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Tye E, Baxendale S. Using the hospital anxiety and depression scale in people with epilepsy: Is overlapping symptomatology a problem? Epilepsy Behav Rep 2023; 25:100641. [PMID: 38235018 PMCID: PMC10792759 DOI: 10.1016/j.ebr.2023.100641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024] Open
Abstract
The Hospital Anxiety and Depression Scale (HADS) is designed to screen for anxiety and depression in clinical settings. However, some items on the HADS may reflect symptoms associated with epilepsy and antiseizure medications rather than anxiety and depression. This study examined whether these items on the HADS contributed disproportionately to the reporting of anxiety and depression on the HADS in people with epilepsy (PWE). As part of a routine clinical assessment, 546 adults with epilepsy completed the HADS. In our sample, 56.2% reported elevated levels of anxiety, and 27.3% reported symptoms of depression with a score of 8 or more on the respective subscales. Scores on the anxiety and depression subscales were not associated with age, sex or epilepsy type. We did not find a relationship between endorsement of items related to panic, feelings of dread or butterflies in the stomach and a diagnosis of temporal lobe epilepsy. The most frequently endorsed item on the anxiety subscale of the HADS in the sample as a whole related to worrying thoughts, rather than the more somatic manifestations of anxiety. The item 'I feel as if I am slowed down' was endorsed by the majority of people with epilepsy and may not reflect a symptom of depression in this group. Careful analyses of the pattern of endorsement of specific items on the HADS may improve the sensitivity of this screening measure to the presence of depression in people with epilepsy.
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Affiliation(s)
- Elisa Tye
- University College Hospital, London, United Kingdom
| | - Sallie Baxendale
- University College Hospital, London, United Kingdom
- UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, United Kingdom
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2
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Cronin SJF, Yu W, Hale A, Licht-Mayer S, Crabtree MJ, Korecka JA, Tretiakov EO, Sealey-Cardona M, Somlyay M, Onji M, An M, Fox JD, Turnes BL, Gomez-Diaz C, da Luz Scheffer D, Cikes D, Nagy V, Weidinger A, Wolf A, Reither H, Chabloz A, Kavirayani A, Rao S, Andrews N, Latremoliere A, Costigan M, Douglas G, Freitas FC, Pifl C, Walz R, Konrat R, Mahad DJ, Koslov AV, Latini A, Isacson O, Harkany T, Hallett PJ, Bagby S, Woolf CJ, Channon KM, Je HS, Penninger JM. Crucial neuroprotective roles of the metabolite BH4 in dopaminergic neurons. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.08.539795. [PMID: 37214873 PMCID: PMC10197517 DOI: 10.1101/2023.05.08.539795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Dopa-responsive dystonia (DRD) and Parkinson's disease (PD) are movement disorders caused by the dysfunction of nigrostriatal dopaminergic neurons. Identifying druggable pathways and biomarkers for guiding therapies is crucial due to the debilitating nature of these disorders. Recent genetic studies have identified variants of GTP cyclohydrolase-1 (GCH1), the rate-limiting enzyme in tetrahydrobiopterin (BH4) synthesis, as causative for these movement disorders. Here, we show that genetic and pharmacological inhibition of BH4 synthesis in mice and human midbrain-like organoids accurately recapitulates motor, behavioral and biochemical characteristics of these human diseases, with severity of the phenotype correlating with extent of BH4 deficiency. We also show that BH4 deficiency increases sensitivities to several PD-related stressors in mice and PD human cells, resulting in worse behavioral and physiological outcomes. Conversely, genetic and pharmacological augmentation of BH4 protects mice from genetically- and chemically induced PD-related stressors. Importantly, increasing BH4 levels also protects primary cells from PD-affected individuals and human midbrain-like organoids (hMLOs) from these stressors. Mechanistically, BH4 not only serves as an essential cofactor for dopamine synthesis, but also independently regulates tyrosine hydroxylase levels, protects against ferroptosis, scavenges mitochondrial ROS, maintains neuronal excitability and promotes mitochondrial ATP production, thereby enhancing mitochondrial fitness and cellular respiration in multiple preclinical PD animal models, human dopaminergic midbrain-like organoids and primary cells from PD-affected individuals. Our findings pinpoint the BH4 pathway as a key metabolic program at the intersection of multiple protective mechanisms for the health and function of midbrain dopaminergic neurons, identifying it as a potential therapeutic target for PD.
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Affiliation(s)
- Shane J F Cronin
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Dr. Bohr-Gasse 3, 1030 Vienna, Austria
| | - Weonjin Yu
- Signature Program in Neuroscience and Behavioural Disorders, Duke-National University of Singapore (NUS) Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Ashley Hale
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - Simon Licht-Mayer
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Dr. Bohr-Gasse 3, 1030 Vienna, Austria
| | - Mark J Crabtree
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - Joanna A Korecka
- Neurodegeneration Research Institute, Harvard Medical School/McLean Hospital, Belmont, MA, 02478, USA
| | - Evgenii O Tretiakov
- Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Marco Sealey-Cardona
- Department of Structural and Computational Biology, Max Perutz Labs, Vienna Biocenter Campus 5, 1030, Vienna, Austria
| | - Mate Somlyay
- Department of Structural and Computational Biology, Max Perutz Labs, Vienna Biocenter Campus 5, 1030, Vienna, Austria
| | - Masahiro Onji
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Dr. Bohr-Gasse 3, 1030 Vienna, Austria
| | - Meilin An
- Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, Canada
| | - Jesse D Fox
- Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, Canada
| | - Bruna Lenfers Turnes
- FM Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Carlos Gomez-Diaz
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Dr. Bohr-Gasse 3, 1030 Vienna, Austria
| | - Débora da Luz Scheffer
- LABOX, Departamento de Bioquímica, Universidade Federal de Santa Catarina, Florianópolis, SC 88037-100, Brazil
| | - Domagoj Cikes
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Dr. Bohr-Gasse 3, 1030 Vienna, Austria
| | - Vanja Nagy
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases (LBI-RUD); Department of Neurology, Medical University of Vienna (MUW), 1090 Vienna, Austria
| | - Adelheid Weidinger
- Ludwig Boltzmann Institute for Traumatology. The Research Center in Cooperation with AUVA, Donaueschingen Str. 13, 1200 Vienna, Austria
| | - Alexandra Wolf
- Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Harald Reither
- Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Antoine Chabloz
- Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, Canada
| | - Anoop Kavirayani
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Dr. Bohr-Gasse 3, 1030 Vienna, Austria
| | - Shuan Rao
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Nick Andrews
- FM Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Alban Latremoliere
- Neurosurgery Department, Neurosurgery Pain Research Institute, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Michael Costigan
- FM Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Gillian Douglas
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | | | - Christian Pifl
- Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Roger Walz
- Center for Applied Neurocience, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Neurology Division, Internal Medicine Department, University Hospital of UFSC, Florianópolis, Brazil
| | - Robert Konrat
- Department of Structural and Computational Biology, Max Perutz Labs, Vienna Biocenter Campus 5, 1030, Vienna, Austria
| | - Don J Mahad
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Andrey V Koslov
- Ludwig Boltzmann Institute for Traumatology. The Research Center in Cooperation with AUVA, Donaueschingen Str. 13, 1200 Vienna, Austria
| | - Alexandra Latini
- LABOX, Departamento de Bioquímica, Universidade Federal de Santa Catarina, Florianópolis, SC 88037-100, Brazil
| | - Ole Isacson
- Neurodegeneration Research Institute, Harvard Medical School/McLean Hospital, Belmont, MA, 02478, USA
| | - Tibor Harkany
- Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, Vienna, Austria
- Department of Neuroscience, Biomedicum 7D, Karolinska Institute, Solna, Sweden
| | - Penelope J Hallett
- Neurodegeneration Research Institute, Harvard Medical School/McLean Hospital, Belmont, MA, 02478, USA
| | - Stefan Bagby
- Department of Biology and Biochemistry and the Milner Centre for Evolution, University of Bath, Bath, UK
| | - Clifford J Woolf
- FM Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Keith M Channon
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - Hyunsoo Shawn Je
- Signature Program in Neuroscience and Behavioural Disorders, Duke-National University of Singapore (NUS) Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Josef M Penninger
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Dr. Bohr-Gasse 3, 1030 Vienna, Austria
- Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, Canada
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3
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Scheffer DDL, Freitas FC, Aguiar AS, Ward C, Guglielmo LGA, Prediger RD, Cronin SJF, Walz R, Andrews NA, Latini A. Impaired dopamine metabolism is linked to fatigability in mice and fatigue in Parkinson's disease patients. Brain Commun 2021; 3:fcab116. [PMID: 34423297 PMCID: PMC8374980 DOI: 10.1093/braincomms/fcab116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022] Open
Abstract
Fatigue is a common symptom of Parkinson’s disease that compromises significantly the patients’ quality of life. Despite that, fatigue has been under-recognized as symptom, its pathophysiology remains poorly understood, and there is no adequate treatment so far. Parkinson’s disease is characterized by the progressive loss of midbrain dopaminergic neurons, eliciting the classical motor symptoms including slowing of movements, muscular rigidity and resting tremor. The dopamine synthesis is mediated by the rate-limiting enzyme tyrosine hydroxylase, which requires tetrahydrobiopterin as a mandatory cofactor. Here, we showed that reserpine administration (1 mg/kg, two intraperitoneal injections with an interval of 48 h) in adult Swiss male mice (8–10 weeks; 35–45 g) provoked striatal depletion of dopamine and tetrahydrobiopterin, and intolerance to exercise. The poor exercise performance of reserpinized mice was not influenced by emotional or anhedonic factors, mechanical nociceptive thresholds, electrocardiogram pattern alterations or muscle-impaired bioenergetics. The administration of levodopa (100 mg/kg; i.p.) plus benserazide (50 mg/kg; i.p.) rescued reserpine-induced fatigability-like symptoms and restored striatal dopamine and tetrahydrobiopterin levels. Remarkably, it was observed, for the first time, that impaired blood dopamine metabolism inversely and idependently correlated with fatigue scores in eighteen idiopathic Parkinson’s disease patients (male n = 13; female n = 5; age 61.3 ± 9.59 years). Altogether, this study provides new experimental and clinical evidence that fatigue symptoms might be caused by the impaired striatal dopaminergic neurotransmission, pointing to a central origin of fatigue in Parkinson’s disease.
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Affiliation(s)
- Débora da Luz Scheffer
- LABOX, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Fernando Cini Freitas
- Graduate Program in Medical Sciences, University Hospital, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil.,Neurology Division, Hospital Governador Celso Ramos, Florianópolis, SC 88015-270, Brazil
| | - Aderbal Silva Aguiar
- LABOX, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Catherine Ward
- Kirby Neurobiology Center, Boston Children's Hospital and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
| | | | - Rui Daniel Prediger
- Departamento de Farmacologia, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Shane J F Cronin
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences, A-1090 Vienna, Austria
| | - Roger Walz
- Graduate Program in Medical Sciences, University Hospital, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil.,Center for Applied Neuroscience, University Hospital, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil.,Neurology Division, Departament of Internal Medicine, University Hospital, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Nick A Andrews
- Kirby Neurobiology Center, Boston Children's Hospital and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA.,The Salk in Institute for Biological Studies, La Jolla, CA 92037, USA
| | - Alexandra Latini
- LABOX, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil.,Kirby Neurobiology Center, Boston Children's Hospital and Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA
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4
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Sap-Anan N, Pascoe M, Wang L, Grigg-Damberger MM, Andrews ND, Foldvary-Schaefer N. The Epworth Sleepiness Scale in epilepsy: Internal consistency and disease-related associations. Epilepsy Behav 2021; 121:108099. [PMID: 34102473 DOI: 10.1016/j.yebeh.2021.108099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Epworth Sleepiness Scale (ESS) is the most common instrument for measuring subjective sleep propensity in people with epilepsy but has not yet been validated in this population. STUDY OBJECTIVES We aimed to systematically assess the validity, performance, and internal consistency of the ESS, as well as correlations between the ESS and disease-specific variables and patient-reported outcome measures in a cohort of adults with epilepsy (AWE). METHODS Ninety-five AWE completed sleep and seizure diaries, in-laboratory polysomnography (PSG) and patient-reported outcome measures, including the ESS, Insomnia Severity Index (ISI), and the Beck Depression Inventory (BDI). Demographic information and data from 95 matched controls referred for PSG for suspected obstructive sleep apnea (OSA) was taken from the electronic medical record. Frequencies of high ESS item ratings (item score ≥2) were calculated for each group. Cronbach's α and factor analysis were performed to assess the internal consistency and validity of the ESS within cases and controls. Multivariable linear models were used to assess the association between ESS and predictors of interest, adjusting for demographic and disease-specific variables, including seizure type, frequency, and anti-seizure medication (ASM) therapy. RESULTS While suspected OSA controls had significantly greater mean ESS total scores (9.9 vs 7.9, p = 0.004) and proportion with ESS >10 (42% vs 25%, p = 0.014), there were no significant differences in the severity of item responses, with the exception of "lying down to rest in the afternoon when circumstances permit," for which more controls rated as likely/very likely (79% vs 64%), p = 0.024). AWE with ESS >10 had higher mean standardized ASM dose (2.5 vs 1.7, p = 0.026). All ESS items were significantly correlated with the total score within each group. Cronbach's α was 0.75 for cases and 0.85 for controls, indicating good internal consistency of the ESS for both groups. After adjusting for demographic and sleep characteristics, higher ESS scores were associated with greater insomnia scores on the ISI (p = 0.024) and depressive symptoms on the BDI (p = 0.018). CONCLUSIONS This study provides validity for the use of the ESS in adult populations with epilepsy.
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Affiliation(s)
| | - Maeve Pascoe
- Sleep Disorders Center, Cleveland Clinic, Cleveland, OH, USA.
| | - Lu Wang
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
| | | | - Noah D Andrews
- Sleep Disorders Center, Cleveland Clinic, Cleveland, OH, USA.
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Benevides ML, Costa Nunes J, Guarnieri R, Pauli C, Wolf P, Lunardi M, Kondageski C, Neves Linhares M, Lin K, Walz R. Quality of life long after temporal lobe epilepsy surgery. Acta Neurol Scand 2021; 143:629-636. [PMID: 33751549 DOI: 10.1111/ane.13406] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/29/2020] [Accepted: 01/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify variables independently associated with a meaningful improvement in QOL long after surgical treatment of drug-resistant MTLE-HS patients. MATERIAL & METHODS We prospectively evaluated 72 consecutive MTLE-HS surgically treated patients and analyzed pre and post-surgical variables independently associated with a meaningful improvement in QOL evaluated by the Quality of Life in Epilepsy-31 (QOLIE-31) overall score, and its domain scores determined at follow-up after 36 to 131 months (mean 93 months) after surgery. RESULTS The mean overall QOLIE-31 score and its subdomain scores improved significantly after surgery (p < 0.01), and 55 patients (76.4%) had a meaningful QOL improvement. Being seizure-free (Engel IA) after surgery showed a non-significant association (OR 2.63, CI 95% 0.53 to 13.05, p = 0.23) and lower depressive symptoms a significant association (OR 4.15, CI 95% 1.19 to 14.53, p = 0.03) with meaningful improvement of QOL. CONCLUSIONS Patients with MTLE-HS who underwent epilepsy surgery show a sustained, meaningful improvement in their QOL. Pre-surgical variables do not predict long-term QOL improvement after surgery. Lower levels of depressive symptoms at postoperative evaluation are associated with meaningful QOL improvement.
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Affiliation(s)
- Maria L. Benevides
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Graduate Program in Translational Neurosciences Federal University of Rio de Janeiro (UFRJ) Rio de Janeiro Brazil
| | - Jean Costa Nunes
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC) HU UFSC Florianópolis Brazil
- Division of Neuropathology UFSC Florianópolis Brazil
- Neurodiagnostic Brasil ‐ Diagnósticos em Neuropatologia Florianópolis Brazil
| | - Ricardo Guarnieri
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Psychiatry Division Internal Medicine Department HU UFSC Florianópolis Brazil
| | - Carla Pauli
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
| | - Peter Wolf
- Graduate Program in Medical Sciences HU UFSC Florianópolis Brazil
| | - Mariana Lunardi
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Graduate Program in Medical Sciences HU UFSC Florianópolis Brazil
| | - Charles Kondageski
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
| | - Marcelo Neves Linhares
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Neurosurgery Division HU UFSC Florianópolis Brazil
| | - Katia Lin
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC) HU UFSC Florianópolis Brazil
- Graduate Program in Medical Sciences HU UFSC Florianópolis Brazil
- Neurology Division Internal Medicine Department HU UFSC Florianópolis Brazil
| | - Roger Walz
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Graduate Program in Translational Neurosciences Federal University of Rio de Janeiro (UFRJ) Rio de Janeiro Brazil
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC) HU UFSC Florianópolis Brazil
- Neurology Division Internal Medicine Department HU UFSC Florianópolis Brazil
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Benevides ML, Costa Nunes J, Guarnieri R, Melo H, Lunardi M, Neves Linhares M, Kupek E, Wolf P, Lin K, Walz R. Anxiety and depressive symptoms long after mesial temporal epilepsy surgery: A prospective study. Epilepsy Behav 2021; 118:107936. [PMID: 33839452 DOI: 10.1016/j.yebeh.2021.107936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anxiety and depressive symptoms are prevalent in patients with refractory mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) before and after anterior temporal lobectomy (ATL). AIMS (1) To follow the levels of anxiety and depressive symptoms long-term after ATL among patients with refractory MTLE-HS; (2) To identify pre- and postsurgical variables associated with the levels of anxiety and depressive symptoms after surgery. METHODS We compared the levels of anxiety and depressive symptoms determined by the Hospital Anxiety and Depression Scale (HADS) before and long after ATL (mean 104 months, range 70-130) in 41 consecutive patients refractory MTLE-HS. The last follow-up was between September 2018 and March 2020. We also determined pre- and postsurgical variables independently associated with the HADS scores after surgery. RESULTS The scores of HADS and its subdomains related to anxiety and depression decreased significantly (p < 0.01) after ATL. After multiple linear regressions, the HADS-Anxiety scores before surgery (B = 0.47, CI 95% 0.20 to 0.75, p = 0.001) and at follow-up after surgery (B = 0.07, CI 0.00 to 0.14, p = 0.05) remain independently and positively associated with HADS-Anxiety scores after surgery. The HADS-Depression scores after surgery were independently positively associated with HADS-Depression scores before surgery (B = 0.39, CI 95% 0.10 to 0.76, p = 0.01) and worse seizure control after surgery (B = 1.55, CI 95% 0.23 to 2.87, p = 0.02). CONCLUSION Anxiety and depressive symptoms in patients with MTLE-HS significantly improved after ATL. Presurgical levels of anxiety and depressive symptoms, respectively, were positively associated with the postsurgical levels of those symptoms. Length of follow-up is associated with anxiety, and worse seizure control is associated with depressive symptoms after ATL. The results have implications for the surgical management of MTLE-HS patients.
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Affiliation(s)
- Maria Luiza Benevides
- Department of Neurology, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina (SC), Brazil; Graduate Program in Translational Neuroscience, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil.
| | - Jean Costa Nunes
- Graduate Program in Translational Neuroscience, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Division of Neuropathology, HU, UFSC, Florianópolis, SC, Brazil; Neurodiagnostic Brasil - Diagnósticos em Neuropatologia, Florianópolis, SC, Brazil; Psychiatry Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil
| | - Ricardo Guarnieri
- Department of Neurology, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina (SC), Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Graduate Program in Neuroscience, UFSC, Florianópolis, Brazil
| | - Hiago Melo
- Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Graduate Program in Neuroscience, UFSC, Florianópolis, Brazil
| | - Mariana Lunardi
- Department of Neurology, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina (SC), Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Marcelo Neves Linhares
- Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Neurosurgery Division, Surgery Department, HU, UFSC, Florianópolis, Brazil; Neurosurgery Service, Governador Celso Ramos Hospital, Florianópolis, Brazil
| | - Emil Kupek
- Neurology Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil; Departament of Public Health, UFSC, Florianópolis, SC, Brazil
| | - Peter Wolf
- Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
| | - Kátia Lin
- Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Neurology Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil; Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
| | - Roger Walz
- Graduate Program in Translational Neuroscience, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Graduate Program in Neuroscience, UFSC, Florianópolis, Brazil; Neurology Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil; Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
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7
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Melo HM, Guarnieri R, Vascouto HD, Formolo DA, de Carvalho CR, Campos WK, Sousa DS, Dionisio S, Wolf P, Lin K, Walz R. Ictal fear is associated with anxiety symptoms and interictal dysphoric disorder in drug-resistant mesial temporal lobe epilepsy. Epilepsy Behav 2021; 115:107548. [PMID: 33348195 DOI: 10.1016/j.yebeh.2020.107548] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/25/2020] [Accepted: 10/02/2020] [Indexed: 11/30/2022]
Abstract
Interictal dysphoric disorder (IDD) is a poorly understood psychiatric disorder of epilepsy patients. Interictal dysphoric disorder is characterized by depressive, somatoform, and affective symptoms observed in up to 5.9% of drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). This study aimed to evaluate the association between ictal fear (IF) and the psychiatric symptoms and diagnosis in MTLE-HS patients. We included 116 (54.3% male) consecutive adult patients (36 ± 11 years) with MTLE-HS. Anxiety and depression symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS) and the psychiatric diagnosis were according to Fourth Edition of the Diagnosis and Statistical Manual of Mental Disorders (DSM-IV). The independent association between the occurrence of IF aura and the psychiatric diagnosis was determined by binary regression. When compared to those with other auras or without aura, patients reporting IF have higher HADS anxiety, but not HADS depression, scores. Ictal fear was independently associated with the diagnosis of interictal dysphoric disorder (OR, IC 95% = 7.6, 1.3-43.2, p = 0.02), but not with the diagnosis of anxiety (OR, CI 95% = 0.72, 0.08-6.0, p = 0.73), depression (OR, CI 95% = 0.94, 0.19-4.8, p = 0.94) or psychotic disorders (p = 0.99). Only patients with drug-resistant MTLE-HS were included and the small number of cases with DD diagnosis in the sample. In MTLE-HS patients, the occurrence of IF is associated with higher levels of anxiety symptoms and IDD. The results provide insights about fear-related neural network connections with anxiety symptoms and the IDD in MTLE-HS.
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Affiliation(s)
- Hiago Murilo Melo
- Applied Neuroscience Center (CeNAp), Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Graduate Program in Neuroscience, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Ricardo Guarnieri
- Applied Neuroscience Center (CeNAp), Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Graduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Psychiatry Unit, Department of Clinical Medicine, Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Helena Dresch Vascouto
- Applied Neuroscience Center (CeNAp), Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Graduate Program in Neuroscience, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Douglas Afonso Formolo
- Applied Neuroscience Center (CeNAp), Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Graduate Program in Neuroscience, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Cristiane Ribeiro de Carvalho
- Applied Neuroscience Center (CeNAp), Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Graduate Program in Neuroscience, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Wuilker Knoner Campos
- Neuron Dor Clinic, Florianópolis, SC, Brazil; Neuron Institute, Baia Sul Medical Center, Florianópolis, SC, Brazil; Neurosurgery Division, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil
| | - Daniel Santos Sousa
- Neuron Dor Clinic, Florianópolis, SC, Brazil; Neuron Institute, Baia Sul Medical Center, Florianópolis, SC, Brazil; Neurosurgery Division, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil
| | - Sasha Dionisio
- Advanced Epilepsy Unit, Mater Centre for Neurosciences, Brisbane, Australia
| | - Peter Wolf
- Epilepsy Center of Santa Catarina (CEPESC), Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark
| | - Katia Lin
- Applied Neuroscience Center (CeNAp), Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Graduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Epilepsy Center of Santa Catarina (CEPESC), Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Neurology Unit, Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Roger Walz
- Applied Neuroscience Center (CeNAp), Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Graduate Program in Neuroscience, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Graduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Epilepsy Center of Santa Catarina (CEPESC), Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Neurology Unit, Department of Clinical Medicine, University Hospital - UFSC (HU - UFSC), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil.
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AMPAr GluA1 Phosphorylation at Serine 845 in Limbic System Is Associated with Cardiac Autonomic Tone. Mol Neurobiol 2021; 58:1859-1870. [PMID: 33404979 DOI: 10.1007/s12035-020-02272-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
The central autonomic network, which is connected to the limbic system structures including the amygdala (AMY) and anterior hippocampus (aHIP), regulates the sympathetic and parasympathetic modulation of visceromotor, neuroendocrine, pain, and behavior manifestations during stress responses. Heart rate variability (HRV) is useful to estimate the cardiac autonomic tone. The levels of phosphorylation on the Ser831 and Ser845 sites of the GluA1 subunit of the AMPAr (P-GluA1-Ser845 and P-GluA1-Ser831) are useful markers of synaptic plasticity. The relation between synaptic plasticity in the human limbic system structures and autonomic regulation in humans is unknown. This study investigated the association between HRV and neurochemistry biomarkers of synaptic plasticity in AMY and aHIP. HRV indices were obtained from the resting state electrocardiogram of patients with drug-resistant mesial temporal lobe epilepsy (MTLE, n = 18) and the levels of P-GluA1-Ser845 and P-GluA1-Ser831 in the AMY and aHIP resected during the epilepsy surgery. A backward stepwise multiple linear regression models were used to analyze the association between HRV and synaptic plasticity biomarkers controlling for imbalances in the distribution of sociodemographic, clinical, neuroimaging, and neurosurgical variables. P-GluA1-Ser845 levels in AMY show a negative association (p < 0.05) with the 3 investigated parasympathetic autonomic HRV indices (SDNN, rMSSD, and HF) predicting 24 to 40% of their variation. The final multiple linear regression models include disease duration and levels of P-GluA1-Ser845 and predict 24 to 56% of cardiac autonomic tone variation (p < 0.01). P-GluA1-Ser845 levels in AMY and aHIP are negatively associated with the resting HRV in MTLE-HS indicating that increased synaptic efficiency in amygdala is associated with a parasympathetic cardiac autonomic tone impairment. The results suggest that specific changes in synaptic plasticity may be involved in the brain-heart axis regulation by the limbic system.
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Gugała-Iwaniuk M, Sławińska K, Bochyńska A, Konopko M, Rola R, Ryglewicz D, Sienkiewicz-Jarosz H. The prevalence of depressive and anxiety symptoms in Polish epilepsy patients - The context of pharmaco-resistance. Epilepsy Behav 2021; 114:107522. [PMID: 33272895 DOI: 10.1016/j.yebeh.2020.107522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Patients with epilepsy (PWE) are at a higher risk of experiencing depressive and anxiety symptoms than the general population; these symptoms are more prevalent in patients with drug-resistant epilepsy (DRE) compared to those with non-drug-resistant epilepsy (NDRE). The aim of the present study was to compare the level of reported depressive and anxiety symptoms in patients with DRE and patients with NDRE and to examine the relationships between demographic and epilepsy-related variables and severity of depression and anxiety symptoms. MATERIAL AND METHODS A total of 193 adult PWE, divided into a DRE group (n = 87), and an NDRE group (n = 106), completed the Beck Depression Inventory (BDI) and the Stat-Trait Anxiety Inventory (STAI-Sand STAI-T). Data analysis included sociodemographic and disease-related variables such as the type of epilepsy syndrome, age at onset of disease, and duration of the disease. RESULTS The DRE group presented a higher score of BDI than the NDRE group (p = 0.04). Age correlated with the score of STAI-S in the NDRE group (r = 0.22). Sex was the only significant predictor of the score of STAI-T in the NDRE group. Men from the DRE group presented higher scores in BDI, STAI-S, and STA-T compared with the NDRE group. CONCLUSIONS Patients with DRE reported more severe depressive symptoms than patients with NDRE. In NDRE patients, the level of anxiety, considered as a state, was correlated with age. Sex was a significant predictor of the level of anxiety in DRE patients. Pharmaco-resistance was significantly associated with severity of depression and anxiety in male patients.
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Affiliation(s)
- Magdalena Gugała-Iwaniuk
- Ist Department of Neurology, The Institute of Psychiatry and Neurology, Warsaw (I Klinika Neurologiczna, Instytut Psychiatrii I Neurologii, ul.Sobieskiego 9, 02-957 Warszawa, Poland.
| | - Ksenia Sławińska
- Ist Department of Neurology, The Institute of Psychiatry and Neurology, Warsaw (I Klinika Neurologiczna, Instytut Psychiatrii I Neurologii, ul.Sobieskiego 9, 02-957 Warszawa, Poland
| | - Anna Bochyńska
- Ist Department of Neurology, The Institute of Psychiatry and Neurology, Warsaw (I Klinika Neurologiczna, Instytut Psychiatrii I Neurologii, ul.Sobieskiego 9, 02-957 Warszawa, Poland
| | - Magdalena Konopko
- Ist Department of Neurology, The Institute of Psychiatry and Neurology, Warsaw (I Klinika Neurologiczna, Instytut Psychiatrii I Neurologii, ul.Sobieskiego 9, 02-957 Warszawa, Poland
| | - Rafał Rola
- Ist Department of Neurology, The Institute of Psychiatry and Neurology, Warsaw (I Klinika Neurologiczna, Instytut Psychiatrii I Neurologii, ul.Sobieskiego 9, 02-957 Warszawa, Poland; Neurological Department, Military Institute of Aviation Medicine, Warsaw (Klinika Neurologiczna, Wojskowy Instytut Medycyny Lotniczej, ul.Krasińskiego 54/56, 01-755 Warszawa, Poland
| | - Danuta Ryglewicz
- Ist Department of Neurology, The Institute of Psychiatry and Neurology, Warsaw (I Klinika Neurologiczna, Instytut Psychiatrii I Neurologii, ul.Sobieskiego 9, 02-957 Warszawa, Poland
| | - Halina Sienkiewicz-Jarosz
- Ist Department of Neurology, The Institute of Psychiatry and Neurology, Warsaw (I Klinika Neurologiczna, Instytut Psychiatrii I Neurologii, ul.Sobieskiego 9, 02-957 Warszawa, Poland
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Olsson P, Pearson K, Reimers A, Källén K. Widespread skeptic attitudes among people with epilepsy toward generic antiseizure drugs - A Swedish survey study. Epilepsy Behav 2021; 114:107554. [PMID: 33303376 DOI: 10.1016/j.yebeh.2020.107554] [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: 07/07/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To explore associations between the characteristics of people with epilepsy (PWE) and their attitudes toward generic substitution of antiseizure drugs (ASDs) in epilepsy. METHODS This was a cross-sectional survey study directed at adults with epilepsy using selected brand drugs: Keppra®, Lamictal®, Lyrica® or Topimax®. Symptoms of anxiety and depression, sense of self-efficacy, and beliefs about medicines were assessed. Caregivers were asked to answer for persons with intellectual or communicative difficulties. RESULTS The total response rate was 41% (n = 178). Almost half (46%) of subjects stated that they would oppose generic substitution (Gen-NEG) if suggested by their neurologist, while 71% would worry about adverse effects and/or increased seizure frequency after a putative switch. Age ≥50 increased the odds of being Gen-NEG (adjusted OR: 2.20, 95% CI: 1.18-4.11). Negative associations with both Gen-NEG and worriers were found for education level of high-school diploma or above, employment/studies, and prior experience of generic ASD switch. The proportion of worriers was much higher among caregivers (21/22) compared to subjects with epilepsy (106/156). CONCLUSION High proportions of PWE express concerns regarding generic substitution of ASDs. The elderly and caregivers seem to express particular concerns. Identifying ways to diminish negative outcomes and worries in connection with a switch is an important future field of research in order to ensure high quality, cost-effective health care for the most vulnerable people in our societies.
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Affiliation(s)
- Patrik Olsson
- Dept. of Emergency Medicine, Helsingborg General Hospital, Helsingborg, Sweden; Dept. of Clinical Sciences Lund, Clinical Sciences Helsingborg, Lund University, Lund, Sweden.
| | - Kevin Pearson
- Dept. of Clinical Sciences Lund, Clinical Sciences Helsingborg, Lund University, Lund, Sweden.
| | - Arne Reimers
- Dept. of Clinical Chemistry and Pharmacology, Division of Laboratory Medicine, Lund, Sweden.
| | - Kristina Källén
- Dept. of Clinical Sciences Lund, Clinical Sciences Helsingborg, Lund University, Lund, Sweden; Dept. of Specialized Medicine, Helsingborg General Hospital, Helsingborg, Sweden; Dept. of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden.
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How predictable is cognitive performance in Brazilian patients with pharmacoresistant mesial temporal lobe epilepsy? Epilepsy Behav 2020; 112:107453. [PMID: 33181899 DOI: 10.1016/j.yebeh.2020.107453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of the study was to investigate the independent association between clinical, demographic, psychiatric, radiologic, electrophysiological, and pharmacologic variables and cognitive performance of Brazilian patients with pharmacoresistant mesial temporal lobe epilepsy (MTLE). METHODS Ninety-three patients with pharmacoresistant MTLE related to hippocampal sclerosis (HS) were included in the study. Multiple linear regressions were done to identify predictor variables for 24 cognitive tests. Independent variables analyzed were sex, hand dominance, age, years of education, marital status, work activity, history for an initial precipitant injury (IPI), family history of epilepsy, lesion side, antiseizure medication (ASM) treatment type, ASM serum levels, benzodiazepine (BDZ) treatment, age at epilepsy onset, disease duration, monthly frequency of seizures, and Hospital Anxiety and Depression Scale (HADS) scores. RESULTS Years of education was an independent and positive predictor in 22 of the 24 cognitive tests evaluated. Male sex was also a positive predictor of one cognitive test. Variables negatively associated with cognitive performance were left side lesion (10 tests), disease duration (5 tests), polytherapy (3 tests), ASM serum levels (3 tests), and BDZ treatment or not working (1 test each). The regression model explained between 6% and 44% of the cognitive test scores variation. SIGNIFICANCE In Brazilian patients with pharmacoresistant MTLE-HS, up to 44% of cognitive test scores variation is predictable by clinical, demographic, psychiatric, radiologic, electrophysiology, and pharmacological variables. The identification of predictors of cognitive performance may be helpful for better planning of patient care.
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Grigg-Damberger M, Andrews N, Wang L, Bena J, Foldvary-Schaefer N. Subjective and objective hypersomnia highly prevalent in adults with epilepsy. Epilepsy Behav 2020; 106:107023. [PMID: 32213453 DOI: 10.1016/j.yebeh.2020.107023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Sleepiness is among the most common complaints of people with epilepsy, but objective documentation is lacking. We systematically investigated subjective and objective sleepiness in an observational cross-sectional cohort of adults with epilepsy (AWE). METHODS This is a prospective study of AWE consecutively recruited without foreknowledge of sleep/wake complaints. Polysomnography (PSG) with 18-channel electroencephalography (EEG) followed by multiple sleep latency testing (MSLT) was performed. Patients completed the Epworth Sleepiness Scale (ESS), a single-item question assessing excessive daytime sleepiness (EDS), and a 7-day sleep and seizure diary. Multivariable linear models were used to assess the association between MSLT mean sleep latency (MSL) and interests with adjustment of covariates of interest. Receiver operating characteristics (ROC) analysis was performed to evaluate the discrimination capability of ESS on MSL < 8 min and <5 min and investigate the optimal cutpoints. RESULTS Among 127 AWE (mean age: 38.7 ± 13.7 years), abnormal MSL (<8 min) was observed in 49.6% and MSL <5 min in 31.5%. While 78% reported feeling sleepy during the day on a single-item question, only 24% had elevated scores on the ESS (>10/24). The ESS score was associated with MSL even after adjusting for seizure frequency, antiseizure medication (ASM) standardized dose and number, age, gender, depression and insomnia symptom severity, and apnea-hypopnea index (HPI) and total sleep time on PSG (coefficients [95% confidence interval (CI)]: -0.26 [-0.48, -0.05], p = 0.018). The area under the curve (AUC) of the ESS ROC predicting MSL < 8 min and MSL < 5 min were similar: 0.62 (95%CI: 0.52-0.72) and 0.62 (95%CI: 0.51-0.74). CONCLUSIONS This is the largest prospective cross-sectional observational study to date using MSLT in AWE. We found subjective and objective daytime sleepiness highly prevalent in AWE and not explained by seizure frequency, ASM burden, symptoms of insomnia/depression, or PSG findings although those with MSL < 5 min were more likely to have obstructive sleep apnea (OSA). Pathologic sleepiness with MSL < 8 min was present in half of AWE. Nearly one-third of AWE unselected for sleep/wake complaints had MSL < 5 min, a range typical of narcolepsy.
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Affiliation(s)
- Madeleine Grigg-Damberger
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, United States of America
| | - Noah Andrews
- Department of Neurology, Sleep Disorders and Epilepsy Centers, Cleveland Clinic, Cleveland, OH, United States of America
| | - Lu Wang
- Cleveland Clinic Quantitative Health Sciences, Cleveland, OH, United States of America
| | - James Bena
- Cleveland Clinic Quantitative Health Sciences, Cleveland, OH, United States of America
| | - Nancy Foldvary-Schaefer
- Department of Neurology, Sleep Disorders and Epilepsy Centers, Cleveland Clinic, Cleveland, OH, United States of America.
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Amygdala levels of the GluA1 subunit of glutamate receptors and its phosphorylation state at serine 845 in the anterior hippocampus are biomarkers of ictal fear but not anxiety. Mol Psychiatry 2020; 25:655-665. [PMID: 29880883 DOI: 10.1038/s41380-018-0084-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/06/2018] [Accepted: 04/04/2018] [Indexed: 11/08/2022]
Abstract
Fear is a conscious state caused by exposure to real or imagined threats that trigger stress responses that affect the body and brain, particularly limbic structures. A sub-group of patients with mesial temporal lobe epilepsy related to hippocampus sclerosis (MTLE-HS) have seizures with fear, which is called ictal fear (IF), due to epileptic activity within the brain defensive survival circuit structures. Synaptic transmission efficacy can be bi-directionally modified through potentiation (long-term potentiation (LTP)) or depression (long-term depression (LTD)) as well as the phosphorylation state of Ser831 and Ser845 sites at the GluA1 subunit of the glutamate AMPA receptors, which has been characterized as a critical event for this synaptic plasticity. In this study, GluA1 levels and the phosphorylation at Ser845 and Ser831 in the amygdala (AMY), anterior hippocampus (aHIP) and middle gyrus of temporal neocortex (CX) were determined with western blots and compared between MTLE-HS patients who were showing (n = 06) or not showing (n = 25) IF. Patients with IF had an 11% decrease of AMY levels of the GluA1 subunit (p = 0.05) and a 21.5% decrease of aHIP levels of P-GluA1-Ser845 (p = 0.009) compared to patients not showing IF. The observed associations were not related to imbalances in the distribution of other concomitant types of aura, demographic, clinical or neurosurgical variables. The lower levels of P-GluA1-Ser845 in the aHIP of patients with IF were not related to changes in the levels of the serine/threonine-protein phosphatase PP1-alpha catalytic subunit or protein kinase A activation. Taken together, the GluA1 subunit levels in AMY and P-GluA1-Ser845 levels in the aHIP show an overall accuracy of 89.3% (specificity 95.5% and sensitivity 66.7%) to predict the presence of IF. AMY levels of the GluA1 subunit and aHIP levels of P-GluA1-Ser845 were not associated with the psychiatric diagnosis and symptoms of patients. Taken together with previous findings in MTLE-HS patients with IF who were evaluated by stereotactic implanted depth electrodes, we speculate our findings are consistent with the hypothesis that AMY is not a centre of fear but together with other sub-cortical and cortical structures integrates the defensive circuit that detect and respond to threats. This is the first report to address neuroplasticity features in human limbic structures connected to the defensive survival circuits, which has implications for the comprehension of highly prevalent psychiatric disorders and symptoms.
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McCartney L, Johnstone B, O'Brien T, Kwan P, Kalincik T, Velakoulis D, Malpas C. Psychometric properties of the Hospital Anxiety and Depression Scale in an inpatient video-monitoring epilepsy cohort. Epilepsy Behav 2020; 103:106631. [PMID: 31870806 DOI: 10.1016/j.yebeh.2019.106631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/29/2019] [Accepted: 10/01/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with epilepsy (PWE) have high rates of comorbid anxiety disorders and depressive disorders, from 25% in general population cohorts to rates of 55% in people with treatment resistant epilepsy. High rates are also seen in patients with psychogenic nonepileptic seizures (PNES). Depressive disorders and anxiety disorders in PWE are associated with decreased quality of life measures and are the strongest risk factors for increased suicidality, rates of which are markedly elevated in PWE, at 12%, compared to the general Australian population (1.8%). The Hospital Anxiety and Depression Scale (HADS) is one of the more commonly used screening tools in medical populations. Past studies of the HADS in general outpatient populations with epilepsy have demonstrated promising validity for detecting depression. OBJECTIVES The following were the objectives of the study: 1. To examine the validity of HADS in detecting depressive disorders and anxiety disorders in an inpatient population of patients admitted for video monitoring. 2. To investigate the measurement structure of the HADS across the diagnosis groups of epilepsy subtypes and PNES. METHODS This was a retrospective cohort study of 485 patients admitted to a tertiary epilepsy video electroencephalography (EEG) monitoring unit. All patients received clinical neurological, neuropsychiatric, and neuroimaging assessments to arrive at consensus epilepsy and psychiatric diagnoses. Clinical psychiatric diagnosis of depressive disorders and anxiety disorders, based on the assessment of a neuropsychiatrist, were compared to accepted HADS cutoff scores for these conditions. FINDINGS Of the 485 patients, 229 patients were with epilepsy, 28 had both epilepsy and PNES, and 121 had PNES. In 107 cases, no definite diagnosis could be made. At a cutoff score of 7 HADS was able to significantly classify patients with depression (area under the curve [AUC] = 0.79, 95% confidence interval [CI] = 0.72-0.82) with a sensitivity of 70% and a specificity of 83%. A similar result was observed for anxiety disorders; a cutoff score of 7 (AUC = 0.75, 95% CI = 0.72-0.81) was able to significantly classify anxiety disorders in patients with a sensitivity of 88% and specificity of 54%. CONCLUSIONS This study has found that HADS measures two separate, yet correlated, constructs of anxiety disorders and depressive disorders. Our results indicate that while the HADS is sensitive to distress in this population, relatively low cutoff scores would be required to achieve highly sensitive screening. This sample includes patients with a diagnosis of epilepsy and/or PNES, and thus, the findings have clinical applicability to screening in tertiary epilepsy video-EEG monitoring units where both these conditions frequently co-occur.
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Affiliation(s)
- Lara McCartney
- The Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia.
| | - Benjamin Johnstone
- The Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Terence O'Brien
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia; The Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department Neurology, The Alfred Hospital, Melbourne, Australia
| | - Patrick Kwan
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia; The Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department Neurology, The Alfred Hospital, Melbourne, Australia
| | - Tomas Kalincik
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia; CORe, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Dennis Velakoulis
- The Melbourne Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Charles Malpas
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia; The Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department Neurology, The Alfred Hospital, Melbourne, Australia; CORe, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
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15
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Zingano BDL, Guarnieri R, Diaz AP, Schwarzbold ML, Wolf P, Lin K, Walz R. Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) and The State-Trait Anxiety Inventory (STAI) accuracy for anxiety disorders detection in drug-resistant mesial temporal lobe epilepsy patients. J Affect Disord 2019; 246:452-457. [PMID: 30599368 DOI: 10.1016/j.jad.2018.12.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/18/2018] [Accepted: 12/23/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is the most prevalent type of surgically remediable epilepsy and highly associated with psychiatric comorbidities. This study aimed to evaluate Hospital anxiety and depression scale-anxiety subscale (HADS-A) and The State-Trait Anxiety Inventory - Trait subscale (STAI-T) accuracy for detection of anxiety disorders in patients with drug-resistant MTLE-HS. METHODS One hundred three consecutive patients with drug-resistant MTLE-HS were enrolled. Diagnosis was based on the anamnesis, neurological examination, video-electroencephalogram (VEEG) 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; HADS-A and STAI-T were used as psychometric diagnostic tests, and receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores. RESULTS The areas under the curve (AUCs) were higher than 0.7 (0.6-0.8) for both scales. The STAI-T cutoff point of ˃53 and the HADS-A cutoff point of ˃7 showed both around of 80% (44.4-97.7) sensitivity and 80% (66.9-86.9) and 60% (46.5-68.6) of specificity, respectively. In this sample the prevalence of anxiety disorders was 11.7% and both scales showed a high negative predictive value such as 96% (87.1-99.0) but low positive predictive value such as 30% (22.1-45.2) and 20% (15.0-27.2) respectively. LIMITATIONS The small number of cases in the diagnostic population; the results are only applied to drug resistant MTLE-HS; the psychiatric diagnosis were not based on a structured psychiatric interview; possible observer bias in 7 illiterate patients; the antidepressant treatment was not controlled. CONCLUSIONS In MTLE-HS, STAI-T and HADS-A had a similar and low positive predictive value and high negative predictive value. The implications for the HADS-A and STAI-T usefulness for anxiety disorders screening in patients with other epilepsies types deserve further investigations. If replicated in other populations, these findings may have important relevance for the presurgical screening of anxiety disorders in MTLE-HS patients who are candidates to epilepsy surgery.
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Affiliation(s)
- Bianca de Lemos Zingano
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Psiquiatria, Hospital Governador Celso Ramos (HGCR), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil.
| | - Ricardo Guarnieri
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Psiquiatria, HU-UFSC, Florianópolis, SC, Brazil
| | - Alexandre Paim Diaz
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Psiquiatria, HU-UFSC, Florianópolis, SC, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina (UNISUL), Palhoça, SC, Brazil
| | - Marcelo Libório Schwarzbold
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Psiquiatria, HU-UFSC, Florianópolis, SC, Brazil
| | - Peter Wolf
- Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil; Danish Epilepsy Center, Dianalund, Denmark
| | - Katia Lin
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil
| | - Roger Walz
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil
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Lin J, Wang X, Dong F, Du Y, Shen J, Ding S, Wang L, Ye M, Wang Y, Xia N, Zheng R, Chen H, Xu H. Validation of the Chinese version of the Hamilton Rating Scale for Depression in adults with epilepsy. Epilepsy Behav 2018; 89:148-152. [PMID: 30415137 DOI: 10.1016/j.yebeh.2018.10.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/06/2018] [Accepted: 10/07/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aimed to validate the Chinese version of the 17-item Hamilton Rating Scale for Depression (C-HRSD-17) for use in adult patients with epilepsy (PWE). METHODS A consecutive sample of Chinese adult PWE from a tertiary hospital was examined using the C-HRSD-17 and the Mini International Neuropsychiatric Interview (MINI) Plus Chinese Version 5.0.0. RESULTS A total of 191 PWE completed the assessment of depression. According to the MINI, thirty patients (15.7%) had current major depressive disorder (MDD). The Cronbach's α coefficient for the C-HRSD-17 was 0.832. Receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.983 (95% CI = 0.968-0.998). With a cutoff score of 9, the C-HRSD-17 demonstrated the best psychometric properties, with a sensitivity of 96.7%, a specificity of 93.8%, a positive predictive value (PPV) of 74.4%, and a negative predictive value (NPV) of 99.3%. CONCLUSION The C-HRSD-17 proved to be a valid and reliable assessment tool, with a cutoff score of 9 for screening of current MDD in Chinese adult PWE.
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Affiliation(s)
- Jiahe Lin
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China
| | - Xinshi Wang
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China
| | - Feirong Dong
- Department of Psychiatry, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China
| | - Yanru Du
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China
| | - Jingzan Shen
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China
| | - Siqi Ding
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China
| | - Li Wang
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China
| | - Mengqian Ye
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China
| | - Yi Wang
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China
| | - Niange Xia
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China
| | - Rongyuan Zheng
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China
| | - Hong Chen
- Department of Psychiatry, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China
| | - Huiqin Xu
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China.
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17
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Wiglusz MS, Landowski J, Cubała WJ. Validation of the Polish version of the Hospital Anxiety and Depression Scale for anxiety disorders in patients with epilepsy. Epilepsy Behav 2018; 84:162-165. [PMID: 29803946 DOI: 10.1016/j.yebeh.2018.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/07/2018] [Accepted: 04/16/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Anxiety disorders are frequent comorbid disorders in patients with epilepsy (PWEs). The availability of validated screening instruments to detect anxiety disorders in PWEs is limited. The aim of the present study was to validate the Polish version of the Hospital Anxiety and Depression Scale (HADS) in adult PWEs for the detection of anxiety disorders. METHODS A total of 96 outpatients with epilepsy completed the self-reported symptom scale, the HADS, and were diagnosed using the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and receiver operating characteristic (ROC) curves were assessed to determine the optimal threshold scores for the HADS anxiety subscale (HADS-A). RESULTS Receiver operating characteristic analyses showed areas under the curve at 80.8%. For diagnoses of anxiety disorder, the HADS-A demonstrated the best psychometric properties for a cutoff score ≥10 with sensitivity of 81.3%, specificity of 70.0%, PPV of 31.5%, and NPV of 94.9%. CONCLUSIONS The HADS-A proved to be a valid and reliable psychometric instrument in terms of screening for anxiety disorders in our sample of PWEs. In the epilepsy setting, the HADS-A maintains adequate sensitivity, acceptable specificity, and high NPV but low PPV for diagnosing anxiety disorders with an optimum cutoff score ≥10.
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Affiliation(s)
| | - Jerzy Landowski
- Department of Psychiatry, Medical University of Gdańsk, Poland
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18
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Wiglusz MS, Landowski J, Michalak L, Cubała WJ. Validation of the Polish version of the Beck Depression Inventory in patients with epilepsy. Epilepsy Behav 2017; 77:58-61. [PMID: 29111504 DOI: 10.1016/j.yebeh.2017.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/19/2017] [Accepted: 09/22/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the fact that depressive disorders are the most common comorbidities among patients with epilepsy (PWE), such disorders often go unrecognized and untreated. In addition, the availability of validated screening instruments to detect depression in PWE is limited. The aim of the present study was thus to validate the Polish version of the Beck Depression Inventory (BDI) in adult PWE. METHODS A group of 118 outpatient PWE were invited to participate in the study. Ninety-six patients meeting the inclusion criteria completed the Polish Version of Beck Depression Inventory-I (BDI-I) and were examined by a trained psychiatrist using the Structured Clinical Interview (SICD-I) for Diagnostic and statistical manual of mental disorders - fourth edition (Text revision) (DSM-IV-TR). Receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores for BDI. RESULTS Receiver operating characteristic analysis showed the area under the curve to be approximately 84%. For major depressive disorder (MDD) diagnosis, the BDI demonstrated the best psychometric properties for a cut-off score to be 18, with a sensitivity of 90.5%, specificity of 70.7%, positive predictive value (PPV) of 46.3%, and negative predictive value (NPV) of 96.4%. For the 'any depressive disorder' group, the BDI optimum cut-off score was 11, with a sensitivity of 82.5%, specificity of 73.2%, PPV of 68.8%, and NPV of 85.4%. CONCLUSIONS The BDI score is a valid psychometric indicator for depressive disorders in PWE maintaining adequate sensitivity and specificity, high NPV, and acceptable PPV with an optimum cut-off score of 18 for MDD diagnosis.
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Affiliation(s)
| | - Jerzy Landowski
- Department of Psychiatry, Medical University of Gdańsk, Poland
| | - Lidia Michalak
- Regional Epilepsy Outpatient Unit, Copernicus Hospital, Gdańsk, Poland
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19
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Osório CM, Latini A, Leal RB, de Oliveira Thais MER, Vascouto HD, Remor AP, Lopes MW, Linhares MN, Ben J, de Paula Martins R, Prediger RD, Hoeller AA, Markowitsch HJ, Wolf P, Lin K, Walz R. Neuropsychological functioning and brain energetics of drug resistant mesial temporal lobe epilepsy patients. Epilepsy Res 2017; 138:26-31. [PMID: 29040828 DOI: 10.1016/j.eplepsyres.2017.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 09/20/2017] [Accepted: 10/09/2017] [Indexed: 11/19/2022]
Abstract
Interictal hypometabolism is commonly measured by 18-fluoro-deoxyglucose Positron Emission Tomography (FDG-PET) in the temporal lobe of patients with mesial temporal lobe epilepsy (MTLE-HS). Left temporal lobe interictal FDG-PET hypometabolism has been associated with verbal memory impairment, while right temporal lobe FDG-PET hypometabolism is associated with nonverbal memory impairment. The biochemical mechanisms involved in these findings remain unknown. In comparison to healthy controls (n=21), surgically treated patients with MTLE-HS (n=32, left side=17) had significant lower scores in the Rey Auditory Verbal Learning Test (RAVLT retention and delayed), Logical Memory II (LMII), Boston Naming test (BNT), Letter Fluency and Category Fluency. We investigated whether enzymatic activities of the mitochondrial enzymes Complex I (C I), Complex II (C II), Complex IV (C IV) and Succinate Dehydrogenase (SDH) from the resected samples of the middle temporal neocortex (mTCx), amygdala (AMY) and hippocampus (HIP) were associated with performance in the RAVLT, LMII, BNT and fluency tests of our patients. After controlling for the side of hippocampus sclerosis, years of education, disease duration, antiepileptic treatment and seizure outcome after surgery, no independent associations were observed between the cognitive test scores and the analyzed mitochondrial enzymatic activities (p>0.37). Results indicate that memory and language impairment observed in MTLE-HS patients are not strongly associated with the levels of mitochondrial CI, CII, SDH and C IV enzymatic activities in the temporal lobe structures ipsilateral to the HS lesion.
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Affiliation(s)
- Camila Moreira Osório
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Alexandra Latini
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Laboratório de Bioenergética e Estresse Oxidativo, LABOX, Depar tamento de Bioquímica, UFSC, Florianópolis, SC, Brazil
| | - Rodrigo Bainy Leal
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Laboratório de Transdução de Sinal no Sistema Nervoso Central, Departamento de Bioquímica, UFSC, Florianópolis, SC, Brazil
| | | | - Helena Dresch Vascouto
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Aline Pertile Remor
- Laboratório de Bioenergética e Estresse Oxidativo, LABOX, Depar tamento de Bioquímica, UFSC, Florianópolis, SC, Brazil
| | - Mark William Lopes
- Laboratório de Bioenergética e Estresse Oxidativo, LABOX, Depar tamento de Bioquímica, UFSC, Florianópolis, SC, Brazil
| | - Marcelo Neves Linhares
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Divisão de Neurocirurgia, Departamento de Cirurgia, HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurocirurgia, Hospital governador Celso Ramos (HGCR), Florianópolis, SC, Brazil
| | - Juliana Ben
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Laboratório de Transdução de Sinal no Sistema Nervoso Central, Departamento de Bioquímica, UFSC, Florianópolis, SC, Brazil
| | - Roberta de Paula Martins
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Laboratório de Bioenergética e Estresse Oxidativo, LABOX, Depar tamento de Bioquímica, UFSC, Florianópolis, SC, Brazil
| | | | - Alexandre Ademar Hoeller
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | | | - Peter Wolf
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, HU, UFSC, Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark
| | - Kátia Lin
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Epilepsia do Estado de Santa Catarina, CEPESC, HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, HU, UFSC, Florianópolis, SC, Brazil
| | - Roger Walz
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Epilepsia do Estado de Santa Catarina, CEPESC, HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, HU, UFSC, Florianópolis, SC, Brazil.
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20
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Pauli C, de Oliveira Thais MER, Guarnieri R, Schwarzbold ML, Diaz AP, Ben J, Linhares MN, Markowitsch HJ, Wolf P, Wiebe S, Lin K, Walz R. Decline in word-finding: The objective cognitive finding most relevant to patients after mesial temporal lobe epilepsy surgery. Epilepsy Behav 2017; 75:218-224. [PMID: 28867574 DOI: 10.1016/j.yebeh.2017.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/24/2017] [Accepted: 08/04/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to investigate the following: i) the objective impairment in neuropsychological tests that were associated with the subjective perception of cognitive function decline in Brazilian patients who underwent mesial temporal lobe epilepsy (MTLE) surgery and ii) the predictive variables for those impaired objective neuropsychological tests. METHODS Forty-eight adults with MTLE (27 right HS and 23 male) were divided according to their perception of changes (Decline or No-decline) of cognitive function domain of the QOLIE-31 questionnaire applied before and 1year after the ATL. The mean (SD) of changes in the raw score difference of the neuropsychological tests before and after the ATL was compared between Decline and No-decline groups. Receiver Operating Characteristic curves, sensitivity, specificity, and predictive values were used to assess the optimum cutoff points of neuropsychological test score changes to predict patient-reported subjective cognitive decline. KEY FINDINGS Six (12.5%) patients reported a perception of cognitive function decline after ATL. Among the 25 cognitive tests analyzed, only changes in the Boston Naming Test (BNT) were associated with subjective cognitive decline reported by patients. A reduction of ≥8 points in the raw score of BNT after surgery had 91% of sensitivity and 45% specificity for predicting subjective perception of cognitive function decline by the patient. Left side surgery and age older than 40years were more associated with an important BNT reduction with overall accuracy of 91.7%, 95% predictive ability for no impairment, and 75% for impairment of cognitive function. SIGNIFICANCE Impairment in word-finding seems to be the objective cognitive finding most relevant to Brazilian patients after mesial temporal lobe epilepsy surgery. Similar to American patients, the side of surgery and age are good predictors for no decline in the BNT, but shows a lower accuracy to predict its decline. If replicated in other populations, the results may have wider implications for the surgical management of patients with drug-resistant MTLE.
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Affiliation(s)
- Carla Pauli
- Serviço de Neurocirurgia, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | | | - Ricardo Guarnieri
- Serviço de Neurocirurgia, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Psiquiatria, Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil
| | - Marcelo Liborio Schwarzbold
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Psiquiatria, Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil
| | - Alexandre Paim Diaz
- Serviço de Neurocirurgia, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Psiquiatria, Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil
| | - Juliana Ben
- Serviço de Neurocirurgia, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil
| | - Marcelo Neves Linhares
- Serviço de Neurocirurgia, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Departamento de Cirurgia, Serviço de Neurocirurgia, HU-UFSC, Florianópolis, SC, Brazil; Centro de Epilepsia de Santa Catarina (CEPESC), HU-UFSC, Florianópolis, SC, Brazil
| | | | - Peter Wolf
- Serviço de Neurologia, Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil; Centro de Epilepsia de Santa Catarina (CEPESC), HU-UFSC, Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Canada
| | - Katia Lin
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil; Centro de Epilepsia de Santa Catarina (CEPESC), HU-UFSC, Florianópolis, SC, Brazil
| | - Roger Walz
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil; Centro de Epilepsia de Santa Catarina (CEPESC), HU-UFSC, Florianópolis, SC, Brazil.
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21
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Pauli C, Schwarzbold ML, Diaz AP, de Oliveira Thais MER, Kondageski C, Linhares MN, Guarnieri R, de Lemos Zingano B, Ben J, Nunes JC, Markowitsch HJ, Wolf P, Wiebe S, Lin K, Walz R. Predictors of meaningful improvement in quality of life after temporal lobe epilepsy surgery: A prospective study. Epilepsia 2017; 58:755-763. [PMID: 28332703 DOI: 10.1111/epi.13721] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate prospectively the independent predictors of a minimum clinically important change (MCIC) in quality of life (QOL) after anterior temporal lobectomy (ATL) for drug-resistant mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) in Brazilian patients. METHODS Multiple binary logistic regression analysis was performed to identify the clinical, demographic, radiologic, and electrophysiologic variables independently associated with MCIC in the Quality of Life in Epilepsy-31 Inventory (QOLIE-31) overall score 1 year after ATL in 77 consecutive patients with unilateral MTLE-HS. RESULTS The overall QOLIE-31 score and all its subscale scores increased significantly (p < 0.0001) 1 year after ATL. In the final logistic regression model, absence of presurgical diagnosis of depression (adjusted odds ratio [OR] 4.4, 95% confidence interval [CI] 1.1-16.1, p = 0.02) and a complete postoperative seizure control (adjusted OR 4.1, 95% CI 1.2-14.5, p = 0.03) were independently associated with improvement equal to or greater than the MCIC in QOL after ATL. The overall model accuracy for MCIC improvement in the QOL was 85.6%, with a 95.2% of sensitivity and 46.7% of specificity. SIGNIFICANCE These results in Brazilian patients reinforce the external validation of previous findings in Canadian patients showing that presurgical depression and complete seizure control after surgery are independent predictors for meaningful improvement in QOL after ATL, and have implications for the surgical management of MTLE patients.
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Affiliation(s)
- Carla Pauli
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.,Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Marcelo Liborio Schwarzbold
- Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Psychiatric Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil
| | - Alexandre Paim Diaz
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.,Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Psychiatric Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil
| | | | - Charles Kondageski
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.,Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Department of Surgery, HU, UFSC, Florianópolis, Santa Catarina, Brazil
| | - Marcelo Neves Linhares
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.,Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Department of Surgery, HU, UFSC, Florianópolis, Santa Catarina, Brazil
| | - Ricardo Guarnieri
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.,Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Psychiatric Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil
| | - Bianca de Lemos Zingano
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.,Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Juliana Ben
- Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Jean Costa Nunes
- Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Laboratory of Neuropathology, Pathology Division, HU, UFSC, Florianópolis, Santa Catarina, Brazil
| | | | - Peter Wolf
- Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Neurology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil.,Danish Epilepsy Centre, Dianalund, Denmark
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Katia Lin
- Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Neurology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil
| | - Roger Walz
- Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Neurology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil
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22
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Valente KD, De Paola L, Palmini A, Faveret E, de Araujo-Filho GM, van der Linden H, Bianchin MM, Walz R, Alessi R, Velasco T, Teixeira WA, LaFrance WC. The approach to patients with psychogenic nonepileptic seizures in epilepsy surgery centers regarding diagnosis, treatment, and education. Epilepsy Behav 2017; 68:78-83. [PMID: 28131930 DOI: 10.1016/j.yebeh.2016.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/29/2016] [Accepted: 12/12/2016] [Indexed: 12/14/2022]
Abstract
Previous studies, using surveys, provided an understanding about how health-care providers address patients with PNES. To date, there is limited information on the management of patients with PNES by tertiary referral centers for epilepsy. In this study, we surveyed 11 Brazilian epilepsy center directors about diagnosis, treatment, education and research on PNES. Respondents reported that patients with PNES represented 10-20% of all adult patients recorded by video-EEG (VEEG). All respondents recognized VEEG as the method to confirm the diagnosis, and 81.8% used this approach for confirmation. Most centers had a standard protocol for diagnosis. None of the centers had a particular protocol to treat PNES, but 90.9% had a uniform treatment approach including therapy and educational measures. Psychotherapy was not easily obtained in nine centers (81.8%). Seven (63.3%) centers reported ongoing research projects with PNES. Five centers referred to an educational PNES program discussing diagnosis, but only one reported an educational program for treatment. This study showed a commitment to PNES diagnosis; however, some gaps remain regarding treatment and training, namely implementing a psychotherapy approach for patients and providing educational curricula for clinicians.
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Affiliation(s)
- Kette D Valente
- Department of Psychiatry, Clinics Hospital of the Faculty of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil.
| | - Luciano De Paola
- Department of Neurology, Clinics Hospital, Federal University of Paraná, Curitiba, PR, Brazil; Comprehensive Epilepsy Center, Hospital N S das Graças, Curitiba, PR, Brazil
| | - Andre Palmini
- Medicine and Health Sciences Post-Graduate Program, São Lucas Hospital, Catholic University (PUCRS) RS, Brazil; Department of Neurology, São Lucas Hospital, Catholic University (PUCRS) RS, Brazil; Epilepsy Surgery Program Service, São Lucas Hospital, Catholic University (PUCRS) RS, Brazil
| | - Eduardo Faveret
- Brain Institute - Paulo Niemeyer, Rio de Janeiro, RJ, Brazil
| | | | | | - Marino M Bianchin
- Basic Research and Advanced Investigations in Neurology, Clinic Hospital of Porto Alegre, Federal University of Rio Grande do Sul, RS, Brazil
| | - Roger Walz
- Applied Neuroscience Center and Epilepsy Center of Santa Catarina (CEPESC), Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Rudá Alessi
- Department of Neurology, Medical School - ABC, Santo André, SP, Brazil
| | - Tonicarlo Velasco
- Department of Neurology, Clinics Hospital, Faculty of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - W Curt LaFrance
- Department of Psychiatry, Rhode Island Hospital, Brown University, Providence, RI, USA; Department of Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
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23
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Gill SJ, Lukmanji S, Fiest KM, Patten SB, Wiebe S, Jetté N. Depression screening tools in persons with epilepsy: A systematic review of validated tools. Epilepsia 2017; 58:695-705. [DOI: 10.1111/epi.13651] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Stephanie J. Gill
- Department of Clinical Neurosciences; University of Calgary; Calgary Alberta Canada
- Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
| | - Sara Lukmanji
- Department of Clinical Neurosciences; University of Calgary; Calgary Alberta Canada
- Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
| | - Kirsten M. Fiest
- Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Department of Critical Care Medicine; University of Calgary; Calgary Alberta Canada
| | - Scott B. Patten
- Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Mathison Centre for Mental Health Research & Education; University of Calgary; Calgary Alberta Canada
- Department of Psychiatry; University of Calgary; Calgary Alberta Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences; University of Calgary; Calgary Alberta Canada
- Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health; University of Calgary; Calgary Alberta Canada
| | - Nathalie Jetté
- Department of Clinical Neurosciences; University of Calgary; Calgary Alberta Canada
- Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health; University of Calgary; Calgary Alberta Canada
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24
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Lopes MW, Leal RB, Guarnieri R, Schwarzbold ML, Hoeller A, Diaz AP, Boos GL, Lin K, Linhares MN, Nunes JC, Quevedo J, Bortolotto ZA, Markowitsch HJ, Lightman SL, Walz R. A single high dose of dexamethasone affects the phosphorylation state of glutamate AMPA receptors in the human limbic system. Transl Psychiatry 2016; 6:e986. [PMID: 27959333 PMCID: PMC5290343 DOI: 10.1038/tp.2016.251] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/15/2016] [Indexed: 12/28/2022] Open
Abstract
Glucocorticoids (GC) released during stress response exert feedforward effects in the whole brain, but particularly in the limbic circuits that modulates cognition, emotion and behavior. GC are the most commonly prescribed anti-inflammatory and immunosuppressant medication worldwide and pharmacological GC treatment has been paralleled by the high incidence of acute and chronic neuropsychiatric side effects, which reinforces the brain sensitivity for GC. Synapses can be bi-directionally modifiable via potentiation (long-term potentiation, LTP) or depotentiation (long-term depression, LTD) of synaptic transmission efficacy, and the phosphorylation state of Ser831 and Ser845 sites, in the GluA1 subunit of the glutamate AMPA receptors, are a critical event for these synaptic neuroplasticity events. Through a quasi-randomized controlled study, we show that a single high dexamethasone dose significantly reduces in a dose-dependent manner the levels of GluA1-Ser831 phosphorylation in the amygdala resected during surgery for temporal lobe epilepsy. This is the first report demonstrating GC effects on key markers of synaptic neuroplasticity in the human limbic system. The results contribute to understanding how GC affects the human brain under physiologic and pharmacologic conditions.
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Affiliation(s)
- M W Lopes
- Department of Biochemistry, Federal University of Santa Catarina, Floranópolis, Brazil
| | - R B Leal
- Department of Biochemistry, Federal University of Santa Catarina, Floranópolis, Brazil,Center for Applied Neuroscience, Hospital Universitário, Federal University of Santa Catarina, Florianópolis, Brazil
| | - R Guarnieri
- Center for Applied Neuroscience, Hospital Universitário, Federal University of Santa Catarina, Florianópolis, Brazil,Epilepsy Center of Santa Catarina, Federal University of Santa Catarina, Florianópolis, Brazil,Neurosurgery Unit, Governador Celso Ramos Hospital, Florianópolis, Brazil
| | - M L Schwarzbold
- Center for Applied Neuroscience, Hospital Universitário, Federal University of Santa Catarina, Florianópolis, Brazil,Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, Brazil
| | - A Hoeller
- Department of Biochemistry, Federal University of Santa Catarina, Floranópolis, Brazil
| | - A P Diaz
- Center for Applied Neuroscience, Hospital Universitário, Federal University of Santa Catarina, Florianópolis, Brazil,Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, Brazil
| | - G L Boos
- Anesthesiology Division, Hospital Governador Celso Ramos, Florianópolis, Brazil
| | - K Lin
- Center for Applied Neuroscience, Hospital Universitário, Federal University of Santa Catarina, Florianópolis, Brazil,Epilepsy Center of Santa Catarina, Federal University of Santa Catarina, Florianópolis, Brazil,Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, Brazil
| | - M N Linhares
- Center for Applied Neuroscience, Hospital Universitário, Federal University of Santa Catarina, Florianópolis, Brazil,Neurosurgery Unit, Governador Celso Ramos Hospital, Florianópolis, Brazil,Department of Surgery, HU, Federal University of Santa Catarina, Florianópolis, Brazil
| | - J C Nunes
- Pathology Division, HU, Federal University of Santa Catarina, Florianópolis, Brazil
| | - J Quevedo
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA,Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA,Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
| | - Z A Bortolotto
- Laboratory of Neurosciences, Graduate Program in Health Sciences, University of Southern Santa Catarina, Criciúma, Brazil,Centre for Synaptic Plasticity, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - H J Markowitsch
- Physiological Psychology, University of Bielefeld, Bielefeld, Germany
| | - S L Lightman
- Centre for Synaptic Plasticity, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK,Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, School of Clinical Sciences, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK
| | - R Walz
- Center for Applied Neuroscience, Hospital Universitário, Federal University of Santa Catarina, Florianópolis, Brazil,Epilepsy Center of Santa Catarina, Federal University of Santa Catarina, Florianópolis, Brazil,Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, Brazil,Departamento de Clínica Médica, 3 andar, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis CEP 88.040-970, Brazil. E-mail:
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25
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Using Hospital Anxiety and Depression Scale (HADS) on patients with epilepsy: Confirmatory factor analysis and Rasch models. Seizure 2016; 45:42-46. [PMID: 27915110 DOI: 10.1016/j.seizure.2016.11.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 10/24/2016] [Accepted: 11/24/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The problems of mood disorders are critical in people with epilepsy. Therefore, there is a need to validate a useful tool for the population. The Hospital Anxiety and Depression Scale (HADS) has been used on the population, and showed that it is a satisfactory screening tool. However, more evidence on its construct validity is needed. METHOD A total of 1041 people with epilepsy were recruited in this study, and each completed the HADS. Confirmatory factor analysis (CFA) and Rasch analysis were used to understand the construct validity of the HADS. In addition, internal consistency was tested using Cronbachs' α, person separation reliability, and item separation reliability. Ordering of the response descriptors and the differential item functioning (DIF) were examined using the Rasch models. RESULTS The HADS showed that 55.3% of our participants had anxiety; 56.0% had depression based on its cutoffs. CFA and Rasch analyses both showed the satisfactory construct validity of the HADS; the internal consistency was also acceptable (α=0.82 in anxiety and 0.79 in depression; person separation reliability=0.82 in anxiety and 0.73 in depression; item separation reliability=0.98 in anxiety and 0.91 in depression). The difficulties of the four-point Likert scale used in the HADS were monotonically increased, which indicates no disordering response categories. No DIF items across male and female patients and across types of epilepsy were displayed in the HADS. CONCLUSIONS The HADS has promising psychometric properties on construct validity in people with epilepsy. Moreover, the additive item score is supported for calculating the cutoff.
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26
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Grewe P, Nikstat A, Koch O, Koch-Stoecker S, Bien C. Subjective memory complaints in patients with epilepsy: The role of depression, psychological distress, and attentional functions. Epilepsy Res 2016; 127:78-86. [DOI: 10.1016/j.eplepsyres.2016.08.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 06/21/2016] [Accepted: 08/17/2016] [Indexed: 01/28/2023]
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Wiglusz MS, Landowski J, Michalak L, Cubała WJ. Validation of the Polish Version of the Hamilton Rating Scale for Depression in patients with epilepsy. Epilepsy Behav 2016; 62:81-4. [PMID: 27450310 DOI: 10.1016/j.yebeh.2016.06.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/19/2016] [Accepted: 06/23/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Depressive disorders are the most common comorbidities among patients with epilepsy (PWE). The availability of standardized clinical instruments for PWE is limited with scarce validation studies available so far. The aim of the study was to validate the Polish Version of the Hamilton Rating Scale for Depression (HRSD) in adult PWE. METHODS A group of 96 outpatient PWE were examined by a trained psychiatrist using the Structured Clinical Interview (SCID-I) for DSM-IV-TR and the 17-item Polish Version of HRSD (HRSD-17). Receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores. RESULTS The ROC analyses showed areas under the curve approximately 0.9. For diagnoses of MDD, HRSD-17 demonstrated the best psychometric properties for a cutoff score of 11 with sensitivity of 100%, specificity of 89.3%, positive predictive value of 72.4%, and negative predictive value of 100%. CONCLUSIONS The 17-item Polish Version of HRSD proved to be reliable and valid in the epilepsy setting with a cutoff score of 11 points.
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Affiliation(s)
| | - Jerzy Landowski
- Department of Psychiatry, Medical University of Gdańsk, Poland
| | - Lidia Michalak
- Regional Epilepsy Outpatient Unit, Copernicus Hospital, Gdańsk, Poland
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28
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Tao K, Wang X. The comorbidity of epilepsy and depression: diagnosis and treatment. Expert Rev Neurother 2016; 16:1321-1333. [PMID: 27327645 DOI: 10.1080/14737175.2016.1204233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Kaiyan Tao
- Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuefeng Wang
- Chongqing Key Laboratory of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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29
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Validation of the Hospital Anxiety and Depression Scale in patients with epilepsy. Epilepsy Behav 2016; 58:97-101. [PMID: 27064829 DOI: 10.1016/j.yebeh.2016.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/25/2016] [Accepted: 03/04/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Despite the fact that depressive disorders are the most common comorbidities among patients with epilepsy (PWEs), they often go unrecognized and untreated. The availability of validated screening instruments to detect depression in PWEs is limited. The aim of the present study was to validate the Hospital Anxiety and Depression Scale (HADS) in adult PWEs. METHODS A consecutive group of 118 outpatient PWEs was invited to participate in the study. Ninety-six patients met inclusion criteria, completed HADS, and were examined by a trained psychiatrist using Structured Clinical Interview (SCID-I) for DSM-IV-TR. Receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores for the HADS depression subscale (HADS-D). RESULTS Receiver operating characteristic analyses showed areas under the curve at approximately 84%. For diagnoses of MDD, the HADS-D demonstrated the best psychometric properties for a cutoff score ≥7 with sensitivity of 90.5%, specificity of 70.7%, positive predictive value of 46.3%, and negative predictive value of 96.4%. In the case of the group with 'any depressive disorder', the HADS-D optimum cutoff score was ≥6 with sensitivity of 82.5%, specificity of 73.2%, positive predictive value of 68.8%, and negative predictive value of 85.4%. CONCLUSIONS The HADS-D proved to be a valid and reliable psychometric instrument in terms of screening for depressive disorders in PWEs. In the epilepsy setting, HADS-D maintains adequate sensitivity, acceptable specificity, and high NPV but low PPV for diagnosing MDD with an optimum cutoff score ≥7.
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