UNICAMP, Campinas, Sao Paulo, Brazil
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Kanner AM, Scharfman H, Jette N, Anagnostou E, Bernard C, Camfield C, Camfield P, Legg K, Dinstein I, Giacobe P, Friedman A, Pohlmann-Eden B. Epilepsy as a Network Disorder (1): What can we learn from other network disorders such as autistic spectrum disorder and mood disorders? Epilepsy Behav 2017; 77:106-113. [PMID: 29107450 PMCID: PMC9835466 DOI: 10.1016/j.yebeh.2017.09.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/16/2017] [Indexed: 01/16/2023]
Abstract
Epilepsy is a neurologic condition which often occurs with other neurologic and psychiatric disorders. The relation between epilepsy and these conditions is complex. Some population-based studies have identified a bidirectional relation, whereby not only patients with epilepsy are at increased risk of suffering from some of these neurologic and psychiatric disorders (migraine, stroke, dementia, autism, depression, anxiety disorders, Attention deficit hyperactivity disorder (ADHD), and psychosis), but also patients with these conditions are at increased risk of suffering from epilepsy. The existence of common pathogenic mechanisms has been postulated as a potential explanation of this phenomenon. To reassess the relationships between neurological and psychiatric conditions in general, and specifically autism, depression, Alzheimer's disease, schizophrenia, and epilepsy, a recent meeting brought together basic researchers and clinician scientists entitled "Epilepsy as a Network Disorder." This was the fourth in a series of conferences, the "Fourth International Halifax Conference and Retreat". This manuscript summarizes the proceedings on potential relations between Epilepsy on the one hand and autism and depression on the other. A companion manuscript provides a summary of the proceedings about the relation between epilepsy and Alzheimer's disease and schizophrenia, closed by the role of translational research in clarifying these relationships. The review of the topics in these two manuscripts will provide a better understanding of the mechanisms operant in some of the common neurologic and psychiatric comorbidities of epilepsy.
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Affiliation(s)
- Andres M. Kanner
- Department of Neurology, University of Miami, Miller School of Medicine, 1120 NW 14th Street, Room #1324, Miami, FL 33136, USA,Corresponding author. (A.M. Kanner)
| | - Helen Scharfman
- New York University Langone Medical Center, New York, NY 10016, USA,The Nathan Kline Institute, Orangeburg, NY, USA
| | - Nathalie Jette
- Icahn School of Medicine at Mount Sinai, Department of Neurology, New York, NY, USA,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Evdokia Anagnostou
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada
| | - Christophe Bernard
- NS – Institute de Neurosciences des Systemes, UMR INSERM 1106, Aix-Marseille Université, Equipe Physionet, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - Carol Camfield
- Department of Pediatrics, Dalhousie University Halifax, Nova Scotia, Canada
| | - Peter Camfield
- Department of Pediatrics, Dalhousie University Halifax, Nova Scotia, Canada
| | - Karen Legg
- Division of Neurology, Department of Medicine, Halifax Infirmary, Halifax B3H4R2, Nova Scotia, Canada
| | - Ilan Dinstein
- Departments of Psychology and Brain & Cognitive Sciences, Zlotowski Centre for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Peter Giacobe
- Centre for Mental Health, University of Toronto, University Health Network, Canada
| | - Alon Friedman
- Departments of Physiology and Cell Biology, Brain & Cognitive Sciences, Zlotowski Centre for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel,Departments of Medical Neuroscience and Pediatrics, Faculty of Medicine, Dalhousie University Halifax, NS, Canada
| | - Bernd Pohlmann-Eden
- Brain Repair Center, Life Science Research Institute, Dalhousie University, Room 229, PO Box 15000, Halifax, Nova Scotia B3H4R2, Canada
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Vivas AC, Reitano CJ, Waseem H, Benbadis SR, Vale FL. An analysis of quality of life (QOL) in patients with epilepsy and comorbid psychogenic nonepileptic seizures (PNES) after vagus nerve stimulation (VNS). Epilepsy Behav 2017. [PMID: 28651170 DOI: 10.1016/j.yebeh.2017.05.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Patients with epilepsy (PWE) may suffer from comorbid psychogenic nonepileptic seizures (PNES). The efficacy of vagus nerve stimulation (VNS) in the treatment of epilepsy and depression is established, however the impact on PNES is unknown. Since many patients with PNES have comorbid depression, we explored the impact on quality of life (QOL) that VNS has on PWE and PNES. METHODS The video electroencephalogram (vEEG) of all patients who underwent VNS at our institution was reviewed. Patients diagnosed with both psychogenic seizures and epileptic seizures on their vEEG were included in this study. These patients were contacted, and given a QOLIE-31 survey to assess their quality of life after VNS. Patients also completed a separate survey created by our group to categorize the quartile of their improvement. Pre-operative psychiatric disease was retrospectively reviewed. RESULTS From a period of 2001 to 2016, 518 patients underwent placement of VNS for drug resistant epilepsy (DRE) at our institution. In total, 16 patients were diagnosed with both epilepsy and PNES. 11/16 patients responded to our questionnaire and survey. 9 out of 11 patients felt that their epileptic seizures had improved after VNS, while 7 of the 11 patients felt that their psychogenic episodes had improved. 2(28.6%), 1 (14.3%), and 4 (57.1%) of participants said their PNES improved by 25-50%, 50-75%, and 75-100%, respectively. 3(27.3%), 3 (27.3%), 1 (9.1%), and 4 (36.4%) of the participants said their epileptic seizures improved by 0-25%, 25-50%, 50-75%, and 75-100%, respectively. The average overall score for quality of life for the study participants was found to be 51 (±8) out of 100. CONCLUSION Patients with epilepsy and comorbid PNES may benefit from VNS. It is unclear whether the benefit is conferred strictly from decreased epileptic seizure burden. The possible effect on PNES may be related to the known effect of VNS on depression. Further studies are necessary to elucidate the role of VNS in the treatment of PNES and possibly other psychiatric disease.
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Affiliation(s)
- Andrew C Vivas
- Department of Neurosurgery, University of South Florida, Tampa, FL, United States
| | - Christian J Reitano
- Department of Neurosurgery, University of South Florida, Tampa, FL, United States
| | - Hena Waseem
- Department of Neurology, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Selim R Benbadis
- Department of Neurosurgery, University of South Florida, Tampa, FL, United States; Department of Neurology, University of South Florida, Tampa, FL, United States
| | - Fernando L Vale
- Department of Neurosurgery, University of South Florida, Tampa, FL, United States; Department of Neurology, University of South Florida, Tampa, FL, United States.
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Kanner AM. Can Neurochemical Changes of Mood Disorders Explain the Increase Risk of Epilepsy or its Worse Seizure Control? Neurochem Res 2017; 42:2071-2076. [PMID: 28667464 DOI: 10.1007/s11064-017-2331-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/12/2017] [Accepted: 06/13/2017] [Indexed: 12/29/2022]
Abstract
The existence of a bidirectional relation between mood disorders and epilepsy has been suggested by six population-based studies. Furthermore, three studies have associated a higher risk of treatment-resistant epilepsy with a history of depression preceding the onset of epilepsy. Common pathogenic mechanisms operant in depression and epilepsy may provide a possible explanation of these observations. This article reviews some of the leading pathogenic mechanisms of depression with respect to potential proconvulsant properties that may provide explanations for these phenomena.
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Affiliation(s)
- Andres M Kanner
- Department of Neurology, University of Miami, Miller School of Medicine, 1120 NW 14th Street, Room #1324, Miami, FL, 33136, USA.
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20
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Mazarati A, Sankar R. Common Mechanisms Underlying Epileptogenesis and the Comorbidities of Epilepsy. Cold Spring Harb Perspect Med 2016; 6:6/7/a022798. [PMID: 27371669 DOI: 10.1101/cshperspect.a022798] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The importance of comorbidities in determining the quality of life of individuals with epilepsy and their families has received increasing attention in the past decade. Along with it has come a recognition that in some individuals, certain comorbidities may have preexisted, and may have contributed to their developing epilepsy. Many mechanisms are capable of interconnecting different dysfunctions that manifest as distinct disorders, often diagnosed and managed by different specialists. We review the human data from the perspective of epidemiology as well as insights gathered from neurodiagnostic and endocrine studies. Animal studies are reviewed to refine our mechanistic understanding of the connections, because they permit the narrowing of variables, which is not possible when studying humans.
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Affiliation(s)
- Andrey Mazarati
- Department of Pediatrics, Division of Pediatric Neurology, David Geffen School of Medicine at UCLA, UCLA Medical Center, Los Angeles, California 90095-1752
| | - Raman Sankar
- Department of Pediatrics, Division of Pediatric Neurology, David Geffen School of Medicine at UCLA, UCLA Medical Center, Los Angeles, California 90095-1752 Department of Neurology, David Geffen School of Medicine at UCLA, UCLA Medical Center, Los Angeles, California 90095-1752
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21
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Validation of diagnostic tests for depressive disorder in drug-resistant mesial temporal lobe epilepsy. Epilepsy Behav 2015; 50:61-6. [PMID: 26119622 DOI: 10.1016/j.yebeh.2015.06.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/03/2015] [Accepted: 06/04/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to evaluate the diagnostic accuracy of the Hamilton Rating Scale for Depression (HRSD), the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale (HADS), and the Hospital Anxiety and Depression Scale-Depression subscale (HADS-D) as diagnostic tests for depressive disorder in drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). METHODS One hundred three patients with drug-resistant MTLE-HS were enrolled. All patients underwent a neurological examination, interictal and ictal video-electroencephalogram (V-EEG) analyses, and magnetic resonance imaging (MRI). Psychiatric interviews were based on DSM-IV-TR criteria and ILAE Commission of Psychobiology classification as a gold standard; HRSD, BDI, HADS, and HADS-D were used as psychometric diagnostic tests, and receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores. RESULTS For all the scales, the areas under the curve (AUCs) were approximately 0.8, and they were able to identify depression in this sample. A threshold of ≥9 on the HRSD and a threshold of ≥8 on the HADS-D showed a sensitivity of 70% and specificity of 80%. A threshold of ≥19 on the BDI and HADS-D total showed a sensitivity of 55% and a specificity of approximately 90%. The instruments showed a negative predictive value of approximately 87% and a positive predictive value of approximately 65% for the BDI and HADS total and approximately 60% for the HRSD and HADS-D. CONCLUSIONS HRSD≥9 and HADS-D≥8 had the best balance between sensitivity (approximately 70%) and specificity (approximately 80%). However, with these thresholds, these diagnostic tests do not appear useful in identifying depressive disorder in this population with epilepsy, and their specificity (approximately 80%) and PPV (approximately 55%) were lower than those of the other scales. We believe that the BDI and HADS total are valid diagnostic tests for depressive disorder in patients with MTLE-HS, as both scales showed acceptable (though not high) specificity and PPV for this type of study.
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22
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Becker C, Bouvier E, Ghestem A, Siyoucef S, Claverie D, Camus F, Bartolomei F, Benoliel JJ, Bernard C. Predicting and treating stress-induced vulnerability to epilepsy and depression. Ann Neurol 2015; 78:128-36. [PMID: 25869354 DOI: 10.1002/ana.24414] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 11/06/2022]
Abstract
Accumulation of stressful events can render individuals susceptible to develop epilepsy and comorbidities. Whether such vulnerability can be predicted and reversed is not known. Here we show that social defeat, although not producing depression by itself, produced in 50% of rats reduced threshold for status epilepticus (SE), accelerated epileptogenesis, and once epilepsy was induced, depression-like profile and cognitive deficits. Low serum brain-derived neurotrophic factor (BDNF) levels measured before SE identified this vulnerable population. Treatment with a BDNF analog before SE prevented the occurrence of comorbidities. Thus, vulnerability to comorbidities after epilepsy onset due to unresolved past stressful events may be predicted and reversed.
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Affiliation(s)
- Christel Becker
- Mixed Unit of Research 119 (UMPC UM 119), Pierre and Marie Curie University-Paris 6, Paris.,Unit 1130, National Institute of Health and Medical Research (INSERM 1130), Paris.,Unit 8246, National Center for Scientific Research (CNRS 8246), Paris.,Faculty of Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris
| | - Elodie Bouvier
- Mixed Unit of Research 119 (UMPC UM 119), Pierre and Marie Curie University-Paris 6, Paris.,Unit 1130, National Institute of Health and Medical Research (INSERM 1130), Paris.,Unit 8246, National Center for Scientific Research (CNRS 8246), Paris
| | - Antoine Ghestem
- Aix Marseille Université, INS, 13005, Marseille, France.,Inserm, UMR_S 1106, 13005, Marseille, France
| | - Safia Siyoucef
- Aix Marseille Université, INS, 13005, Marseille, France.,Inserm, UMR_S 1106, 13005, Marseille, France
| | - Damien Claverie
- Mixed Unit of Research 119 (UMPC UM 119), Pierre and Marie Curie University-Paris 6, Paris.,Unit 1130, National Institute of Health and Medical Research (INSERM 1130), Paris.,Unit 8246, National Center for Scientific Research (CNRS 8246), Paris.,Army Institute of Biomedical Research, Brétigny sur Orge
| | - Françoise Camus
- Mixed Unit of Research 119 (UMPC UM 119), Pierre and Marie Curie University-Paris 6, Paris.,Unit 1130, National Institute of Health and Medical Research (INSERM 1130), Paris.,Unit 8246, National Center for Scientific Research (CNRS 8246), Paris
| | - Fabrice Bartolomei
- Aix Marseille Université, INS, 13005, Marseille, France.,Inserm, UMR_S 1106, 13005, Marseille, France
| | - Jean-Jacques Benoliel
- Mixed Unit of Research 119 (UMPC UM 119), Pierre and Marie Curie University-Paris 6, Paris.,Unit 1130, National Institute of Health and Medical Research (INSERM 1130), Paris.,Unit 8246, National Center for Scientific Research (CNRS 8246), Paris.,Department of Biochemistry and Endocrine Oncology, Pitié-Salpêtrière Hospital, Paris, France
| | - Christophe Bernard
- Aix Marseille Université, INS, 13005, Marseille, France.,Inserm, UMR_S 1106, 13005, Marseille, France
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Kanner AM. Is depression associated with an increased risk of treatment-resistant epilepsy? Research strategies to investigate this question. Epilepsy Behav 2014; 38:3-7. [PMID: 25260238 DOI: 10.1016/j.yebeh.2014.06.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 06/24/2014] [Indexed: 11/18/2022]
Abstract
Persons with epilepsy (PWE) have a higher risk of developing depressive disorders (DDs), and people with primary DD have an increased risk of developing epilepsy. Furthermore, a lifetime history of DD has been associated with a worse response of the seizure disorder to pharmacotherapy and epilepsy surgery. The first part of this article reviews the literature of this problem with the intention of highlighting the neurobiologic pathogenic mechanisms operant in DD with a potential to facilitate the epileptogenic process and/or cortical hyperexcitability in humans and experimental animal studies of depression. They include the following: (i) a hyperactive hypothalamic-pituitary-adrenal axis and the associated structural and functional abnormalities of limbic structures, (ii) increased glutamatergic activity and decreased GABAergic and serotonergic activity, and (iii) immunologic disturbances. In the second part of this article, we suggest research strategies to test the hypothesis of whether depression worsens the course of epilepsy and identify the pathogenic mechanisms operant in this process.
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Affiliation(s)
- Andres M Kanner
- Department of Neurology, University of Miami, Miller School of Medicine, USA.
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24
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Abstract
The last decade has witnessed a significant shift on our understanding of the relationship between psychiatric disorders and epilepsy. While traditionally psychiatric disorders were considered as a complication of the underlying seizure disorder, new epidemiologic data, supported by clinical and experimental research, have suggested the existence of a bidirectional relation between the two types of conditions: not only are patients with epilepsy at greater risk of experiencing a psychiatric disorder, but patients with primary psychiatric disorders are at greater risk of developing epilepsy. Do these data suggest that some of the pathogenic mechanisms operant in psychiatric comorbidities play a role in epileptogenesis? The aim of this article is to review the epidemiologic data that demonstrate that primary psychiatric disorders are more frequent in people who develop epilepsy, before the onset of the seizure disorder than among controls. The next question looks at the available data of pathogenic mechanisms of primary mood disorders and their potential for facilitating the development and/or exacerbation in the severity of epileptic seizures. Finally, we review data derived from experimental studies in animal models of depression and epilepsy that support a potential role of pathogenic mechanisms of mood disorders in the development of epileptic seizures and epileptogenesis. The data presented in this article do not yet establish conclusive evidence of a pathogenic role of psychiatric comorbidities in epileptogenesis, but raise important research questions that need to be investigated in experimental, clinical, and population-based epidemiologic research studies.
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Affiliation(s)
- Andres M Kanner
- Department of Neurology, University of Miami, Miller School of Medicine, 1120 NW, 14th Street, Room 1324, Miami, FL, 33136, USA,
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Pope RA, Centeno M, Flügel D, Symms MR, Koepp M, Thompson PJ, Foong J. Neural correlates of de novo depression following left temporal lobe epilepsy surgery: a voxel based morphometry study of pre-surgical structural MRI. Epilepsy Res 2013; 108:517-25. [PMID: 24438916 DOI: 10.1016/j.eplepsyres.2013.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/04/2013] [Accepted: 12/15/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate cerebral grey matter (GM) volumetric abnormalities in temporal lobe epilepsy (TLE) patients who develop de novo depression following TLE surgery using voxel-based morphometry (VBM). METHODS We retrospectively examined pre-surgical grey matter (GM) volumes in 30 patients with TLE due to unilateral left-sided hippocampal sclerosis using 1.5-T MRI scan, which were segmented with optimised VBM parameters and normalised to a sample template using DARTEL, with SPM8 software. Voxel-wise GM differences between patients that developed de novo post-surgical depression (n=5) were compared with patients with no pre- or postoperative psychiatric diagnoses (n=25), using independent samples t-tests with age, gender and secondary generalised tonic-clonic seizures (SGTCS) as covariates (p<.001, unc). KEY FINDINGS Reduced preoperative bilateral GM in orbitofrontal cortices (OFC) and ipsilateral cingulate gyrus and thalamus were significantly associated with the development of de novo depression within 4 years postoperatively. Further analyses revealed no differences in seizure freedom (ILAE 1 vs 2-6) or postoperative memory decline between the groups. SIGNIFICANCE Although the development of postoperative de novo depression following TLE surgery is likely to be multi-factorial, our results suggest that bilateral OFC and ipsilateral cingulate gyrus and thalamic atrophy in left-sided TLE patients may play a modulatory role. Abnormalities in these areas have also been implicated in primary mood disorders. Prospective neuroimaging studies with larger cohorts are warranted to replicate these results, and further elucidate the neural correlates of de novo depression.
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Affiliation(s)
- Rebecca Anne Pope
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3BG, UK.
| | - Maria Centeno
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; Institute of Child Health, University College London, London WC1N 1EH, UK
| | | | - Mark Robert Symms
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK
| | - Matthias Koepp
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 2BG, UK
| | - Pamela Jane Thompson
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 2BG, UK
| | - Jacqueline Foong
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 2BG, UK
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Cardamone L, Salzberg MR, O'Brien TJ, Jones NC. Antidepressant therapy in epilepsy: can treating the comorbidities affect the underlying disorder? Br J Pharmacol 2013; 168:1531-54. [PMID: 23146067 PMCID: PMC3605864 DOI: 10.1111/bph.12052] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 10/24/2012] [Accepted: 10/29/2012] [Indexed: 12/20/2022] Open
Abstract
There is a high incidence of psychiatric comorbidity in people with epilepsy (PWE), particularly depression. The manifold adverse consequences of comorbid depression have been more clearly mapped in recent years. Accordingly, considerable efforts have been made to improve detection and diagnosis, with the result that many PWE are treated with antidepressant drugs, medications with the potential to influence both epilepsy and depression. Exposure to older generations of antidepressants (notably tricyclic antidepressants and bupropion) can increase seizure frequency. However, a growing body of evidence suggests that newer ('second generation') antidepressants, such as selective serotonin reuptake inhibitors or serotonin-noradrenaline reuptake inhibitors, have markedly less effect on excitability and may lead to improvements in epilepsy severity. Although a great deal is known about how antidepressants affect excitability on short time scales in experimental models, little is known about the effects of chronic antidepressant exposure on the underlying processes subsumed under the term 'epileptogenesis': the progressive neurobiological processes by which the non-epileptic brain changes so that it generates spontaneous, recurrent seizures. This paper reviews the literature concerning the influences of antidepressants in PWE and in animal models. The second section describes neurobiological mechanisms implicated in both antidepressant actions and in epileptogenesis, highlighting potential substrates that may mediate any effects of antidepressants on the development and progression of epilepsy. Although much indirect evidence suggests the overall clinical effects of antidepressants on epilepsy itself are beneficial, there are reasons for caution and the need for further research, discussed in the concluding section.
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Affiliation(s)
- L Cardamone
- Department of Medicine (RMH), University of Melbourne, Melbourne, Victoria, Australia
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Valente KDR, Busatto Filho G. Depression and temporal lobe epilepsy represent an epiphenomenon sharing similar neural networks: clinical and brain structural evidences. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:183-90. [DOI: 10.1590/s0004-282x2013000300011] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Indexed: 11/22/2022]
Abstract
The relationship between depression and epilepsy has been known since ancient times, however, to date, it is not fully understood. The prevalence of psychiatric disorders in persons with epilepsy is high compared to general population. It is assumed that the rate of depression ranges from 20 to 55% in patients with refractory epilepsy, especially considering those with temporal lobe epilepsy caused by mesial temporal sclerosis. Temporal lobe epilepsy is a good biological model to understand the common structural basis between depression and epilepsy. Interestingly, mesial temporal lobe epilepsy and depression share a similar neurocircuitry involving: temporal lobes with hippocampus, amygdala and entorhinal and neocortical cortex; the frontal lobes with cingulate gyrus; subcortical structures, such as basal ganglia and thalamus; and the connecting pathways. We provide clinical and brain structural evidences that depression and epilepsy represent an epiphenomenon sharing similar neural networks.
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Maguire J, Salpekar JA. Stress, seizures, and hypothalamic-pituitary-adrenal axis targets for the treatment of epilepsy. Epilepsy Behav 2013; 26:352-62. [PMID: 23200771 PMCID: PMC3874873 DOI: 10.1016/j.yebeh.2012.09.040] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
Abstract
Epilepsy is a heterogeneous condition with varying etiologies including genetics, infection, trauma, vascular, neoplasms, and toxic exposures. The overlap of psychiatric comorbidity adds to the challenge of optimal treatment for people with epilepsy. Seizure episodes themselves may have varying triggers; however, for decades, stress has been commonly and consistently suspected to be a trigger for seizure events. This paper explores the relationship between stress and seizures and reviews clinical data as well as animal studies that increasingly corroborate the impact of stress hormones on neuronal excitability and seizure susceptibility. The basis for enthusiasm for targeting glucocorticoid receptors for the treatment of epilepsy and the mixed results of such treatment efforts are reviewed. In addition, this paper will highlight recent findings identifying a regulatory pathway controlling the body's physiological response to stress which represents a novel therapeutic target for modulation of the hypothalamic-pituitary-adrenal (HPA) axis. Thus, the HPA axis may have important clinical implications for seizure control and imply use of anticonvulsants that influence this neuronal pathway.
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Affiliation(s)
- Jamie Maguire
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA, U.S.A
| | - Jay A. Salpekar
- Center for Neuroscience and Behavioral Medicine, Children’s National Medical Center, Washington, DC, U.S.A
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Kanner AM. Can neurobiological pathogenic mechanisms of depression facilitate the development of seizure disorders? Lancet Neurol 2012; 11:1093-102. [DOI: 10.1016/s1474-4422(12)70201-6] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kanner AM, Schachter SC, Barry JJ, Hesdorffer DC, Mula M, Trimble M, Hermann B, Ettinger AE, Dunn D, Caplan R, Ryvlin P, Gilliam F, LaFrance WC. Depression and epilepsy: epidemiologic and neurobiologic perspectives that may explain their high comorbid occurrence. Epilepsy Behav 2012; 24:156-68. [PMID: 22632406 DOI: 10.1016/j.yebeh.2012.01.007] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2012] [Indexed: 12/25/2022]
Abstract
Depression is the most frequent psychiatric comorbidity in people with epilepsy (PWE) with lifetime prevalence rates ranging between 30 and 35%. Multifactorial variables play a pathogenic role in the high comorbid occurrence of these two disorders. These variables were critically examined during an international symposium held in Chicago in September 2010, the results of which are presented in two companion manuscripts. The first manuscript summarizes new epidemiologic data highlighting the bidirectional relation between depression and epilepsy and related methodological issues in studying this relationship. An examination of the neurobiologic aspects of primary mood disorders, mood disorders in PWE and pathogenic mechanisms of epilepsy derived from studies in animal models and humans is allowing a better understanding of the complex relation between the two conditions. In the first manuscript, we review data from animal models of epilepsy in which equivalent symptoms of depression and anxiety disorders develop and, conversely, animal models of depression in which the kindling process is facilitated. Data from structural and functional neuroimaging studies in humans provide a further understanding of potential common pathogenic mechanisms operant in depression and epilepsy that may explain their high comorbidity. The negative impact of depression on the control of seizure disorders has been documented in various studies. In this manuscript, these data are reviewed and potential mechanisms explaining this phenomenon are proposed.
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Affiliation(s)
- Andres M Kanner
- Department of Neurological Sciences, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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Gonçalves EB, Cendes F. Depression in patients with refractory temporal lobe epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 69:775-7. [PMID: 22042180 DOI: 10.1590/s0004-282x2011000600010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 05/11/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the comorbidity of depressive disorders in patients with refractory temporal lobe epilepsy (TLE). METHOD We evaluated 25 consecutive patients with refractory TLE (16 women and 9 men), using semi-structured psychiatric interviews, according to the International Classification of Diseases (ICD-10), and the Beck Depression Inventory. RESULTS Seventeen of 25 patients (68%) had depressive disorder: 6 with dysthymia, three with major depressive episodes and 8 with recurrent depressive disorders. Two (8%) were diagnosed with mixed anxiety and depression. Only 5 of 17 patients (29.4%) were previously diagnosed with depressive disorder and received prior antidepressant treatment. Duration of epilepsy was significantly higher in patients with depressive disorder (p=0.016), but there was no relationship between depression and seizure frequency. CONCLUSION This study confirmed that depressive disorders are common and underdiagnosed in patients with TLE refractory to AEDs. Patients with longer duration of epilepsy are at higher risk of having depression.
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Sanchez-Gistau V, Sugranyes G, Baillés E, Carreño M, Donaire A, Bargalló N, Pintor L. Is major depressive disorder specifically associated with mesial temporal sclerosis? Epilepsia 2012; 53:386-92. [PMID: 22220776 DOI: 10.1111/j.1528-1167.2011.03373.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Whether a specific lesion such as mesial temporal sclerosis (MTS) increases the risk for a mood disorder in epilepsy remains subject to debate. Despite evidence of limbic system involvement in the genesis of emotional symptoms, recent studies fail to support an association between depression and MTS. We aimed to clarify this controversial issue by overcoming prior methodologic limitations, hypothesizing that rates of major depressive disorder (MDD) would be higher in patients with MTS. METHODS Three hundred eight patients with focal epilepsy (International League Against Epilepsy [ILAE] criteria), were classified into three groups on the basis of neuroimaging findings: MTS, a lesion different from MTS, or absence of lesion. Patients were assessed using the Structured Interview for DSM-IV axis I psychiatric disorders (SCID-I), by a psychiatrist blinded to epilepsy subtype. The Spanish version of the Hospital Anxiety and Depression Scale (HADS) was also administered. A complete logistic regression analysis was performed to investigate the association between MTS and MDD. KEY FINDINGS MTS increased the likelihood of a lifetime MDD by nearly 2.5. No other current or "postseizure onset" lifetime Axis I DSM-IV psychiatric disorder was associated with MTS. Female gender, primary education, comorbid anxiety disorders, and antidepressant treatment were also associated with an increased risk of MDD. Marriage was found to be a protective factor for MDD. SIGNIFICANCE Our results support a specific association between MTS and lifetime "postseizure onset," MDD. The lack of association with current depression is in line with the hypothesis that the link between MTS and depression is more of a chronic than a state-dependent condition.
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Affiliation(s)
- Vanessa Sanchez-Gistau
- Department of Child and Adolescent Psychiatry, Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.
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Garcia CS. Depression in temporal lobe epilepsy: a review of prevalence, clinical features, and management considerations. EPILEPSY RESEARCH AND TREATMENT 2011; 2012:809843. [PMID: 22957244 PMCID: PMC3420378 DOI: 10.1155/2012/809843] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 09/10/2011] [Indexed: 11/17/2022]
Abstract
Depression in temporal lobe epilepsy has been established as a frequent occurrence, and various possible mechanisms for this significant comorbidity have been posited. However, there is still little to guide a clinician in the recognition and management of depression in patients with temporal lobe epilepsy. This is in part due to the lack of consistent findings in earlier studies, which was likely partly due to variabilities in methodology, sampling, and diagnosis of both temporal lobe epilepsy and depression. However, in recent years, significant effort has been made to address these issues and provide a framework for diagnosis and management of depression in this population. The following is a review of the literature, with special emphasis on clinical phenomenology of depressive symptoms, described bidirectional risk between depression and temporal lobe epilepsy, and treatment strategies in the context of potential drug interactions with antiepileptic drugs.
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Affiliation(s)
- C. S. Garcia
- Department of Psychiatry, Schulich School of Medicine, University of Western Ontario, London, ON, Canada N6A 5C1
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Hoppe C, Elger CE. Depression in epilepsy: a critical review from a clinical perspective. Nat Rev Neurol 2011; 7:462-72. [PMID: 21750525 DOI: 10.1038/nrneurol.2011.104] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kanner AM. Is depression a risk factor of worse response to therapy in epilepsy? Epilepsy Curr 2011; 11:50-1. [PMID: 21852875 PMCID: PMC3117502 DOI: 10.5698/1535-7511-11.2.50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Tchekalarova J, Pechlivanova D, Atanasova T, Markova P, Lozanov V, Stoynev A. Diurnal variations in depression-like behavior of Wistar and spontaneously hypertensive rats in the kainate model of temporal lobe epilepsy. Epilepsy Behav 2011; 20:277-85. [PMID: 21277833 DOI: 10.1016/j.yebeh.2010.12.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 12/14/2010] [Accepted: 12/14/2010] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to explore whether the kainate (KA) model of temporal lobe epilepsy (TLE) can be used as a model of comorbid epilepsy and depression to study diurnal behavioral variations in rats. Development of chronic epilepsy was confirmed by the detection of spontaneous motor seizures (SMS) with video monitoring (24 hours/3-5 months after status epilepticus [SE]). KA-treated spontaneously hypertensive rats (SHRs) exhibited higher seizure frequency than Wistar rats during the light phase in the fourth and fifth months after SE. Although epileptic Wistar rats showed depression-like behavior and reduced anxiety mostly during the light phase, there were no diurnal variations in depression-like patterns in SHRs. Anxiety levels of control and epileptic SHRs were similar. Decreases in serotonin, tryptophan, and dopamine concentrations in the hippocampus were detected in epileptic Wistar rats compared with naive controls. However, monoamine levels of epileptic SHRs were close to those of their controls. Wistar rats and SHRs develop stable depression-like behavior during the chronic epileptic phase with strain-dependent diurnal differences.
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Affiliation(s)
- Jana Tchekalarova
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria.
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