Prevalence and risk factors for depression and anxiety in adult patients with epilepsy: Caregivers' anxiety and place of residence do mater

Hypothalamic-Pituitary-Adrenal Axis Dysfunction Elevates SUDEP Risk in a Sex-Specific Manner

Epilepsy is often comorbid with psychiatric illnesses, including anxiety and depression. Despite the high incidence of psychiatric comorbidities in people with epilepsy, few studies address the underlying mechanisms. Stress can trigger epilepsy and depression. Evidence from human and animal studies supports that hypothalamic-pituitary-adrenal (HPA) axis dysfunction may contribute to both disorders and their comorbidity ( Kanner, 2003). Here, we investigate if HPA axis dysfunction may influence epilepsy outcomes and psychiatric comorbidities. We generated a novel mouse model (Kcc2/Crh KO mice) lacking the K+/Cl- cotransporter, KCC2, in corticotropin-releasing hormone (CRH) neurons, which exhibit stress- and seizure-induced HPA axis hyperactivation ( Melon et al., 2018). We used the Kcc2/Crh KO mice to examine the impact on epilepsy outcomes, including seizure frequency/burden, comorbid behavioral deficits, and sudden unexpected death in epilepsy (SUDEP) risk. We found sex differences in HPA axis dysfunction's effect on chronically epileptic KCC2/Crh KO mice seizure burden, vulnerability to comorbid behavioral deficits, and SUDEP. Suppressing HPA axis hyperexcitability in this model using pharmacological or chemogenetic approaches decreased SUDEP incidence, suggesting that HPA axis dysfunction may contribute to SUDEP. Altered neuroendocrine markers were present in SUDEP cases compared with people with epilepsy or individuals without epilepsy. Together, these findings implicate HPA axis dysfunction in the pathophysiological mechanisms contributing to psychiatric comorbidities in epilepsy and SUDEP.

Factors Associated With Anxiety and Depression in Persons With Epilepsy (PWE)

INTRODUCTION

Epilepsy is a common neurological disease that is associated with increased morbidity and mortality globally. Persons with epilepsy (PWE) experience a heavy emotional burden mainly due to social stigmatization and limited opportunities in life. The purpose of this study was to explore factors associated with anxiety and depression in PWE.

MATERIAL AND METHODS

In the present cross-sectional study, we enrolled 100 PWE who visited outpatient settings in a public hospital for scheduled follow-up. Data collection was carried out by the completion of the Hospital Anxiety and Depression Scale (HADS), which included participants' characteristics. The statistical significance level was p < 0.05.

RESULTS

Of the 100 participants, the majority were women (65%), below 50 years old (62%), and single (40%). In terms of mental comorbidity, 58% and 48% experienced anxiety and depression, respectively. A statistically significant association was observed between anxiety and age (p = 0.002). Furthermore, a statistically significant association was observed between depression and gender (p = 0.044), age (p = 0.001), marital status (p = 0.036), educational level (p = 0.003), job (p = 0.025), residency (p = 0.041), and whether they went out at night (p = 0.009).

CONCLUSION

Identifying factors associated with anxiety and depression is essential for PWE to receive appropriate support.

A model for the diagnosis of anxiety in patients with epilepsy based on phase locking value and Lempel-Ziv complexity features of the electroencephalogram

OBJECTIVE

Anxiety disorders (AD) are critical factors that significantly (about one-fifth) impact the quality of life (QoL) in patients with epilepsy (PWE). Objective diagnostic methods have contributed to the identification of PWE susceptible to AD. This study aimed to identify AD in PWE by constructing a diagnostic model based on the phase locking value (PLV) and Lempel-Ziv Complexity (LZC) features of the electroencephalogram (EEG).

METHODS

EEG data from 131 patients with epilepsy (PWE) were enrolled in this study. Patients were divided into two groups, anxiety disorder (AD, n = 61) and non-anxiety disorder (NAD, n = 70), according to the Hamilton Rating Scale for Anxiety (HAM-A). Support vector machine (SVM) and K-Nearest-Neighbor(KNN) algorithms were used to construct three models - the PLVEEG, LZCEEG, and PLVEEG + LZCEEG feature models. Finally, the area under the receiver operating characteristic curve (AUC) and statistical analyses were performed to evaluate the model performance.

RESULTS

The efficiency of the KNN-based PLCEEG + LZCEEG feature model was the best, and the accuracy, precision, recall, F1-score, and AUC of the model after five-fold cross-validations scores were 87.89 %, 82.27 %, 98.33 %, 88.95 %, and 0.89, respectively. When the model efficiency was optimal, 29 EEG features were suggested. Further analysis of these features indicated 22 EEG features that were significantly different between the two groups, including 50 % features of the alpha (α)-band.

CONCLUSIONS

The PLVEEG + LZCEEG model features can identify AD in PWE. The PLVEEG and LZCEEG characteristics of the α-band may further be explored as potential biomarkers for AD in PWE.

Risk analysis of depression among adult patients with epilepsy of different sex: a retrospective single-center study from China

Objective

To determine sex differences in the prevalence of depression and assess the risk factors for depression among adult patients with epilepsy from the Dali area of China.

Methods

We retrospectively analyzed the clinical data of adult patients with epilepsy who visited the First Affiliated Hospital of Dali University from January 2017 to January 2022. Patient Health Questionnaire-9 was used to assess depressive symptoms in patients with epilepsy. The risk factors of depression were analyzed by binary logistic regression among different sex in patients with epilepsy.

Results

There were significant sex differences in depression in patients with epilepsy (p < 0.001), and females were 4.27 times more likely to suffer from depression than males (95% confidence interval: 3.70-4.92). The risk factors for depression among female patients with epilepsy included occupation (p < 0.001), years with epilepsy (p < 0.001), seizure frequency (p < 0.001), seizure type (p < 0.001), etiology (p < 0.001), number of antiseizure medications used (p < 0.001), antiseizure medications (p < 0.001), and electroencephalogram findings (p < 0.001). The risk factors for depression among male patients with epilepsy included age (p < 0.001), ethnicity (p < 0.001), occupation (p < 0.001), years with epilepsy (p < 0.001), seizure frequency (p < 0.001), seizure type (p < 0.001), etiology (p < 0.001), number of antiseizure medications used (p < 0.001), antiseizure medications (p < 0.001), and electroencephalogram findings (p < 0.001).

Conclusion

Adult female patients with epilepsy had a higher risk of depression than adult male patients with epilepsy. There were sex differences in the risk factors associated with depression among patients with epilepsy.

Analysis and hierarchical clustering of infratentorial morphological MRI identifies SCAs phenogroups

BACKGROUND

Clinical decision-making in spinocerebellar ataxia spectrum diseases (SCAs) has mainly been based on genetic tests, not considering the SCAs' imaging and clinical heterogenicity.

OBJECTIVE

To identify SCAs phenogroups by analysis and hierarchical clustering of infratentorial morphological MRI for unveiling pathophysiological differences among common SCA subtypes.

METHODS

We prospectively enrolled 119 (62 women; mean age 37 years) genetically diagnosed SCAs (SCA1 n = 21, SCA2 n = 10, symptomatic SCA3 n = 59, presymptomatic SCA3 n = 22, SCA6 n = 7) and 35 healthy controls (HCs). All patients underwent MRI and detailed neurological and neuropsychology examinations. The width of each cerebellar peduncle (CP) and anteroposterior diameter of the spinal cord and pontine were measured. Twenty-five SCAs patients (15 women; mean age 35 years) were followed for at least a year (17 (15, 24) months), whose MRI and the Scale for the Assessment and Rating of Ataxia (SARA) were collected.

RESULTS

Infratentorial morphological MRI measurements could significantly discriminate SCAs from HCs, even among SCA subtypes. Two mutually exclusive and clinically distinct phenogroups were identified. Despite similar (CAG)n, phenogroup 1 (n = 66, 55.5%) presented more atrophied infratentorial brain structures and more severe clinical symptoms with older age and earlier age of onset when compared with phenogroup 2. More importantly, all SCA2, most of SCA1 (76%), and symptomatic SCA3 (68%) were classified into phenogroup 1, whereas all SCA6 and all presymptomatic SCA3 were in phenogroup 2. The right middle CP had the highest diagnostic value in predicting phenogroup 2 (AUC = 0.99; P < 0.01) with high specificity (95%). Consistent with the significantly increased SARA (7.5 vs 10, P = 0.021), the bilateral inferior CP, spinal cord, and pontine tegmentum were more atrophy during the follow-up (P < 0.05).

CONCLUSION

SCAs were with significant infratentorial brain atrophy than HCs. We identified two different SCAs phenogroups associated with substantial differences in infratentorial brain atrophy, clinical presentation, and may reflect the underlying molecular profiles to some extent, paving the way for a more personalized diagnostic and treatment approach.

Epilepsy risk awareness and background factors in patients with epilepsy and family caregivers

OBJECTIVES

Patients with epilepsy are at risk of various injuries throughout their lives. Awareness of patients and family caregivers about risk factors and self-care prevents potential injuries. This study aimed to investigate epilepsy risk awareness and background factors in patients with epilepsy and family caregivers.

METHODS

This descriptive study was conducted with the recruitment of 120 patients with epilepsy and 120 family caregivers who were referred to the Neurological Clinic of Tabriz Razi Hospital in Iran. Data was collected using Persian version of the epilepsy risk awareness questionnaires for patients (3rd Edition) and family caregivers.

RESULTS

The average age of the patients (65.8% women) was 29.2 and of the family caregivers (58.3% women) 41.5 years. The average score of risk awareness in family caregivers was 82.6 ± 8.8 and higher than that in patients with epilepsy 84.9 ± 8.5 (obtainable score: 0-120). Compared to the maximum score, the average scores of both groups in all domains including epilepsy, personal security, physical health, and mental health were low. A statistically significant relationship was observed between the mean scores of risk awareness and some background variables.

CONCLUSION

The results showed that epilepsy risk awareness in patients and family caregivers is low and there is a need for education and support. By developing education programs for the patient and their family and increasing epilepsy risk awareness, patients can be protected from potential risks and their safety and quality of life can be improved.

Effects of progressive muscle relaxation exercises on patients with epilepsy on level of depression, quality of sleep, and quality of life: A randomized controlled trial

OBJECTIVE

This study aims to evaluate the effects of progressive relaxation exercises applied to patients with epilepsy on patients' depressive symptom severity, quality of sleep, and quality of life.

METHODS

The study was designed as a randomized controlled interventional study with a control group and pre-and post-test intervention. It was conducted with 70 patients with epilepsy, 35 in the intervention group and 35 in the control group, between November 1, 2021, and April 15, 2022. The patients in the intervention group were required to perform 12 progressive muscle relaxation exercise sessions 3 days a week for a total of 4 weeks. No interventions were made in the control group during the study. The data were collected with a "Personal Information Form," "Pittsburgh Sleep Quality Index (PSQI)," "Beck Depression Inventory (BDI)," and "Quality of Life in Epilepsy Inventory (QUOLIE -31)."

RESULTS

The mean PSQI total score, subscale scores, and mean BDI total scores of the patients in the intervention group decreased significantly compared to those in the control group after the intervention (p<0.05). Additionally, a significant difference was found between the mean QUOLIE-31 total scores and subscale scores of the patients in the intervention and control group after the intervention (p<0.05), the mean scores of the intervention group were significantly higher than those of the control group (p<0.05).

CONCLUSION

Progressive muscle relaxation exercises decreased depressive symptoms severity and improved sleep and life quality in patients with epilepsy. Progressive relaxation exercises may be recommended as a complementary nursing intervention in treating epilepsy.

Difficulties in emotion and social support in people with epilepsy: relationship with depression levels

Amaç: Bu çalışmada epilepsili bireylerde depresyon düzeyi ile duygu düzenleme güçlükleri ve sosyal destek arasındaki ilişkiyi incelemeyi amaçladık. Gereç ve Yöntem: Fokal epilepsi tanısı ile takip edilmekte olan hastalara Nörolojik Bozukluklarda Depresyon Ölçeği-Epilepsi (NDDI-E), Duygu Düzenleme Güçlükleri Ölçeği (DDGÖ) ve İki Yönlü Sosyal Destek Ölçeği (2-YSDÖ) verilmiştir. Bulgular: Çalışmaya 109 hasta dahil edilmiştir. Hastaların %25’inde depresyon saptanmıştır. Depresyonu olan olguların DDGÖ median değeri 45 (28-55), depresyon saptanmayan grubun ise 24 (18-33,5)’dür. Depresyonu olan grubun DDGÖ skorunun depresyonu olmayan gruba kıyasla anlamlı derecede yüksek olduğu tespit edilmiştir. Tüm çalışma popülasyonunda yapılan 2-YSDÖ (92 (69,5-102,5)) ve DDGÖ (27 (19-41)) skorlarının korelasyon analizinde sosyal destek ve duygu düzenleme güçlükleri arasında negatif bir ilişki mevcuttur. Regresyon analizine göre ise duygu düzenleme güçlükleri depresyonun ana belirleyicisidir ve depresyonu %16,8 oranında açıklamaktadır. Sonuç: Epilepsili bireylerde duygu düzenleme güçlükleri depresyonun ana belirleyicilerinden biridir ve yetersiz sosyal destek duygu düzenleme güçlükleri ile ilişkilidir. Epilepsili bireylerde depresyon sıklığını azaltmak için duygu düzenleme stratejilerini güçlendirecek rehabilitasyon programlarına ihtiyaç vardır.

Family Caregiving during the COVID-19 Pandemic in Canada: A Mediation Analysis

Family caregiving is a public health issue because of caregivers' significant contribution to the health and social care systems, as well as the substantial impact that giving and receiving care has on the health and quality of life of care receivers and caregivers. While there have been many studies that associate caregivers' care work, financial difficulty, navigation, and other caregiving factors with family caregivers' psychological distress, we were interested not only in the factors related to family caregiver anxiety but also in hypothesizing how those effects occur. In this study, we used Andrew Hayes' PROCESS moderation analysis to explore the link between caregiver frailty, weekly care hours, and perceptions of financial difficulty, social support, and anxiety. In this analysis, we included 474 caregivers with relatively complete data on all of the variables. In regression analysis after controlling for gender and age, social loneliness (β = 0.245), frailty (β = 0.199), financial difficulty (β = 0.196), care time (β = 0.143), and navigation confidence (β = 0.131) were all significant. We then used PROCESS Model 6 to determine the significance of the direct, indirect, and total effects through the serial mediation model. The model pathway from frailty to care time to financial difficulty to social loneliness to anxiety was significant. The proportions of family caregivers who were moderately frail, anxious, and experiencing social loneliness after eighteen months of the COVID-19 pandemic found in this survey should be of concern to policymakers and healthcare providers.