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Jeschke S, Charisius M, Lange S, Bertsche T, Makiello P, Neininger MP, Bertsche A. How do children with focal epilepsies perceive the moment they realize that they are about to have a seizure? A pilot study. Epilepsy Behav 2024; 152:109663. [PMID: 38306740 DOI: 10.1016/j.yebeh.2024.109663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/04/2024]
Abstract
PROBLEM A seizure is a challenging situation for children with epilepsy. Little is known regarding the experience of children who perceive in advance that they are about to have a seizure. METHODS From September 2020 to February 2021, we invited children with focal epilepsies aged 6-18 years to participate in a semi-structured interview. RESULTS Of 52 children with focal epilepsies, 22 (42 %) said they perceive in advance that they are about to experience a seizure [11 with self-limited epilepsy with centro-temporal spikes (SELECTs), 11 with other focal epilepsies]. All 22/22 (100 %) children described physical symptoms such as headache or a numb feeling in one half of the body. Of those children, 17/22 (77 %) stated they try to do something about the seizure. Those strategies were perceived as helpful by 0/11 (0 %) children with SELECTs and 9/11 (86 %) children with other focal epilepsies (p < 0.001). Of the children with SELECTs 5/11 (45 %), and of those with other focal epilepsies 9/11 (86 %) stated they would like to know in the morning if they are to experience a seizure that day (n.s.). CONCLUSION Children who perceive in advance that they are about to have a seizure are well able to describe their experience. Most children take measures to manage their seizures. Those measures were regarded as helpful by most children with other focal epilepsies, but by no child with SELECTs. Larger studies are necessary to determine the factors contributing to the child's perception as well as the nature of the support that they require.
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Affiliation(s)
- Sarah Jeschke
- University Medicine Rostock, Hospital for Children and Adolescents, Department of Neuropaediatrics, Rostock, Germany; University Medicine Greifswald, Hospital for Children and Adolescents, Department of Neuropaediatrics, Greifswald, Germany.
| | - Mathilda Charisius
- University Medicine Rostock, Hospital for Children and Adolescents, Department of Neuropaediatrics, Rostock, Germany; University Medicine Greifswald, Hospital for Children and Adolescents, Department of Neuropaediatrics, Greifswald, Germany.
| | - Sarah Lange
- University Medicine Rostock, Hospital for Children and Adolescents, Department of Neuropaediatrics, Rostock, Germany; University Medicine Greifswald, Hospital for Children and Adolescents, Department of Neuropaediatrics, Greifswald, Germany.
| | - Thilo Bertsche
- Leipzig University, Medical Faculty, Institute of Pharmacy, Clinical Pharmacy, and Leipzig University and University Hospital, Drug Safety Center, Leipzig, Germany.
| | - Phoebe Makiello
- University Medicine Greifswald, Hospital for Children and Adolescents, Department of Neuropaediatrics, Greifswald, Germany.
| | - Martina P Neininger
- Leipzig University, Medical Faculty, Institute of Pharmacy, Clinical Pharmacy, and Leipzig University and University Hospital, Drug Safety Center, Leipzig, Germany.
| | - Astrid Bertsche
- University Medicine Rostock, Hospital for Children and Adolescents, Department of Neuropaediatrics, Rostock, Germany; University Medicine Greifswald, Hospital for Children and Adolescents, Department of Neuropaediatrics, Greifswald, Germany.
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Nakamura H, Sugihara G, Hara K, Inaji M, Noha M, Takumi I, Watanabe M, Takahashi H, Maehara T, Yamamoto H, Takagi S. Seizure-related stress and arousal responses mediate a relationship between anxiety trait and state in epilepsy. Epilepsy Behav 2023; 147:109442. [PMID: 37716325 DOI: 10.1016/j.yebeh.2023.109442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Epilepsy causes substantial psychological distress and anxiety, primarily due to seizures. However, the impact of stress responses and changes in arousal and their association with anxiety patterns in patients with epilepsy (PWE) remains unclear. This study aimed to investigate the relationships among seizures, stress and arousal characteristics, and trait and state anxiety characteristics in PWE. METHODS Our sample consisted of 159 outpatients with epilepsy recruited from five institutions in Japan in 2020. Participants completed the State-Trait Anxiety Inventory-Form JYZ (STAI) and the Japanese-Stress Arousal Check List (J-SACL). We analyzed the correlations between inventory scores and clinical information. Using principal component analysis (PCA), we derived epilepsy-specific stress/arousal characteristics, which accounted for high arousal and low-stress levels, termed epilepsy-specific stress or arousal response (ESAR), from the J-SACL scores. We conducted a mediation analysis to assess the mediating role of ESAR in the relationship between traits and state anxiety. RESULTS We found significant correlations between J-SACL stress and arousal factors (r = -0.845, p < 0.001), ESAR and seizure frequency (r = -0.29, p < 0.001), ESAR and trait anxiety scores on the STAI (r = -0.77, p < 0.0001), and ESAR and state anxiety scores on the STAI (r = -0.60, p < 0.0001). Mediation analysis supported by the Monte Carlo method revealed that ESAR significantly mediated the association between trait and state anxiety. CONCLUSIONS These findings elucidate the epilepsy-specific stress and arousal characteristics and their roles in mediating traits and state anxiety. These results may reflect the long-term clinical course and unique emotion recognition tendencies in epilepsy.
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Affiliation(s)
- Hironobu Nakamura
- Department of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, Tokyo, Japan; Hara Clinic, Kanagawa, Japan
| | - Genichi Sugihara
- Department of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Keiko Hara
- Hara Clinic, Kanagawa, Japan; Department of Respiratory and Nervous System Science, Biomedical Laboratory Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Noha
- Department of Neurosurgery, Okinawa Red Cross Hospital, Okinawa, Japan
| | - Ichiro Takumi
- Department of Neurosurgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Hidehiko Takahashi
- Department of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, Tokyo, Japan; Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hitoshi Yamamoto
- Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shunsuke Takagi
- Department of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University Graduate School, Tokyo, Japan; Sleep Research Institute, Waseda University, 513 Waseda-Tsurumakicho, Shinjuku, Tokyo 162-0041 Japan.
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Bauer PR, Bronnec MLA, Schulze-Bonhage A, Altenmüller DM, Fuchs T. Seizures as a Struggle between Life and Death: An Existential Approach to the Psychosocial Impact of Seizures in Candidates for Epilepsy Surgery. Psychopathology 2023; 56:417-429. [PMID: 36927809 DOI: 10.1159/000528924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/28/2022] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Mental health comorbidities such as depression and anxiety are common in epilepsy, especially among people with pharmacoresistant epilepsy who are candidates for epilepsy surgery. The Psychology Task Force of the International League Against Epilepsy advised that psychological interventions should be integrated into comprehensive epilepsy care. METHODS To better understand the psychological impact of epilepsy and epileptic seizures in epilepsy surgery candidates, we analysed interviews with this subgroup of patients using Karl Jaspers' concept of limit situations, which are characterised by a confrontation with the limits and challenges of life. These are especially chance, randomness, and unpredictability, death and finitude of life, struggle and self-assertion, guilt, failure, and falling short of one's aspirations. RESULTS In 43 interviews conducted with 15 people with drug-resistant epilepsy who were candidates for epilepsy surgery, we found that these themes are recurrent and have a large psychosocial impact, which can result in depression and anxiety. For some people, epileptic seizures appear to meet the criteria for traumatic events. CONCLUSION Understanding epilepsy and seizures as existential challenges complements the neurobiological explanations for psychological comorbidities and can help tailor psychological interventions to the specific needs of people with epilepsy, especially those who are candidates for surgical treatment.
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Affiliation(s)
- Prisca R Bauer
- Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Marie L A Bronnec
- Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Dirk-Matthias Altenmüller
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Thomas Fuchs
- Phenomenological Psychopathology and Psychotherapy, Psychiatric Clinic, Heidelberg University, Heidelberg, Germany
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Jayalakshmi S, Telugu R, Vooturi S, Patil A, Sirisha S, Somayajula S. Anxiety, depression, and psychosocial adjustment in people with epilepsy. J Neurosci Rural Pract 2023; 14:111-118. [PMID: 36891095 PMCID: PMC9945281 DOI: 10.25259/jnrp-2022-6-40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/09/2022] [Indexed: 01/28/2023] Open
Abstract
Objective Effect of psychological disorders on social functioning in people with epilepsy (PWE) is not extensively reported. We evaluate psychosocial functioning in PWE attending an outpatient clinic and aim to understand the differences in psychosocial functioning between anxiety, depression, and coexisting anxiety and depression in PWE. Materials and Methods A prospective evaluation of psychosocial functioning of 324 consecutive adult PWE attending outpatient epilepsy clinic was done using self-reported Washington Psychosocial Seizure Inventory. The study population was divided in four groups - without psychological disorders, anxiety, depression, and both anxiety and depression. Results The mean age of study population was 25.90 ± 6.22 years. Anxiety was noted in 73 (22.5%), depression in 60 (18.5%), and both anxiety and depression were seen in 70 (21.6%) and the rest had normal psychosocial function. There were no significant differences across all the four sub-groups for sociodemographics. Psychosocial functioning did not differ significantly between PWE with normal psychosocial function and PWE with anxiety alone. However, psychosocial functioning scores were worse in PWE with depression and PWE with both anxiety and depression when compared to PWE with normal psychosocial function. Conclusion In the present study of PWE attending an outpatient epilepsy clinic, one-fifth of PWE had both anxiety and depression. Psychosocial functioning in PWE with anxiety was similar to otherwise healthy/normal PWE, whereas PWE with depression showed poor psychosocial functioning. Role of psychological interventions on psychosocial aspects of epilepsy should be studied extensively in future.
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Affiliation(s)
- Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Ramakrishna Telugu
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Sudhindra Vooturi
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Anuja Patil
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Sai Sirisha
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Shanmukhi Somayajula
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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Lee SA, Im K, Choi EJ. Felt stigma may potentiate the relationship between perceived stress and depressive symptoms in persons with epilepsy. Epilepsy Behav 2022; 134:108765. [PMID: 35908417 DOI: 10.1016/j.yebeh.2022.108765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study assessed the strengths of association among perceived stress, felt stigma, and depression in adults with epilepsy, and evaluated whether felt stigma altered the association between perceived stress and depression. METHODS This multicenter, cross-sectional study included adults with epilepsy. Depression was assessed using the Beck Depression Inventory (BDI), and perceived stress was evaluated using the 10-item Perceived Stress Scale. Felt stigma was determined using the three-item Stigma Scale for Epilepsy, with individuals categorized as positive for felt stigma if they answered "yes" to at least one of these items. A hierarchical linear regression analysis and an analysis of covariance with interaction terms were performed. RESULTS The 316 adults with epilepsy included 171 men and 145 women; of these, 109 (34.5%) reported felt stigma. A hierarchical linear regression analysis showed that perceived stress was the most important correlate of depressive symptoms, followed by felt stigma, being unemployed, recurrence of generalized or focal to bilateral tonic-clonic seizures, and being married. The model explained 54.0% of the variance of BDI scores. Significant interactions between felt stigma and perceived stress on BDI scores was identified in both crude and adjusted models (p < 0.05 each). Specifically, in an adjusted model, BDI scores were more strongly associated with perceived stress in persons with (p < 0.001, partial eta2 = 0.225) than without (p < 0.001, partial eta2 = 0.205) felt stigma. CONCLUSIONS Perceived stress was the most significant correlate of depressive symptoms in adults with epilepsy, followed by felt stigma. The interaction between perceived stress and felt stigma on depressive symptoms was significant. These findings may help in developing cognitive behavioral therapy for stigma and stress management in persons with epilepsy.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Kayeong Im
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Choi
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Early life adversity accelerates epileptogenesis and enhances depression-like behaviors in rats. Exp Neurol 2022; 354:114088. [DOI: 10.1016/j.expneurol.2022.114088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/29/2022] [Accepted: 04/15/2022] [Indexed: 11/24/2022]
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Tao G, Auvrez C, Nightscales R, Barnard S, McCartney L, Malpas CB, Perucca P, Chen Z, Adams S, McIntosh A, Ignatiadis S, O'Brien P, Cook MJ, Kwan P, Berkovic SF, D'Souza W, Velakoulis D, O'Brien TJ. Association Between Psychiatric Comorbidities and Mortality in Epilepsy. Neurol Clin Pract 2021; 11:429-437. [PMID: 34824893 PMCID: PMC8610550 DOI: 10.1212/cpj.0000000000001114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/07/2021] [Indexed: 01/26/2023]
Abstract
Objective To explore the impact of psychiatric comorbidities on all-cause mortality in adults with epilepsy from a cohort of patients admitted for video-EEG monitoring (VEM) over 2 decades. Methods A retrospective medical record audit was conducted on 2,709 adults admitted for VEM and diagnosed with epilepsy at 3 Victorian comprehensive epilepsy programs from 1995 to 2015. A total of 1,805 patients were identified in whom the record of a clinical evaluation by a neuropsychiatrist was available, excluding 27 patients who died of a malignant brain tumor known at the time of VEM admission. Epilepsy and lifetime psychiatric diagnoses were determined from consensus opinion of epileptologists and neuropsychiatrists involved in the care of each patient. Mortality and cause of death were determined by linkage to the Australian National Death Index and National Coronial Information System. Results Compared with the general population, mortality was higher in people with epilepsy (PWE) with a psychiatric illness (standardized mortality ratio [SMR] 3.6) and without a psychiatric illness (SMR 2.5). PWE with a psychiatric illness had greater mortality compared with PWE without (hazard ratio 1.41, 95% confidence interval 1.02-1.97) after adjusting for age and sex. No single psychiatric disorder by itself conferred increased mortality in PWE. The distribution of causes of death remained similar between PWE with psychiatric comorbidities and those without. Conclusion The presence of comorbid psychiatric disorders in adults with epilepsy is associated with increased mortality, highlighting the importance of identifying and treating psychiatric comorbidities in these patients.
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Affiliation(s)
- Gerard Tao
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Clarissa Auvrez
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Russell Nightscales
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Sarah Barnard
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Lara McCartney
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Charles B Malpas
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Piero Perucca
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Zhibin Chen
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Sophia Adams
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Anne McIntosh
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Sophia Ignatiadis
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Patrick O'Brien
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Mark J Cook
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Patrick Kwan
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Samuel F Berkovic
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Wendyl D'Souza
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Dennis Velakoulis
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
| | - Terence J O'Brien
- Departments of Medicine and Neurology (GT, CA, RN, CBM, PP, ZC, AM, PK, TJO), The Royal Melbourne Hospital, The University of Melbourne; Department of Neuroscience (RN, SB, CBM, PP, ZC, AM, PK, TJO), The Alfred Hospital, Monash University Central Clinical School, Melbourne; Melbourne Neuropsychiatry Centre (LM, SA, DV), Department of Psychiatry, The Royal Melbourne Hospital, The University of Melbourne; Departments of Medicine and Neurology (SI, POB, MJC, WDS), St. Vincent's Hospital Melbourne, The University of Melbourne; and Department of Medicine (Neurology) (SFB), The University of Melbourne (Austin Health), Victoria, Australia
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Agarwal S, Vyas P, Nirwan N, Vohora D. Effect of lacosamide on neuroinflammation-mediated seizures comorbid with depression in C57BL/6 mice- Role of kynurenine pathway. Epilepsy Behav 2021; 123:108262. [PMID: 34425328 DOI: 10.1016/j.yebeh.2021.108262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
Comorbid conditions in persons with epilepsy (PWE) are very common with depression being highly prevalent. Lacosamide (LCM) is used to treat patients with seizures, but the underlying pathways associating the seizures and comorbid depression are still unknown. Kynurenine pathway (KP) has a major role in seizures, inflammation as well as depression, considering which we evaluated the effect of LCM on kynurenine levels in murine model of neuroinflammation-mediated seizures. We then evaluated the effects on the depressive symptoms associated with seizures. Lipopolysaccharide (LPS) primed pilocarpine (PILO) is an established model for neuro-inflammation-mediated seizures. The anti-seizure and anti-depressive effects of 21 days of LCM administration were studied in this model. After 24 h of seizure termination, behavioral parameters viz. forced swimming test and sucrose preference test were performed to study its antidepressant effect. Biochemical estimations of levels of kynurenine, inflammatory cytokines, and oxidative markers were also evaluated. Lacosamide significantly reduced hippocampal kynurenine levels in LPS and LPS + PILO groups but did not show significant reduction in the PILO alone group. Levels of inflammatory cytokines and oxidative stress markers were also reduced significantly. Lacosamide has shown positive effects against neuroinflammation-mediated model of seizures comorbid with depression by reducing hippocampal kynurenine levels. No reduction in the PILO group is suggestive of the principal contribution of its anti-inflammatory and antioxidant activity in its anti-seizure potential in this model via KP.
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Affiliation(s)
- Shivani Agarwal
- Neurobehavioral Pharmacology Laboratory, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Preeti Vyas
- Neurobehavioral Pharmacology Laboratory, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Nikita Nirwan
- Neurobehavioral Pharmacology Laboratory, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Divya Vohora
- Neurobehavioral Pharmacology Laboratory, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
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9
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Cahill PT, Ferro MA, Campbell WN, Ronen GM. Self-esteem mediates mental health outcomes in young people with epilepsy. Epilepsia 2021; 62:2072-2081. [PMID: 34275131 DOI: 10.1111/epi.17006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the extent to which self-esteem mediates the impacts of epilepsy-specific and environmental factors on mental health outcomes in young people with epilepsy. METHODS A prospective cohort of 480 young people with epilepsy and their families participated in five visits over 28 months. We collected data on clinical seizure burden, cognitive comorbidity, peer and parental support, self-esteem, and self-reported mental health symptoms. We used structural equation modeling to specify and test relationships among these constructs simultaneously. Direct, indirect, and total effects were estimated with confidence intervals constructed through bias-corrected bootstrapping. RESULTS Self-esteem mediated the effects of clinical seizure burden ( β = 0.23, 95% confidence interval [0.05, 0.42]) and peer support ( β = -0.15, 95% CI [-0.28, -0.03]) on mental health. There were no mediating effects of parental support ( β = -0.07, 95% CI [-0.14, 0.00]) or cognitive comorbidity ( β = -0.01, 95% CI [-0.02, 0.01]) on mental health. SIGNIFICANCE We found evidence that self-esteem mediates the impact that both clinical seizure burden and peer support have on mental health outcomes, indicating that assessment of and interventions targeting self-esteem may be appropriate for young people with epilepsy. Supporting self-esteem could mitigate negative influences on mental health, whether from resistant epilepsy or low peer support.
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Affiliation(s)
- Peter T Cahill
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.,CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
| | - Wenonah N Campbell
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
| | - Gabriel M Ronen
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada.,Department of Paediatrics (Neurology), McMaster University, Hamilton, ON, Canada
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10
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Gupta SK, Margolis SA, Grant AC, Gonzalez JS, Nakhutina L. Relationships among illness representations and depressive symptom severity in predominantly African-American and Caribbean-American people with epilepsy. Clin Neuropsychol 2021; 36:462-478. [PMID: 34027793 DOI: 10.1080/13854046.2021.1923802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Depression is the most common psychiatric comorbidity among people with epilepsy (PWE) and tends to be more prevalent among people of color (POC) and those with intractable seizures. However, the extent to which illness-related perceptions are associated with depressive symptom severity among POC with intractable seizures is unclear. Method: This cross-sectional study examined relationships among illness representations and self-rated depressive symptoms in 55 PWE (M Age = 41; 61.8% female) with intractable seizures (M seizures per month = 2) who identified as Black/African-American (52.7%), Black/Caribbean-American (27.3%), and/or Hispanic/Latino (21.8%). Epilepsy-related illness perceptions were assessed with the Illness Perception Questionnaire-Revised and depression was measured via the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Results: Nearly half of the sample (41.8%) scored above the NDDI-E depression cut-off. PWE endorsing more severe depressive symptoms indicated that their epilepsy had more negative consequences, was hard to comprehend, was insufficiently controlled by treatment, and had a negative emotional impact (p's ≤ 0.02). Controlling for sex, these four illness representations accounted for 48% of the variance in depression severity. Interestingly, participants with probable major depressive episodes were more likely to endorse several psychological causes of seizures compared to non-depressed PWE. Conclusions: Worse depression symptom severity was associated with negative illness perceptions and a tendency to attribute one's epilepsy to psychological causes. Future research is needed to understand how the relationship between negative illness perceptions and depression symptoms unfold over time and whether interventions aimed at modifying illness representations reduce psychological distress in diverse PWE.
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Affiliation(s)
- Sugandha K Gupta
- Graduate Center, City University of New York, Psychology, New York, NY, USA
| | - Seth A Margolis
- Alpert Medical School, Brown University, Providence, RI, USA
| | - Arthur C Grant
- Downstate Medical Center, State University of New York, New York, NY, USA
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA.,Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Luba Nakhutina
- Downstate Medical Center, State University of New York, New York, NY, USA
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11
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Singh T, Goel RK. Epilepsy Associated Depression: An Update on Current Scenario, Suggested Mechanisms, and Opportunities. Neurochem Res 2021; 46:1305-1321. [PMID: 33665775 DOI: 10.1007/s11064-021-03274-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/07/2021] [Accepted: 02/10/2021] [Indexed: 12/21/2022]
Abstract
Depression is one of the most frequent psychiatric comorbidities associated with epilepsy having a major impact on the patient's quality of life. Several screening tools are available to identify and follow up psychiatric disorders in epilepsy. Out of various psychiatric disorders, people with epilepsy (PWE) are at greater risk of developing depression. This bidirectional relationship further hinders pharmacotherapy of comorbid depression in PWE as some antiepileptic drugs (AEDs) worsen associated depression and coadministration of existing antidepressants (ADs) to alleviate comorbid depression has been reported to worsen seizures. Selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs) are first choice of ADs and are considered safe in PWE, but there are no high-quality evidences. Similar to observations in people with depression, PWE also showed pharmacoresistant to available SSRI/SNRIs, which further complicates the disease prognosis. Randomized double-blind placebo-controlled clinical trials are necessary to report efficacy and safety of available ADs in PWE. We should also move beyond ADs, and therefore, we reviewed common pathological mechanisms such as neuroinflammation, dysregulated hypothalamus pituitary adrenal (HPA) axis, altered neurogenesis, and altered tryptophan metabolism responsible for coexistent relationship of epilepsy and depression. Based on these common pertinent pathways involved in the genesis of epilepsy and depression, we suggested novel targets and therapeutic approaches for safe management of comorbid depression in epilepsy.
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Affiliation(s)
- Tanveer Singh
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, 147002, India
| | - Rajesh Kumar Goel
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, 147002, India.
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12
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Nnajekwu CO, Nnajekwu UC, Ikefuna NA, Ojinnaka CN. Mental Health of Adolescents With Epilepsy in Enugu, Nigeria: A Cross-Sectional Study. J Child Neurol 2021; 36:116-122. [PMID: 32928040 DOI: 10.1177/0883073820954060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adolescence is an important period, marked by significant changes in biological and psychosocial domains. Epilepsy is a chronic neurologic disorder associated with social stigma and prejudice. The etiology of depression in epilepsy appears to be a complex interplay between psychosocial and neurobiologic factors. This period may be too taxing for the adolescent with epilepsy to steer, as epilepsy can affect the development of independence by its social, educational, and mental health effects. The study aimed to compare the burden of depression in adolescents with epilepsy with the general population.One hundred forty-five adolescents with epilepsy and their classmates matched for age and gender were studied over a 9-month period. Zung Self-rating Depression Scale was used to determine the burden of depression in the study population.Among the subjects, 70 (48.3%) had scores in the depressive range to varying degrees compared to 38 (26.2%) controls. The difference in scores was significant (OR=2.628, P < .001). Among the population with positive scores, mild depression category was the commonest for both groups (40% and 22.8%, respectively). There was a statistically significant relationship between gender, seizure type, and depression, whereas there was no significant relationship between age, social class, number of antiepileptic drugs, seizure frequency in the last 12 months, and depression.Adolescents with epilepsy had higher rates of depression than the general population. Hence, there might be need for routine screening of adolescents with epilepsy for early detection and management of depression to improve their overall well-being and quality of life.
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Affiliation(s)
| | | | - Nnaemeka Anthony Ikefuna
- 291413University of Nigeria Teaching Hospital, Enugu, Nigeria.,College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Chinyelu Ngozi Ojinnaka
- 291413University of Nigeria Teaching Hospital, Enugu, Nigeria.,College of Medicine, University of Nigeria, Nsukka, Nigeria
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13
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Kuzman Z, Mlinarevic-Polic I, Aleric I, Katalinic D, Vcev A, Babic D. Clinical evaluation of psychiatric and behavioral disorders in adolescents with epilepsy: a cross-sectional study. Nord J Psychiatry 2020; 74:352-358. [PMID: 31961263 DOI: 10.1080/08039488.2020.1715475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Epilepsy is a neurological disease that is often associated with psychiatric comorbidities.Subjects and methods: The aim of the study was to examine the frequency of psychic symptoms and their association with different types of epilepsy in the adolescent population. The study involved 100 adolescents with epilepsy and 100 healthy adolescents of both sexes at the age of 13-19. The examinees completed a standardized Symptom Checklist-90-R (SCL-90-R) questionnaire, concerning self-assessment of psychological disorders in the previous week. The value system of nine dimensions and three global indexes of SCL-90-R scales were analyzed.Results: Our results suggest that adolescents with epilepsy have more than one psychic disorder compared to a healthy group of respondents. Somatic symptoms are more common in non-epileptic subjects, while obsessive-compulsive, depressive and phobic symptoms, as well as anxiety, aggressiveness, interpersonal vulnerability and paranoia, are more common in adolescents with epilepsy. Due to the type of epilepsy, obsessive compulsive symptoms are more common in adolescents with focal epilepsy, while the symptoms of phobia are more present in those with generalized epilepsy. The depth and intensity of psychological stress is higher in the group of adolescents with epilepsy compared to the healthy group of respondents.Conclusions: Psychiatric comorbidity is very common in epileptic patients and depending on the type of diagnosed epilepsy, various symptoms are expressed. Furthermore, psychological stress is more observable in adolescents with epilepsy. For patients with epilepsy, mental health care and seizure control is extremely important in the prevention of serious mental disabilities.
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Affiliation(s)
- Zdravko Kuzman
- Department of Pediatrics, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ines Mlinarevic-Polic
- Department of Pediatrics, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ivan Aleric
- Department of Clinical Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Internal Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Pulmonology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Darko Katalinic
- Department of Clinical Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Internal Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Aleksandar Vcev
- Department of Clinical Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Internal Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Dragan Babic
- Department of Psychiatry, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
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14
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Yang Y, Yang M, Shi Q, Wang T, Jiang M. Risk factors for depression in patients with epilepsy: A meta-analysis. Epilepsy Behav 2020; 106:107030. [PMID: 32248060 DOI: 10.1016/j.yebeh.2020.107030] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/04/2020] [Accepted: 03/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Depression is common and associated with reduced quality of life (QoL) in people with epilepsy (PWE). Although multiple studies have investigated the relevant predictors, the results have been inconsistent. This meta-analysis aimed to investigate the risk factors that might increase the possibility of depression in this population. METHODS Medline, The Cochrane Library, Web of Science, and Embase were comprehensively searched for cross-sectional studies on the occurrence of depression in PWE. A random effects model was used to calculate the pooled hazard ratios (HRs) and 95% confidence intervals (95% CIs). Heterogeneity between the study results and the probability of publication bias were also assessed. RESULTS Fifty-one cross-sectional studies with sample sizes ranging from 36 to 1763 were included in this meta-analysis. The significant factors associated with an increased risk of depression were older age (odds ratio [OR]: 1.02, 95% CI: 1.00-1.04; p = 0.019), female gender (OR: 1.58, 95% CI: 1.30-1.93; p < 0.001), low education level (OR: 3.38, 95% CI: 2.86-4.00; p < 0.001), not being employed (OR: 1.61, 95% CI: 1.08-2.38; p = 0.019), poor antiepileptic drug (AED) adherence (OR: 2.84, 95% CI: 1.94-4.16; p < 0.001), polytherapy (OR: 2.25, 95% CI: 1.48-3.41; p < 0.001), stigma (OR: 2.22, 95% CI: 1.71-2.88; p < 0.001), and anxiety (OR: 2.21, 95% CI: 1.66-2.94; p < 0.001). A shorter epilepsy duration was significantly associated with a lower risk of depression (OR: 0.99, 95% CI: 0.99-0.99; p < 0.001), whereas marital status (OR: 1.07, 95% CI: 0.90-1.20; p = 0.684), economic level (OR: 1.01, 95% CI: 0.95-1.08; p = 0.684), age at seizure onset (OR: 0.99, 95% CI: 0.75-1.29; p = 0.912), and seizure control (OR: 1.03, 95% CI: 0.65-1.63; p = 0.900) did not increase the risk of depression. CONCLUSION This meta-analysis defined several factors related to an increased risk of depression in PWE and can contribute to better prevention and screening strategies for depression in this group. The mechanisms behind this comorbidity remain to be further investigated to determine individually appropriate and targeted interventions.
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Affiliation(s)
- Yanhong Yang
- Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Mengyang Yang
- Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qianling Shi
- The First School of Clinical Medicine, The Cochrane Center of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Tiancheng Wang
- The Epilepsy Center, Department of Neurology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.
| | - Min Jiang
- Beijing Children's Hospital, Capital Medical University, Beijing, China.
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15
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Liu X, Chen H, Zheng X. Effects of seizure frequency, depression and generalized anxiety on suicidal tendency in people with epilepsy. Epilepsy Res 2020; 160:106265. [PMID: 31981793 DOI: 10.1016/j.eplepsyres.2020.106265] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/30/2019] [Accepted: 01/01/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The highest risk of suicide was identified among patients diagnosed with both epilepsy and comorbid psychiatric disease. The most common comorbid psychiatric conditions of epilepsy are anxiety and depression. This study examines whether and how seizure frequency, depression and generalized anxiety interact to influence suicidal tendency. METHODS A consecutive cohort of PWE was recruited from the First Affiliated Hospital of Chongqing Medical University. Each patient completed the Neurological Disorders Depression Inventory for Epilepsy scale[NDDI-E], the Generalized Anxiety Disorder-7 (GAD-7), and the suicidality module of Mini-International Neuropsychiatric Interview(MINI) v.5.0.0. Spearman's correlation and moderated mediation analysis were used to examine the associations among seizure frequency, depression, generalized anxiety and suicidal tendency. RESULTS Seizure frequency was positively associated with suicidal tendency. Depression severity partially mediated the relationship between seizure frequency and suicidal tendency. The indirect effect of seizure frequency on suicidal tendency was positive, and accounted for 50.2 % of the total effect of seizure frequency on suicidal tendency. The indirect effect of seizure frequency on suicidal tendency through depression severity was positively moderated by generalized anxiety severity. CONCLUSIONS Reducing seizure frequency may be the basis of suicide prevention in PWE. At the same time, the effect of seizure frequency on suicidal tendency can be partially explained by the mediation of depression severity, and the magnitude of the indirect effect of seizure frequency on suicidal tendency was contingent upon generalized anxiety severity. In addition to depression severity, generalized anxiety severity also exerts an important effect on suicidal tendency in PWE.
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Affiliation(s)
- Xing Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Yixueyuan Rd. Yuzhong District, 400016, Chongqing, China
| | - Hongnian Chen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Yixueyuan Rd. Yuzhong District, 400016, Chongqing, China
| | - Xiao Zheng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Yixueyuan Rd. Yuzhong District, 400016, Chongqing, China.
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16
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Zapata Barco AM, Restrepo-Martínez M, Restrepo D. Depression in People with Epilepsy. What is the Connection? REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:53-61. [PMID: 32081210 DOI: 10.1016/j.rcp.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/25/2017] [Accepted: 10/22/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Depression is the most common psychiatric comorbidity in people with epilepsy. It worsens the prognosis and quality of life of these patients. Despite this, depression is poorly diagnosed and when the treatment is given, it is frequently suboptimal. OBJECTIVE To perform a narrative review of the medical literature, seeking to collect useful information regarding the relationship between epilepsy and depression. RESULTS Narrative reviews, systematic reviews, meta-analyses, clinical trials, and follow-up studies were identified in English and Spanish with no time limit, including epidemiological, clinical, associated factors, etiological explanations, diagnostic and therapeutic approaches to comorbid depression in epilepsy. CONCLUSION The relationship between epilepsy and depression is complex. The available scientific evidence suggests the possibility of a bidirectional relationship that could be explained from common aetiopathogenic mechanisms. Despite the high prevalence of depression in epileptic patients, this mental disorder continues to be poorly identified by clinicians. To improve this, we have easy-to-apply instruments that routinely screen this patient population and contribute substantially to making the problem more visible and seek to improve the quality of life for this population.
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17
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Matraszek-Gawron R, Chwil M, Terlecka P, Skoczylas MM. Recent Studies on Anti-Depressant Bioactive Substances in Selected Species from the Genera Hemerocallis and Gladiolus: A Systematic Review. Pharmaceuticals (Basel) 2019; 12:ph12040172. [PMID: 31775329 PMCID: PMC6958339 DOI: 10.3390/ph12040172] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/04/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022] Open
Abstract
Herbal therapy is a potential alternative applied to pharmacological alleviation of depression symptoms and treatment of this disorder, which is predicted by the World Health Organization (WHO) to be the most serious health problem worldwide over the next several years. It has been well documented that many herbs with psychotropic effects have far fewer side effects than a variety of pharmaceutical agents used by psychiatrists for the treatment of depression. This systematic review presents literature data on the antidepressant activity of representatives of the genera Hemerocallis (H. fulva and H. citrina Baroni, family Xanthorrhoeaceae) and Gladiolus (G. dalenii, family Iridaceae) and on biologically active compounds and their mechanisms of action to consider the application of herbal preparations supporting the treatment of depression.
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Affiliation(s)
- Renata Matraszek-Gawron
- Department of Botany and Plant Physiology, University of Life Sciences in Lublin, 15 Akademicka Street, 20-950 Lublin, Poland;
| | - Mirosława Chwil
- Department of Botany and Plant Physiology, University of Life Sciences in Lublin, 15 Akademicka Street, 20-950 Lublin, Poland;
- Correspondence: ; Tel.: +48-81-445-66-24
| | - Paulina Terlecka
- Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 8 Jaczewskiego Street, 20-090 Lublin, Poland;
| | - Michał M. Skoczylas
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University in Szczecin, 1 Unii Lubelskiej Street, 71-252 Szczecin, Poland;
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18
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Billakota S, Devinsky O, Kim KW. Why we urgently need improved epilepsy therapies for adult patients. Neuropharmacology 2019; 170:107855. [PMID: 31751547 DOI: 10.1016/j.neuropharm.2019.107855] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Up to a third of patients with epilepsy suffer from recurrent seizures despite therapeutic advances. RESULTS Current epilepsy treatments are limited by experiential data from treating different types of epilepsy. For example, we lack evidence-based approaches to efficacious multi-drug therapies or identifying potentially serious or disabling adverse events before medications are initiated. Despite advances in neuroscience and genetics, our understanding of epilepsy pathogenesis and mechanisms of treatment-resistance remains limited. For most patients with epilepsy, precision medicine for improved seizure control and reduced toxicity remains a future goal. CONCLUSION A third of epilepsy patients suffer from ongoing seizures and even more suffer from adverse effects of treatment. There is a critical need for more effective and safer therapies for epilepsy patients with frequent comorbitidies, including depression, anxiety, migraine, and cognitive impairments, as well as special populations (e.g., women, elderly). Advances from genomic sequencing techniques may identify new genes and regulatory elements that influence both the depth of the epilepsies' roots within brain circuitry as well as ASD resistance. Improved understanding of epilepsy mechanisms, identification of potential new therapeutic targets, and their assessment in randomized controlled trials are needed to reduce the burden of refractory epilepsy. This article is part of the special issue entitled 'New Epilepsy Therapies for the 21st Century - From Antiseizure Drugs to Prevention, Modification and Cure of Epilepsy'.
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Affiliation(s)
- Santoshi Billakota
- NYU Langone Comprehensive Epilepsy Center and NYU Langone School of Medicine, New York, NY, USA.
| | - Orrin Devinsky
- NYU Langone Comprehensive Epilepsy Center and Professor of Neurology, Neurosurgery, and Psychiatry at NYU Langone School of Medicine, New York, NY, USA; Saint Barnabas Institute of Neurology and Neurosurgery, Livingston, NJ, USA
| | - Kyung-Wha Kim
- NYU Langone Comprehensive Epilepsy Center and NYU Langone School of Medicine, New York, NY, USA
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19
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Snoeijen‐Schouwenaars FM, van Ool JS, Tan IY, Aldenkamp AP, Schelhaas HJ, Hendriksen JGM. Mood, anxiety, and perceived quality of life in adults with epilepsy and intellectual disability. Acta Neurol Scand 2019; 139:519-525. [PMID: 30820944 DOI: 10.1111/ane.13085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Depression and anxiety symptoms are common among patients with epilepsy, but are relatively under-researched in patients with both epilepsy and intellectual disability (ID). The aim was to investigate whether epilepsy and ID characteristics are associated with mood, anxiety, and quality of life. MATERIALS AND METHODS Adult patients with epilepsy and ID who rely on tertiary epilepsy care were included (N = 189). Mood, anxiety, and quality of life were assessed by standardized questionnaires. Epilepsy and ID characteristics were retrieved from patient charts or determined by psychometric instruments. RESULTS Elevated levels of depressive and anxiety symptoms were present in 21.7% and 12.7%, respectively. Anxiety was significantly associated with a focal epilepsy type and ID domain discrepancy (substantial difference between two domains of adaptive behavior), but was negatively related to seizure frequency and drug load of mood-stabilizing antiepileptic drugs. Depressive symptoms were not significantly related to epilepsy characteristics, but a severe ID and ID domain discrepancy was associated with more depressive symptoms. Quality of life was significantly worse in those with multiple seizure types and ID domain discrepancy. CONCLUSION Whereas anxiety and quality of life are associated with individual epilepsy characteristics, this could not be confirmed for depressive symptoms in patients with epilepsy and ID, despite its high prevalence.
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Affiliation(s)
| | - Jans S. van Ool
- Department of Residential Care Kempenhaeghe Epilepsy Center Heeze The Netherlands
| | - In Y. Tan
- Department of Residential Care Kempenhaeghe Epilepsy Center Heeze The Netherlands
| | - Albert P. Aldenkamp
- Department of Behavioral Sciences Kempenhaeghe Epilepsy Center Heeze The Netherlands
- Department of Neurology Maastricht University Medical Center Maastricht The Netherlands
- Department of Neurology Ghent University Hospital Ghent Belgium
- Department of Electrical Engineering University of Technology Eindhoven The Netherlands
| | - Helenius J. Schelhaas
- Department of Neurology Academic Center for Epileptology Kempenhaeghe Heeze The Netherlands
| | - Jos G. M. Hendriksen
- Department of Behavioral Sciences Kempenhaeghe Epilepsy Center Heeze The Netherlands
- Department of Neurology Maastricht University Medical Center Maastricht The Netherlands
- Center of Neurological Learning Disabilities Kempenhaeghe Heeze The Netherlands
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Snowball A, Chabrol E, Wykes RC, Shekh-Ahmad T, Cornford JH, Lieb A, Hughes MP, Massaro G, Rahim AA, Hashemi KS, Kullmann DM, Walker MC, Schorge S. Epilepsy Gene Therapy Using an Engineered Potassium Channel. J Neurosci 2019; 39:3159-3169. [PMID: 30755487 PMCID: PMC6468110 DOI: 10.1523/jneurosci.1143-18.2019] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 12/24/2018] [Accepted: 01/21/2019] [Indexed: 12/21/2022] Open
Abstract
Refractory focal epilepsy is a devastating disease for which there is frequently no effective treatment. Gene therapy represents a promising alternative, but treating epilepsy in this way involves irreversible changes to brain tissue, so vector design must be carefully optimized to guarantee safety without compromising efficacy. We set out to develop an epilepsy gene therapy vector optimized for clinical translation. The gene encoding the voltage-gated potassium channel Kv1.1, KCNA1, was codon optimized for human expression and mutated to accelerate the recovery of the channels from inactivation. For improved safety, this engineered potassium channel (EKC) gene was packaged into a nonintegrating lentiviral vector under the control of a cell type-specific CAMK2A promoter. In a blinded, randomized, placebo-controlled preclinical trial, the EKC lentivector robustly reduced seizure frequency in a male rat model of focal neocortical epilepsy characterized by discrete spontaneous seizures. When packaged into an adeno-associated viral vector (AAV2/9), the EKC gene was also effective at suppressing seizures in a male rat model of temporal lobe epilepsy. This demonstration of efficacy in a clinically relevant setting, combined with the improved safety conferred by cell type-specific expression and integration-deficient delivery, identify EKC gene therapy as being ready for clinical translation in the treatment of refractory focal epilepsy.SIGNIFICANCE STATEMENT Pharmacoresistant epilepsy affects up to 0.3% of the population. Although epilepsy surgery can be effective, it is limited by risks to normal brain function. We have developed a gene therapy that builds on a mechanistic understanding of altered neuronal and circuit excitability in cortical epilepsy. The potassium channel gene KCNA1 was mutated to bypass post-transcriptional editing and was packaged in a nonintegrating lentivector to reduce the risk of insertional mutagenesis. A randomized, blinded preclinical study demonstrated therapeutic effectiveness in a rodent model of focal neocortical epilepsy. Adeno-associated viral delivery of the channel to both hippocampi was also effective in a model of temporal lobe epilepsy. These results support clinical translation to address a major unmet need.
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Affiliation(s)
- Albert Snowball
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
| | - Elodie Chabrol
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
| | - Robert C Wykes
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
| | - Tawfeeq Shekh-Ahmad
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
| | - Jonathan H Cornford
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
| | - Andreas Lieb
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
| | - Michael P Hughes
- UCL School of Pharmacy, University College London, London WC1N 1AX, United Kingdom, and
| | - Giulia Massaro
- UCL School of Pharmacy, University College London, London WC1N 1AX, United Kingdom, and
| | - Ahad A Rahim
- UCL School of Pharmacy, University College London, London WC1N 1AX, United Kingdom, and
| | - Kevan S Hashemi
- Open Source Instruments Inc., Watertown, Massachusetts 02472
| | - Dimitri M Kullmann
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, United Kingdom,
| | - Matthew C Walker
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, United Kingdom,
| | - Stephanie Schorge
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
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Becker C, Mancic A, Ghestem A, Poillerat V, Claverie D, Bartolomei F, Brouillard F, Benoliel JJ, Bernard C. Antioxidant treatment after epileptogenesis onset prevents comorbidities in rats sensitized by a past stressful event. Epilepsia 2019; 60:648-655. [PMID: 30866060 DOI: 10.1111/epi.14692] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Unresolved past stressful events can induce a state of vulnerability to epilepsy and comorbidities. Using an experimental model of stress-induced vulnerability to depression, we tested whether an antioxidant treatment applied after the onset of epileptogenesis was disease modifying and could prevent the occurrence of comorbidities. METHODS We used social defeat (SD) to trigger a state of vulnerability in half of the SD-exposed population of rats. One month after SD, we used repeated injections of kainic acid to trigger status epilepticus (SE). One subset of animals was treated after SE during 2 weeks with Tempol, a strong antioxidant. Supradural 24/7 recordings were used to assess the development of epilepsy. We assessed spatial and nonspatial memory as well as a depressionlike profile 6 weeks after SE. RESULTS Serum brain-derived neurotrophic factor (BDNF) levels decreased after SD in all animals and recovered to pre-SD levels 1 month later in half of them (SDN group). The other half kept low serum BDNF levels (SDL group). At that stage, SDN and SDL animals do not present a depressionlike profile. The SDL group was more sensitive than the SDN group to epileptogenic conditions. Following SE, the SDL group displayed accelerated epileptogenesis, a depressionlike profile, and severe cognitive deficits as compared to SDN rats. Transient Tempol treatment was disease-modifying, reducing the number of seizures, and prevented the development of comorbidities in the SDL group. Tempol treatment normalized oxidative stress in the SDL group to SDN levels. SIGNIFICANCE This study illustrates the disease-modifying effect of antioxidant treatment after the onset of epileptogenesis in a population rendered vulnerable by past stressful events. The transient treatment decreased seizure burden and had long-term effects, preventing the occurrence of a depressionlike profile and cognitive deficits. We propose that vulnerability to comorbidities can be reversed after the onset of epilepsy.
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Affiliation(s)
- Christel Becker
- INSERM UMR-S 1124, Paris Descartes University, Sorbonne Paris Cité, Faculté des Sciences Fondamentales et Biomédicales, Paris, France
| | - Angelina Mancic
- INSERM UMR-S 1124, Paris Descartes University, Sorbonne Paris Cité, Faculté des Sciences Fondamentales et Biomédicales, Paris, France
| | - Antoine Ghestem
- INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France
| | - Victoria Poillerat
- INSERM UMR-S 1124, Paris Descartes University, Sorbonne Paris Cité, Faculté des Sciences Fondamentales et Biomédicales, Paris, France
| | - Damien Claverie
- INSERM UMR-S 1124, Paris Descartes University, Sorbonne Paris Cité, Faculté des Sciences Fondamentales et Biomédicales, Paris, France.,Institut de Recherche Biomédicale des Armées (IRBA), Brétigny sur Orge, France
| | - Fabrice Bartolomei
- INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France.,Service de Neurophysiologie Clinique, CHU Timone AP-HM, Marseille, France
| | - Franck Brouillard
- INSERM UMR-S 1124, Paris Descartes University, Sorbonne Paris Cité, Faculté des Sciences Fondamentales et Biomédicales, Paris, France
| | - Jean-Jacques Benoliel
- INSERM UMR-S 1124, Paris Descartes University, Sorbonne Paris Cité, Faculté des Sciences Fondamentales et Biomédicales, Paris, France.,Service de Biochimie Endocrinienne et Oncologique, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Christophe Bernard
- INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France
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Coppola G, Operto FF, Matricardi S, Verrotti A. Monitoring And Managing Depression In Adolescents With Epilepsy: Current Perspectives. Neuropsychiatr Dis Treat 2019; 15:2773-2780. [PMID: 31576132 PMCID: PMC6765392 DOI: 10.2147/ndt.s192714] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 09/02/2019] [Indexed: 11/23/2022] Open
Abstract
Epilepsy is associated with a significantly increased risk of developing depressive disorder during adolescence. On the other hand, depression is highly detected in adolescents with epilepsy. These findings highlight the importance of early identification and proper management of comorbid depression in adolescent age. The prevalence of depressive disorders in adolescents with epilepsy ranges between 8 and 35% and is higher than the general population of the same age. The relationship between epilepsy and depression is complex and potentially bidirectional, thereby suggesting a common underlying pathophysiology. Furthermore, failure to detect and treat depressive disorder mostly in adolescence could lead to several negative implications such as an increased risk of suicidal ideation or behavior and poor quality of life. A number of methods are available to detect depressive disorder, such as psychiatric or psychological assessments, structured or semi-structured interviews, and self-report screening tools. Thus, physicians should be able to regularly screen depressive symptoms in youths with epilepsy. Recently, the NDDI-E-.Y inventory has been developed from the adult NDDI-E, and has been validated in many countries. NDDI-E-Y has showed reliable validity, being a brief screening tool (12 items) that can be easily included in routine epilepsy care. The first step to be considered for the management of depressive disorder in adolescents with epilepsy is to consider potential reversible causes of anxiety and depression (i.e., a new AEDs; seizure control). Secondly, great attention has to be given to the education of the child/adolescent and his/her family, trying to improve knowledge about epilepsy as well as to decrease parental stress and improving the child's sense of competence. Pharmacological treatment should also be considered in adolescents diagnosed with depression.
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Affiliation(s)
- Giangennaro Coppola
- Child and Adolescent Neuropsychiatry, Department of Medicine, Surgery, and Odontoiatry, University of Salerno, Salerno, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry, Department of Medicine, Surgery, and Odontoiatry, University of Salerno, Salerno, Italy
| | - Sara Matricardi
- Department of Pediatric Neurology, Ospedali Riuniti, Ancona, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
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Demin K, Berger J, Holtkamp M, Bengner T. Are mental distress and cognitive impairment related in temporal lobe epilepsy? Epilepsy Res 2018; 146:126-131. [PMID: 30142462 DOI: 10.1016/j.eplepsyres.2018.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/14/2018] [Accepted: 07/27/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Cognitive impairment and depression often co-exist among patients with epilepsy. However, there is still debate whether depression and cognition are related in patients with temporal lobe epilepsy (TLE). Even if they were related, it is still unclear whether symptoms of depression specifically, or rather symptoms of mental distress in general, have a negative impact on cognition in patients with TLE. In the present study, we examined whether self-rated symptoms of mental distress and of depression are related to different cognitive functions in unilateral TLE. METHODS We retrospectively studied 162 patients undergoing preoperative evaluation for epilepsy surgery (95 patients with left TLE (LTLE) and 67 patients with right TLE (RTLE)). Severity of mental distress and symptoms of depression were measured with the Symptom Checklist-90-Revised (SCL-90-R) and the Beck Depression Inventory (BDI), respectively. Bivariate correlations were calculated between these two measures and neuropsychological measures of verbal recall, figural learning, psychomotor speed, and phonemic word fluency. Due to multiple testing, a corrected level of p < 0.0063 was regarded as significant, only. RESULTS Seventeen and 19% of patients reported meaningful mental distress and meaningful symptoms of depression, respectively. Mental distress highly correlated with symptoms of depression (rs = 0.80). We found no significant correlations of either mental distress or symptoms of depression with measures of cognitive function. CONCLUSIONS In contrast to some former studies with smaller sample sizes, the present study could not detect a relationship of depression with cognitive impairment in patients with unilateral TLE. Likewise, mental distress and cognition were unrelated in our sample of patients. Our results may argue against theoretical models claiming a causal link between depression and cognitive impairment or a common pathogenic mechanism for these conditions in patients with TLE.
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Affiliation(s)
- Katharina Demin
- Epilepsy-Center Berlin-Brandenburg, Department of Epileptology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.
| | - Justus Berger
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Department of Epileptology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin, Berlin, Germany.
| | - Thomas Bengner
- Epilepsy-Center Berlin-Brandenburg, Department of Epileptology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.
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Tian WT, Huang XJ, Liu XL, Shen JY, Liang GL, Zhu CX, Tang WG, Chen SD, Song YY, Cao L. Depression, anxiety, and quality of life in paroxysmal kinesigenic dyskinesia patients. Chin Med J (Engl) 2018; 130:2088-2094. [PMID: 28836553 PMCID: PMC5586178 DOI: 10.4103/0366-6999.213431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Paroxysmal kinesigenic dyskinesia (PKD) is a rare movement disorder characterized by recurrent dystonic or choreoathetoid attacks triggered by sudden voluntary movements. Under the condition of psychological burden, some patients’ attacks may get worsened with longer duration and higher frequency. This study aimed to assess nonmotor symptoms and quality of life of patients with PKD in a large population. Methods: We performed a cross-sectional survey in 165 primary PKD patients from August 2008 to October 2016 in Rui Jin Hospital, using Symptom Check List-90-Revised (SCL-90-R), World Health Organization Quality of Life-100 (WHOQoL-100), Self-Rating Depression Scale, and Self-Rating Anxiety Scale. We evaluated the differences of SCL-90-R and WHOQOL-100 scores in patients and Chinese normative data (taken from literature) by using the unpaired Student's t-test. We applied multivariate linear regression to analyze the relationships between motor manifestations, mental health, and quality of life among PKD patients. Results: Compared with Chinese normative data taken from literature, patients with PKD exhibited significantly higher (worse) scores across all SCL-90-R subscales (somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism; P = 0.000 for all) and significantly lower (worse) scores of five domains in WHOQoL-100 (physical domain, psychological domain, independence domain, social relationship domain, and general quality of life; P = 0.000 for all). Nonremission of dyskinesia episodes (P = 0.011) and higher depression score (P = 0.000) were significantly associated with lower levels of quality of life. The rates of depression and anxiety in patients with PKD were 41.2% (68/165) and 26.7% (44/165), respectively. Conclusions: Depression, anxiety, and low levels of quality of life were prevalent in patients with PKD. Co-occurrence of depression and anxiety was common among these patients. Regular mental health interventions could set depression and anxiety as intervention targets. Considering that the motor episodes could be elicited by voluntary movements and sometimes also by emotional stress, and that symptoms may get worsened with longer duration and higher frequency when patients are stressed out, intervention or treatment of depression and anxiety might improve the motor symptoms and overall quality of life in PKD patients.
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Affiliation(s)
- Wo-Tu Tian
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xiao-Jun Huang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China
| | - Xiao-Li Liu
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jun-Yi Shen
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Gui-Ling Liang
- Basic Medical Science College, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Chen-Xi Zhu
- Basic Medical Science College, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wei-Guo Tang
- Department of Neurology, Zhoushan Hospital, Zhoushan, Zhejiang 316000, China
| | - Sheng-Di Chen
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yan-Yan Song
- Department of Biostatistics, Institute of Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Li Cao
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Insel BJ, Ottman R, Heiman GA. Mood disorders in familial epilepsy: A test of shared etiology. Epilepsia 2018; 59:431-439. [PMID: 29318616 DOI: 10.1111/epi.13985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Mood disorders are the most common comorbid conditions in epilepsy, but the cause remains unclear. One possible explanation is a shared genetic susceptibility to epilepsy and mood disorders. We tested this hypothesis by evaluating lifetime prevalence of mood disorders in relatives with and without epilepsy in families containing multiple individuals with epilepsy, and comparing the findings with rates from a general population sample. METHODS The Composite International Diagnostic Interview was administered to 192 individuals from 60 families, including 110 participants with epilepsy of unknown cause (50 focal epilepsy [FE], 42 generalized epilepsy [GE], 6 FE and GE, 12 unclassifiable) and 82 relatives without epilepsy (RWOE). Odds ratios (ORs) for lifetime prevalence of mood disorders in participants with versus without epilepsy were computed through logistic regression, using generalized estimation equations to account for familial clustering. Standardized prevalence ratios (SPRs) were used to compare prevalence in family members with general population rates. RESULTS Compared with RWOE, ORs for mood disorders were significantly increased in participants with FE (OR = 2.4, 95% confidence interval [CI] = 1.1-5.2) but not in those with GE (OR = 1.0, 95% CI = 0.4-2.2). In addition, prevalence of mood disorders was increased in individuals with epilepsy who had ≥1 relative with FE. Compared with general population rates, mood disorders were significantly increased in individuals with FE but not in those with GE. Rates were also increased in RWOE, but not significantly so (SPR = 1.4, P = .14). SIGNIFICANCE These findings are consistent with the hypothesis of shared genetic susceptibility to epilepsy and mood disorders, but suggest (1) the effect may be restricted to FE, and (2) the shared genetic effect on risk of mood disorders and epilepsy may be restricted to individuals with epilepsy, that is, to those in whom the genetic risk for epilepsy is "penetrant."
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Affiliation(s)
- Beverly J Insel
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ruth Ottman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.,G. H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - Gary A Heiman
- Department of Genetics, Human Genetics Institute of New Jersey, Rutgers, State University of New Jersey, Piscataway, NJ, USA
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Lee HM, Chai OH, Hahn SJ, Choi BH. Antidepressant drug paroxetine blocks the open pore of Kv3.1 potassium channel. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2017; 22:71-80. [PMID: 29302214 PMCID: PMC5746514 DOI: 10.4196/kjpp.2018.22.1.71] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/27/2017] [Indexed: 12/20/2022]
Abstract
In patients with epilepsy, depression is a common comorbidity but difficult to be treated because many antidepressants cause pro-convulsive effects. Thus, it is important to identify the risk of seizures associated with antidepressants. To determine whether paroxetine, a very potent selective serotonin reuptake inhibitor (SSRI), interacts with ion channels that modulate neuronal excitability, we examined the effects of paroxetine on Kv3.1 potassium channels, which contribute to highfrequency firing of interneurons, using the whole-cell patch-clamp technique. Kv3.1 channels were cloned from rat neurons and expressed in Chinese hamster ovary cells. Paroxetine reversibly reduced the amplitude of Kv3.1 current, with an IC50 value of 9.43 µM and a Hill coefficient of 1.43, and also accelerated the decay of Kv3.1 current. The paroxetine-induced inhibition of Kv3.1 channels was voltage-dependent even when the channels were fully open. The binding (k+1) and unbinding (k−1) rate constants for the paroxetine effect were 4.5 µM−1s−1 and 35.8 s−1, respectively, yielding a calculated KD value of 7.9 µM. The analyses of Kv3.1 tail current indicated that paroxetine did not affect ion selectivity and slowed its deactivation time course, resulting in a tail crossover phenomenon. Paroxetine inhibited Kv3.1 channels in a usedependent manner. Taken together, these results suggest that paroxetine blocks the open state of Kv3.1 channels. Given the role of Kv3.1 in fast spiking of interneurons, our data imply that the blockade of Kv3.1 by paroxetine might elevate epileptic activity of neural networks by interfering with repetitive firing of inhibitory neurons.
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Affiliation(s)
- Hyang Mi Lee
- Department of Pharmacology, Institute for Medical Science, Chonbuk National University Medical School, Jeonju 54097, Korea
| | - Ok Hee Chai
- Department of Anatomy, Institute for Medical Science, Chonbuk National University Medical School, Jeonju 54097, Korea
| | - Sang June Hahn
- Department of Physiology, Medical Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Bok Hee Choi
- Department of Pharmacology, Institute for Medical Science, Chonbuk National University Medical School, Jeonju 54097, Korea
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Abstract
AbstractPeople with epilepsy are significantly more likely to have a mental health disorder than those without a chronic illness. The reasons for this are multiple but may include the mental health difficulties being perceived as complex due to the presence of a chronic illness. In part due to the apparent complexity of the co-occurring physical and mental illness, many are not offered evidence-based treatment (EBT) for the mental health disorder. There is little guidance to inform clinicians about the interventions to use to treat mental health disorders in people with epilepsy. The present paper reports a case of treatment for depression using a standard EBT in a young person with epilepsy. The patient also had clinically significant symptoms of anxiety and an eating disorder and would be considered ‘complex’ according to standard criteria. The intervention, however, was relatively simple and was delivered as guided self-help via 10 weekly telephone calls of approximately 30 minutes duration, and two follow-up calls at one month and three months post-intervention. Self-report and parent-report questionnaire measures were completed before and after the intervention, and at both follow-up time points. A blind-rated online diagnostic interview measure was also completed before and after the intervention. The young person and her family also completed a qualitative interview of their experiences of the intervention. This simple intervention was effective in working towards the client's goals, although pre–post measurement on standard measures was variable. This interesting case raises questions about whether patients with mental and physical comorbidities are complex, or just perceived as complex.
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Design, synthesis, characterization, and molecular modeling studies of novel oxadiazole derivatives of nipecotic acid as potential anticonvulsant and antidepressant agents. Med Chem Res 2017. [DOI: 10.1007/s00044-017-2047-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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30
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Helmstaedter C, Witt JA. Epilepsy and cognition – A bidirectional relationship? Seizure 2017; 49:83-89. [DOI: 10.1016/j.seizure.2017.02.017] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/09/2016] [Accepted: 02/28/2017] [Indexed: 11/29/2022] Open
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Wang D, Yu Z, Yan J, Xue F, Ren G, Jiang C, Wang W, Piao Y, Yang X. Photolysis of Caged-GABA Rapidly Terminates Seizures In Vivo: Concentration and Light Intensity Dependence. Front Neurol 2017; 8:215. [PMID: 28572790 PMCID: PMC5435768 DOI: 10.3389/fneur.2017.00215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/02/2017] [Indexed: 02/05/2023] Open
Abstract
The therapy of focal epilepsy remains unsatisfactory for as many as 25% of patients. The photolysis of caged-γ-aminobutyric acid (caged-GABA) represents a novel and alternative option for the treatment of intractable epilepsy. Our previous experimental results have demonstrated that the use of blue light produced by light-emitting diode to uncage ruthenium-bipyridine-triphenylphosphine-c-GABA (RuBi-GABA) can rapidly terminate paroxysmal seizure activity both in vitro and in vivo. However, the optimal concentration of RuBi-GABA, and the intensity of illumination to abort seizures, remains unknown. The aim of this study was to explore the optimal anti-seizure effects of RuBi-GABA by using implantable fibers to introduce blue light into the neocortex of a 4-aminopyridine-induced acute seizure model in rats. We then investigated the effects of different combinations of RuBi-GABA concentrations and light intensity upon seizure. Our results show that the anti-seizure effect of RuBi-GABA has obvious concentration and light intensity dependence. This is the first example of using an implantable device for the photolysis of RuBi-GABA in the therapy of neocortical seizure, and an optimal combination of RuBi-GABA concentration and light intensity was explored. These results provide important experimental data for future clinical translational studies.
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Affiliation(s)
- Dan Wang
- Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.,Center of Epilepsy, Center for Brain Disorders Research, Capital Medical University, Beijing, China
| | - Zhixin Yu
- Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.,Center of Epilepsy, Center for Brain Disorders Research, Capital Medical University, Beijing, China
| | - Jiaqing Yan
- College of Electrical and Control Engineering, North China University of Technology, Beijing, China
| | - Fenqin Xue
- Core Facilities Center, Capital Medical University, Beijing, China
| | - Guoping Ren
- Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.,Center of Epilepsy, Center for Brain Disorders Research, Capital Medical University, Beijing, China
| | - Chenxi Jiang
- Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.,Center of Epilepsy, Center for Brain Disorders Research, Capital Medical University, Beijing, China
| | - Weimin Wang
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yueshan Piao
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Yang
- Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.,Center of Epilepsy, Center for Brain Disorders Research, Capital Medical University, Beijing, China
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Wang Z, Guo C, Chen G, Zhang L, Wen X, Zheng X. Mutual associations between intellectual disability and epilepsy-related psychiatry disability: Population-based study. Medicine (Baltimore) 2017; 96:e6831. [PMID: 28489764 PMCID: PMC5428598 DOI: 10.1097/md.0000000000006831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Epilepsy is the third-leading cause of psychiatry disability in China, and intellectual disability (ID) is also 1 major type of disabilities in China. This study estimates the prevalence of comorbidities with ID and epilepsy-related psychiatry disability (EPD) and examines mutual associations within ID and EPD.Data were taken from the Second China National Sample Survey on Disability, which was a nationally representative, population-based survey. To derive a nationally representative sample, the survey used multistage, stratified, cluster random sampling with probability proportional to size. The disabled people who had ID and EPD based on the World Health Organization International Classification of Functioning, Disability, and Health and the International Statistical Classification of Diseases. The cox-proportional hazards model was used to examine the associations between ID and EPD considering the happened sequence of ID and EPD.The prevalence of ID with EPD was 0.14 (95% confidence interval: 0.09-0.19) per 1000 people. Age was strongly associated with the risk of EPD, which was diagnosed after ID, especially among young ID population. Except for age, other variables were also associated between ID and EPD considering sequence of ID and EPD.This study is the first national study to explore mutual associations with ID and EPD and highlights the young ID children with high risk of development of epilepsy. To address the challenge of ID with EPD disability in China, the government should adjust its strategies for healthcare systems to prevent disability.
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Błaszczyk B, Czuczwar SJ. Epilepsy coexisting with depression. Pharmacol Rep 2017; 68:1084-92. [PMID: 27634589 DOI: 10.1016/j.pharep.2016.06.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/14/2016] [Accepted: 06/17/2016] [Indexed: 12/15/2022]
Abstract
Depression episodes in epilepsy is the most common commorbidity, affecting between 11% and 62% of patients with epilepsy. Although researchers have documented a strong association between epilepsy and psychiatric comorbidities, the nature of this relationship is poorly understood. The manifestation of depression in epilepsy is a complex issue having many interacting neurobiological and psychosocial determinants, including clinical features of epilepsy (seizure frequency, type, foci, or lateralization of foci) and neurochemical or iatrogenic mechanisms. Other risk factors are a family history of psychiatric illness, particularly depression, a lack of control over the seizures and iatrogenic causes (pharmacologic and surgical). In addition, treatment with antiepileptic drugs (AEDs) as well as social coping and adaptation skills have also been recognised as risk factors of depression associated with epilepsy. Epilepsy may foster the development of depression through being exposed to chronic stress. The uncertainty and unpredictability of seizures may instigate sadness, loneliness, despair, low self-esteem, and self-reproach in patients with epilepsy and lead to social isolation, stigmatization, or disability. Often, depression is viewed as a reaction to epilepsy's stigma and the associated poor quality of life. Moreover, patients with epilepsy display a 4-5 higher rate of depression and suicide compared with healthy population.
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Affiliation(s)
- Barbara Błaszczyk
- Faculty of Health Sciences, High School of Economics, Law and Medical Sciences, Kielce, Poland; Private Neurological Practice, Kielce, Poland.
| | - Stanisław J Czuczwar
- Department of Pathophysiology, Medical University of Lublin, Lublin, Poland; Department of Physiopathology, Institute of Rural Health, Lublin, Poland.
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VEGF-related polymorphisms identified by GWAS and risk for major depression. Transl Psychiatry 2017; 7:e1055. [PMID: 28267147 PMCID: PMC5416679 DOI: 10.1038/tp.2017.36] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/24/2017] [Indexed: 12/21/2022] Open
Abstract
Depression is a common, severe, disabling mental disease that affects millions of people of all ages worldwide. Various studies have shown that neurotrophic/growth factors have a key role in depression and, more specifically, vascular endothelial growth factor (VEGF) is implicated in the pathogenesis of depression. The purpose of this study was to investigate the potential links between four VEGF-related single-nucleotide polymorphisms (SNPs), previously identified through a genome-wide association study (GWAS) and depression. The direct effects and epistatic interactions of the four VEGF-related SNPs (rs10738760, rs6921438, rs6993770 and rs4416670) on depression were investigated through a case-control study including 437 individuals diagnosed with depression and 477 healthy volunteers as controls. Gender, age and body mass index influence was additionally analyzed. The SNP rs4416670 was associated with increased risk for depression (OR: 1.60, P: 0.010). This result demonstrates the existence of relationships between VEGF genetic determinants and depression. This novel association reveals new molecular mechanisms suggesting the potential role of VEGF in depression development that could help to promote a personalized prediction for this severe common disease.
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Loughman A, Bowden SC, D'Souza WJ. Self and informant report ratings of psychopathology in genetic generalized epilepsy. Epilepsy Behav 2017; 67:13-19. [PMID: 28086188 DOI: 10.1016/j.yebeh.2016.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/23/2016] [Accepted: 11/07/2016] [Indexed: 11/29/2022]
Abstract
The psychological sequelae of genetic generalized epilepsies (GGE) is of growing research interest, with up to a third of all adults with GGE experiencing significant psychiatric comorbidity according to a recent systematic review. A number of unexplored questions remain. Firstly, there is insufficient evidence to determine relative prevalence of psychopathology between GGE syndromes. Secondly, the degree to which self-report and informant-report questionnaires accord in adults with epilepsy is unknown. Finally, while epilepsy severity is one likely predictor of worse psychopathology in GGE, evidence regarding other possible contributing factors such as epilepsy duration and antiepileptic drugs (AEDs) has been equivocal. The potential impact of subclinical epileptiform discharges remains unexplored. Self-report psychopathology symptoms across six DSM-Oriented Subscales were prospectively measured in 60 adults with GGE, with informant-report provided for a subset of 47. We assessed the burden of symptoms from both self- and informant-report, and the relationship between clinical epilepsy variables and self-reported symptoms. Results showed elevated symptoms in almost half of the sample overall. Depression and anxiety were the most commonly reported types of symptoms. There was a trend towards greater symptoms endorsement by self-report, and relatively modest interrater agreement. Symptoms of ADHD were significantly positively associated with number of AEDs currently prescribed. Other psychopathology symptoms were not significantly predicted by epilepsy duration, seizure-free duration or total duration of epileptiform discharges over a 24-hour period. The high prevalence of psychological needs suggests that routine screening of psychopathology and provision of psychoeducation may be essential to improving patient care and outcomes. Further investigation is required to better understand predictive and causal factors for psychopathology in GGE.
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Affiliation(s)
- Amy Loughman
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC 3010, Australia; School of Health & Biomedical Sciences, RMIT University, PO Box 71, Bundoora, VIC 3083, Australia.
| | - Stephen C Bowden
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC 3010, Australia; Department of Clinical Neurosciences, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
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Diagnosing and treating depression in epilepsy. Seizure 2016; 44:184-193. [PMID: 27836391 DOI: 10.1016/j.seizure.2016.10.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 01/24/2023] Open
Abstract
At least one third of patients with active epilepsy suffer from significant impairment of their emotional well-being. A targeted examination for possible depression (irrespective of any social, financial or personal burdens) can identify patients who may benefit from medical attention and therapeutic support. Reliable screening instruments such as the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) are suitable for the timely identification of patients needing help. Neurologists should be capable of managing mild to moderate comorbid depression but referral to mental health specialists is mandatory in severe and difficult-to-treat depression, or if the patient is acutely suicidal. In terms of the therapeutic approach, it is essential first to optimize seizure control and minimize unwanted antiepileptic drug-related side effects. Psychotherapy for depression in epilepsy (including online self-treatment programs) is underutilized although it has proven effective in ten well-controlled trials. In contrast, the effectiveness of antidepressant drugs for depression in epilepsy is unknown. However, if modern antidepressants are used (e.g. SSRI, SNRI, NaSSA), concerns about an aggravation of seizures and or problematic interactions with antiepileptic drugs seem unwarranted. Epilepsy-related stress ("burden of epilepsy") explains depression in many patients but acute and temporary seizure-related states of depression or suicidality have also been reported. Limbic encephalitits may cause isolated mood alteration without any recognizable psychoetiological background indicating a possible role of neuroinflammation. This review will argue that, overall, a bio-psycho-social model best captures the currently available evidence relating to the etiology and treatment of depression as a comorbidity of epilepsy.
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Abstract
Mood disorders associated with epilepsy are very common and overrepresented compared with other chronic medical conditions. Depression is a particularly common and worrisome comorbidity, especially because suicidality seems to be increased significantly in the context of epilepsy. Although psychosocial stressors commonly are associated, intrinsic characteristics of seizure disorders may contribute to the expression of depressive symptoms. Depression and epilepsy may exacerbate each other. Epilepsy with seizure foci in the temporal lobe may represent a higher risk of developing depression, especially if the seizures do not generalize. Treatment of depression is multifaceted and includes psychotherapy and sophisticated regimens of anticonvulsants. Most antidepressants may be used safely and effectively in the context of depression, although high-quality evidence is lacking. Ultimately, treatment of comorbid mood disorder has important implications for outcome and quality of life, perhaps even more than treatment of epilepsy itself.
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Affiliation(s)
- Jay Salpekar
- Dr. Salpekar is director of the Neuropsychiatry and Epilepsy Program, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore (e-mail: )
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Outcome of antiepileptic drug treatment of 1282 patients with epilepsy, their pharmacovigilance reports and concomitant medication on CNS in an East-Hungarian adult database. J Neurol Sci 2016; 369:220-226. [DOI: 10.1016/j.jns.2016.08.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/24/2016] [Accepted: 08/16/2016] [Indexed: 01/17/2023]
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Bernard C. The Diathesis-Epilepsy Model: How Past Events Impact the Development of Epilepsy and Comorbidities. Cold Spring Harb Perspect Med 2016; 6:cshperspect.a022418. [PMID: 27194167 DOI: 10.1101/cshperspect.a022418] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In epilepsy, seizures and comorbidities (e.g., cognitive deficits and depression) occur when specific thresholds are crossed. These thresholds depend on the diathesis (or vulnerability) of a given individual. The diathesis is controlled by multiple genetic and environmental factors. Diathesis changes over multiple timescales: on a daily basis, and as part of the development/aging processes, etc. The diathesis-epilepsy model introduced here provides a conceptual framework to understand how past events (e.g., a very stressful event) can directly influence the occurrence of epilepsy and comorbidities later in life. Experimental evidence supports this model, and the existence of biomarkers predictive of a vulnerability state have led to the development of preventive therapeutic strategies. Epigenetic modifications could be a key determinant of diathesis. Their role is discussed.
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Affiliation(s)
- Christophe Bernard
- Aix Marseille Université, Inserm, INS UMR S 1106, 13005 Marseille, France
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Li J, Wang X, Meng H, Zeng K, Quan F, Liu F. Systemic Family Therapy of Comorbidity of Anxiety and Depression with Epilepsy in Adolescents. Psychiatry Investig 2016; 13:305-10. [PMID: 27247596 PMCID: PMC4878964 DOI: 10.4306/pi.2016.13.3.305] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/18/2015] [Accepted: 07/20/2015] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The aim of this study was to find if systemic family therapy (SFT) does work in anxiety and depression with epilepsy in adolescents (ADAE). METHODS 104 adolescents with epilepsy, aged 13-20 years old, were included from December 2009 to December 2010, the enrolled patients were with anxiety [Hamilton Anxiety Scale (HAMA) score ≥14 points] or depression [Hamilton Depression Scale (HAMD) score ≥20 points]. The patients were randomly divided into the control group (n=52) treated with antiepileptic drugs (AED) and the intervention group (n=52) undergone Systemic Family Therapy (SFT) as well as AED. The AED improvements, anxiety and depression scores, Social Support Rating Scale (SSRS), Family Assessment Device (FAD) and scale of systemic family dynamics (SSFD) were observed after 3-month treatment. RESULTS The frequencies of epileptic seizures in intervention group was decreased much more significantly than the control group (4.22±3.54 times/month vs. 6.20±5.86 times/month, p=0.04); and the scores of anxiety (9.52±6.28 points vs. 13.48±8.47 points, p=0.01) and depression (13.86±9.17 points vs. 18.89±8.73 points, p=0.02) were significantly decreased than the control group; meanwhile, the family dynamics and family functions were significantly improved, and the social support was also increased (p<0.05). CONCLUSION SFT combined with AEDs had better efficacies than AEDs alone, not only the frequency of epileptic seizures was decreased, but also the patients' anxiety and depression were improved, and the family dynamics, family functions and social support were improved.
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Affiliation(s)
- Jing Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuefeng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huaqing Meng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kebin Zeng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fengying Quan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fang Liu
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Osman A, Seri S, Cavanna AE. Clinical characteristics of patients with epilepsy in a specialist neuropsychiatry service. Epilepsy Behav 2016; 58:44-7. [PMID: 27057744 DOI: 10.1016/j.yebeh.2016.02.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 02/21/2016] [Accepted: 02/23/2016] [Indexed: 12/29/2022]
Abstract
Neuropsychiatry services provide specialist input into the assessment and management of behavioral symptoms associated with a range of neurological conditions, including epilepsy. Despite the centrality of epilepsy to neuropsychiatry and the recent expansion of neuropsychiatry service provision, little is known about the clinical characteristics of patients with epilepsy who are routinely seen by a specialist neuropsychiatry service. This retrospective study filled this gap by retrospectively evaluating a naturalistic series of 60 consecutive patients with epilepsy referred to and assessed within a neuropsychiatry setting. Fifty-two patients (86.7%) had active epilepsy and were under the ongoing care of the referring neurologist for seizure management. The majority of patients (N=42; 70.0%) had a diagnosis of localization-related epilepsy, with temporal lobe epilepsy as the most common epilepsy type (N=37; 61.7%). Following clinical assessment, 39 patients (65.0%) fulfilled formal diagnostic criteria for at least one psychiatric disorder; nonepileptic attack disorder (N=37; 61.7%), major depression (N=23; 38.3%), and generalized anxiety disorder (N=16; 26.7%) were the most commonly diagnosed comorbidities. The clinical characteristics of patients seen in specialist neuropsychiatry settings are in line with the results from previous studies in neurology clinics in terms of both epilepsy and psychiatric comorbidity. Our findings confirm the need for the development and implementation of structured care pathways for the neuropsychiatric aspects of epilepsy, with focus on comorbid nonepileptic attacks and affective and anxiety symptoms. This is of particular importance in consideration of the impact of behavioral symptoms on patients' health-related quality of life.
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Affiliation(s)
- Adam Osman
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Stefano Seri
- School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, UK; Children's Epilepsy Surgery Programme, The Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Andrea E Cavanna
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK; School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, UK; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and UCL, London, UK.
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Coppola A, Caccavale C, Santulli L, Balestrini S, Cagnetti C, Licchetta L, Esposito M, Bisulli F, Tinuper P, Provinciali L, Minetti C, Zara F, Striano P, Striano S. Psychiatric comorbidities in patients from seven families with autosomal dominant cortical tremor, myoclonus, and epilepsy. Epilepsy Behav 2016; 56:38-43. [PMID: 26827300 DOI: 10.1016/j.yebeh.2015.12.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/20/2015] [Accepted: 12/23/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this report was to assess the psychiatric comorbidity in a group of patients affected by autosomal dominant cortical tremor, myoclonus, and epilepsy (ADCME). METHODS Reliable and validated psychodiagnostic scales including the BDI (Beck Depression Inventory), STAI-Y1 and 2 (State-Trait Anxiety Inventory - Y; 1 and 2), MMPI-2 (Minnesota Multiphasic Personality Inventory - 2), and QoLIE-31 (Quality of Life in Epilepsy Inventory - 31) were administered to 20 patients with ADCME, 20 patients with juvenile myoclonic epilepsy (JME), and 20 healthy controls. RESULTS There was a higher prevalence of mood disorders in patients with ADCME compared to patients with JME and healthy controls, particularly depression (p=0.035 and p=0.017, respectively) and state anxiety (p=0.024 and p=0.019, respectively). Trait anxiety was not different from JME (p=0.102) but higher than healthy controls (p=0.017). The myoclonus score positively correlated with both state (rho: 0.58, p=0.042) and trait anxiety (rho: 0.65, p=0.011). These psychiatric features were also often associated with pathological traits of personality: paranoid (OR: 25.7, p=0.003), psychasthenia (OR: 7.0, p=0.023), schizophrenia (OR: 8.5, p=0.011), and hypomania (OR: 5.5, p=0.022). Finally, in patients with ADCME, decreased quality of life correlated with these psychiatric symptoms. SIGNIFICANCE Patients with ADCME show a significant psychiatric burden that impairs their quality of life. A comprehensive psychiatric evaluation should be offered at the time of diagnosis to detect these comorbidities and to treat them.
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Affiliation(s)
- Antonietta Coppola
- Epilepsy Centre, Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy; Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genova, Italy.
| | - Carmela Caccavale
- Epilepsy Centre, Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy
| | - Lia Santulli
- Epilepsy Centre, Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy
| | - Simona Balestrini
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK; Epilepsy Society, Chesham Lane, Chalfont St. Peter, Bucks, UK; Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Claudia Cagnetti
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Laura Licchetta
- IRCCS, Neurological Science Institute of Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Marcello Esposito
- Department of Neurological Science, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy
| | - Francesca Bisulli
- IRCCS, Neurological Science Institute of Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Paolo Tinuper
- IRCCS, Neurological Science Institute of Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Leandro Provinciali
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Carlo Minetti
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genova, Italy
| | - Federico Zara
- Laboratory of Neurogenetics and Neurosciences, Department of Neurosciences, "G. Gaslini" Institute, Genova, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genova, Italy
| | - Salvatore Striano
- Epilepsy Centre, Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University, Naples, Italy
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Lacey CJ, Salzberg MR, D'Souza WJ. What factors contribute to the risk of depression in epilepsy?--Tasmanian Epilepsy Register Mood Study (TERMS). Epilepsia 2016; 57:516-22. [PMID: 26763001 DOI: 10.1111/epi.13302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To model the factors associated with depression in a community sample of people with epilepsy. The factors investigated were derived from proposed risk factors for depression from patients with epilepsy, other chronic illness, and the general population. METHODS Multivariate analysis using general linear regression models of factors associated with depression in the Tasmanian Epilepsy Register Mood Study (TERMS), a cross-sectional community sample of 440 patients with epilepsy. RESULTS A model with acceptable fit was created that explained 66% of the variance of depression. Associated factors included in this model were neuroticism, physical functioning, social support, past history of depression, and stressful life events. SIGNIFICANCE In this cross-sectional study designed specifically to investigate depression in epilepsy, we showed that general risk factors for depression in other illness and in the general population are also important in patients with epilepsy, with little support for disease-related risk factors.
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Affiliation(s)
- Cameron J Lacey
- Department of Psychiatry, St. Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, St. Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael R Salzberg
- Department of Psychiatry, St. Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St. Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
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Wiglusz MS, Landowski J, Michalak L, Cubała WJ. Reevaluating the prevalence and diagnostic subtypes of depressive disorders in epilepsy. Epilepsy Behav 2015; 53:15-9. [PMID: 26515153 DOI: 10.1016/j.yebeh.2015.09.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/20/2015] [Accepted: 09/21/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Depressive disorders are common among patients with epilepsy (PWE). The aim of this study was to estimate the prevalence of different forms of depressive disorders among PWE treated in the outpatient setting. METHODS A group of consecutive PWE that visited the epilepsy outpatient clinic was invited to participate in the study. Ninety-six patients met inclusion criteria and were examined by a trained psychiatrist using standardized measures. RESULTS A diagnosis of a current major depression was established in 21 (22.3%) out of 96 participants. Furthermore, almost 20% of the study group fulfilled criteria for mood disorder categories other than MDD, adding up to over 40% of PWE suffering from any mood disorder category. Older age and later age at seizure onset, as well as unemployment, were associated with an increase in the odds of MDD diagnosis. STUDY LIMITATIONS A number of limitations are to be considered: the sample size is relatively small, and the findings may not be representative of PWE in general because our population represents a sample coming from a single outpatient clinic with a higher ratio of drug-resistant epilepsy. CONCLUSIONS Major depression as well as other forms of depressive disorders are common among PWE. Unemployment, age, and age at seizure onset are important factors associated with major depression among PWE.
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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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Becker C, Bouvier E, Ghestem A, Siyoucef S, Claverie D, Camus F, Bartolomei F, Benoliel JJ, Bernard C. Predicting and treating stress-induced vulnerability to epilepsy and depression. Ann Neurol 2015; 78:128-36. [PMID: 25869354 DOI: 10.1002/ana.24414] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 11/06/2022]
Abstract
Accumulation of stressful events can render individuals susceptible to develop epilepsy and comorbidities. Whether such vulnerability can be predicted and reversed is not known. Here we show that social defeat, although not producing depression by itself, produced in 50% of rats reduced threshold for status epilepticus (SE), accelerated epileptogenesis, and once epilepsy was induced, depression-like profile and cognitive deficits. Low serum brain-derived neurotrophic factor (BDNF) levels measured before SE identified this vulnerable population. Treatment with a BDNF analog before SE prevented the occurrence of comorbidities. Thus, vulnerability to comorbidities after epilepsy onset due to unresolved past stressful events may be predicted and reversed.
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Affiliation(s)
- Christel Becker
- Mixed Unit of Research 119 (UMPC UM 119), Pierre and Marie Curie University-Paris 6, Paris.,Unit 1130, National Institute of Health and Medical Research (INSERM 1130), Paris.,Unit 8246, National Center for Scientific Research (CNRS 8246), Paris.,Faculty of Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris
| | - Elodie Bouvier
- Mixed Unit of Research 119 (UMPC UM 119), Pierre and Marie Curie University-Paris 6, Paris.,Unit 1130, National Institute of Health and Medical Research (INSERM 1130), Paris.,Unit 8246, National Center for Scientific Research (CNRS 8246), Paris
| | - Antoine Ghestem
- Aix Marseille Université, INS, 13005, Marseille, France.,Inserm, UMR_S 1106, 13005, Marseille, France
| | - Safia Siyoucef
- Aix Marseille Université, INS, 13005, Marseille, France.,Inserm, UMR_S 1106, 13005, Marseille, France
| | - Damien Claverie
- Mixed Unit of Research 119 (UMPC UM 119), Pierre and Marie Curie University-Paris 6, Paris.,Unit 1130, National Institute of Health and Medical Research (INSERM 1130), Paris.,Unit 8246, National Center for Scientific Research (CNRS 8246), Paris.,Army Institute of Biomedical Research, Brétigny sur Orge
| | - Françoise Camus
- Mixed Unit of Research 119 (UMPC UM 119), Pierre and Marie Curie University-Paris 6, Paris.,Unit 1130, National Institute of Health and Medical Research (INSERM 1130), Paris.,Unit 8246, National Center for Scientific Research (CNRS 8246), Paris
| | - Fabrice Bartolomei
- Aix Marseille Université, INS, 13005, Marseille, France.,Inserm, UMR_S 1106, 13005, Marseille, France
| | - Jean-Jacques Benoliel
- Mixed Unit of Research 119 (UMPC UM 119), Pierre and Marie Curie University-Paris 6, Paris.,Unit 1130, National Institute of Health and Medical Research (INSERM 1130), Paris.,Unit 8246, National Center for Scientific Research (CNRS 8246), Paris.,Department of Biochemistry and Endocrine Oncology, Pitié-Salpêtrière Hospital, Paris, France
| | - Christophe Bernard
- Aix Marseille Université, INS, 13005, Marseille, France.,Inserm, UMR_S 1106, 13005, Marseille, France
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Citraro R, Leo A, De Fazio P, De Sarro G, Russo E. Antidepressants but not antipsychotics have antiepileptogenic effects with limited effects on comorbid depressive-like behaviour in the WAG/Rij rat model of absence epilepsy. Br J Pharmacol 2015; 172:3177-88. [PMID: 25754610 DOI: 10.1111/bph.13121] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 01/22/2015] [Accepted: 02/21/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Two of the most relevant unmet needs in epilepsy are represented by the development of disease-modifying drugs able to affect epileptogenesis and/or the study of related neuropsychiatric comorbidities. No systematic study has investigated the effects of chronic treatment with antipsychotics or antidepressants on epileptogenesis. However, such drugs are known to influence seizure threshold. EXPERIMENTAL APPROACH We evaluated the effects of an early long-term treatment (ELTT; 17 weeks), started before seizure onset (P45), with fluoxetine (selective 5-HT-reuptake inhibitor), duloxetine (dual-acting 5-HT-noradrenaline reuptake inhibitor), haloperidol (typical antipsychotic drug), risperidone and quetiapine (atypical antipsychotic drugs) on the development of absence seizures and comorbid depressive-like behaviour in the WAG/Rij rat model. Furthermore, we studied the effects of these drugs on established absence seizures in adult (6-month-old) rats after a chronic 7 weeks treatment. KEY RESULTS ELTT with all antipsychotics did not affect the development of seizures, whereas, both ELTT haloperidol (1 mg · kg(-1) day(-1)) and risperidone (0.5 mg · kg(-1) day(-1)) increased immobility time in the forced swimming test and increased absence seizures only in adult rats (7 weeks treatment). In contrast, both fluoxetine (30 mg · kg(-1) day(-1)) and duloxetine (10-30 mg · kg(-1) day(-1)) exhibited clear antiepileptogenic effects. Duloxetine decreased and fluoxetine increased absence seizures in adult rats. Duloxetine did not affect immobility time; fluoxetine 30 mg · kg(-1) day(-1) reduced immobility time while at 10 mg · kg(-1) day(-1) an increase was observed. CONCLUSIONS AND IMPLICATIONS In this animal model, antipsychotics had no antiepileptogenic effects and might worsen depressive-like comorbidity, while antidepressants have potential antiepileptogenic effects even though they have limited effects on comorbid depressive-like behaviour.
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Affiliation(s)
- Rita Citraro
- Pharmacology Unit, Science of Health Department School of Medicine and Surgery, University 'Magna Graecia' of Catanzaro, Catanzaro, Italy
| | - Antonio Leo
- Pharmacology Unit, Science of Health Department School of Medicine and Surgery, University 'Magna Graecia' of Catanzaro, Catanzaro, Italy
| | - Pasquale De Fazio
- Psichiatry Unit, Science of Health Department School of Medicine and Surgery, University 'Magna Graecia' of Catanzaro, Catanzaro, Italy
| | - Giovambattista De Sarro
- Pharmacology Unit, Science of Health Department School of Medicine and Surgery, University 'Magna Graecia' of Catanzaro, Catanzaro, Italy
| | - Emilio Russo
- Pharmacology Unit, Science of Health Department School of Medicine and Surgery, University 'Magna Graecia' of Catanzaro, Catanzaro, Italy
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49
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Chartrand D. [The psychosocial challenges of epilepsy and the role of the clinical nurse specialist]. SOINS. PEDIATRIE, PUERICULTURE 2015; 36:31-36. [PMID: 26100483 DOI: 10.1016/j.spp.2015.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Epilepsy in children is a complex disease with significant psychosocial consequences for the child and their family. The intervention of a multidisciplinary team enables the care to be adapted and provides support for the families. At Sainte-Justine Hospital in Montreal, Canada, the nurse clinician specialised in epilepsy plays a key role in this team.
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Affiliation(s)
- Dominic Chartrand
- Clinique de neurologie, Hôpital Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1C4, Canada.
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Micoulaud-Franchi JA, Barkate G, Trébuchon-Da Fonseca A, Vaugier L, Gavaret M, Bartolomei F, McGonigal A. One step closer to a global tool for rapid screening of major depression in epilepsy: validation of the French NDDI-E. Epilepsy Behav 2015; 44:11-6. [PMID: 25597527 DOI: 10.1016/j.yebeh.2014.12.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/06/2014] [Accepted: 12/09/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Depression in people with epilepsy (PWE) is underdiagnosed and undertreated. The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) is a screening questionnaire used for detecting major depressive episode (MDE) in PWE, and is already validated in 10 languages. However a version in French, one of the world's widely spoken languages, was, until now, lacking. We aimed to translate and validate the French NDDI-E. METHODS This study was performed under the auspices of the ILAE. People with epilepsy >18years of age were recruited from 2 specialist epilepsy units in Marseille, France. Two native French speakers and 2 native English speakers performed a forward-backward translation. The Mini International Neuropsychiatric Interview (MINI) was performed as the gold standard, and the Center for Epidemiological Studies Depression symptoms index (CES-D) was performed for external validity. Data were compared between PWE with MDE and PWE without MDE using the chi-square test and Student's t-test. Internal structural validity, external validity, and receiver operator characteristics were analyzed. RESULTS Testing was performed on 116 PWE: mean age=40.39years (SD=13.83, range: [18-81]years old); 58.6% (68) were women; 87.1% had focal epilepsy. Using the MINI, we found that 33 (28.4%) patients had current MDE and that 15 (12.9%) patients had dysthymia; also, we found that 37 (31.9%) patients presented suicidal ideation and/or behavior. Cronbach's alpha coefficient was 0.838, indicating satisfactory internal consistency. Correlation between the NDDI-E and the CES-D scores was high (r(116)=0.817, p<0.0001), indicating good external validity. Receiver operator characteristic analysis showed an area under the curve of 0.958 (95% CI=0.904-0.986), (p<0.0001), indicating good capacity of the NDDI-E to detect MDE (defined by MINI). The cutoff for maximal sensitivity and specificity was 15. The mean NDDI-E score in PWE with MDE was 18.27 (SD=2.28), and the mean NDDI-E score in PWE without MDE was 10.61 (SD=3.63). SIGNIFICANCE This study validated the French NDDI-E, with a cutoff score of 15/24 for MDE, similar to previous studies, and reinforces the NDDI-E as a global tool for detection of MDE.
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Affiliation(s)
- Jean-Arthur Micoulaud-Franchi
- Pôle de Psychiatrie "Solaris", Centre Hospitalier Universitaire de Sainte-Marguerite, 270 Bd de Sainte-Marguerite, 13009 Marseille, France; Laboratoire de Neurosciences Cognitives, UMR CNRS 7291, 31 Aix-Marseille Université, 13331 Marseille, France
| | - Gérald Barkate
- Hôpital Henri Gastaut, Etablissement Hospitalier Spécialisé dans le traitement des Epilepsies, 300 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Agnès Trébuchon-Da Fonseca
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; INSERM UMR 1106, INS, 27 Bd Jean Moulin, 13385 Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France
| | - Lisa Vaugier
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; Service de Neurophysiologie Clinique, APHM, Hôpital Nord, 13015 Marseille, France
| | - Martine Gavaret
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; INSERM UMR 1106, INS, 27 Bd Jean Moulin, 13385 Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France
| | - Fabrice Bartolomei
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; INSERM UMR 1106, INS, 27 Bd Jean Moulin, 13385 Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France; Hôpital Henri Gastaut, Etablissement Hospitalier Spécialisé dans le traitement des Epilepsies, 300 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Aileen McGonigal
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; INSERM UMR 1106, INS, 27 Bd Jean Moulin, 13385 Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France.
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