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Salpekar JA, Ma GJ, Mietchen J, Mani J, Jones JE. Treatment of Comorbid Anxiety and Epilepsy. J Neuropsychiatry Clin Neurosci 2023; 35:218-227. [PMID: 36785943 DOI: 10.1176/appi.neuropsych.20220116] [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] [Indexed: 02/15/2023]
Abstract
Objective: Anxiety is among the most common psychiatric illnesses, and it commonly co-occurs with epilepsy. This review of the existing literature on anxiety comorbid with epilepsy aims to generate new insights into strategies for assessment and treatment. Methods: The authors conducted a narrative literature review to select key publications that help clarify the phenomenology and management of comorbid anxiety and epilepsy. Results: Anxiety symptoms may be relevant even if the criteria for a diagnosis of an anxiety disorder are not met. Associating specific seizure types or seizure localization with anxiety symptoms remains difficult; however, the amygdala is a brain region commonly associated with seizure foci and panic or fear sensations. The hypothalamic-pituitary-adrenal axis may also be relevant for anxiety symptoms, particularly for the selection of treatments. Nonpharmacological treatment is appropriate for anxiety comorbid with epilepsy, particularly because relaxation techniques may reduce hypersympathetic states, which improve symptoms. Medication options include antidepressants and anticonvulsants that may have efficacy for anxiety symptoms. Benzodiazepines are a good choice to address this comorbid condition, although side effects may limit utility. Conclusions: Ultimately, there are numerous treatment options, and although there is a limited evidence base, quality of life may be improved with appropriate treatment for individuals experiencing comorbid anxiety and epilepsy.
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Affiliation(s)
- Jay A Salpekar
- Johns Hopkins University School of Medicine, Baltimore (Salpekar); Department of Psychiatry, Brigham and Women's Hospital, Boston (Ma); Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison (Mietchen, Jones); Howard University College of Medicine, Washington, D.C. (Mani)
| | - Grace J Ma
- Johns Hopkins University School of Medicine, Baltimore (Salpekar); Department of Psychiatry, Brigham and Women's Hospital, Boston (Ma); Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison (Mietchen, Jones); Howard University College of Medicine, Washington, D.C. (Mani)
| | - Jonathan Mietchen
- Johns Hopkins University School of Medicine, Baltimore (Salpekar); Department of Psychiatry, Brigham and Women's Hospital, Boston (Ma); Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison (Mietchen, Jones); Howard University College of Medicine, Washington, D.C. (Mani)
| | - Jeremy Mani
- Johns Hopkins University School of Medicine, Baltimore (Salpekar); Department of Psychiatry, Brigham and Women's Hospital, Boston (Ma); Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison (Mietchen, Jones); Howard University College of Medicine, Washington, D.C. (Mani)
| | - Jana E Jones
- Johns Hopkins University School of Medicine, Baltimore (Salpekar); Department of Psychiatry, Brigham and Women's Hospital, Boston (Ma); Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison (Mietchen, Jones); Howard University College of Medicine, Washington, D.C. (Mani)
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Zinchuk M, Kustov G, Pashnin E, Gersamia A, Rider F, Voinova N, Popova S, Sviatskaia E, Yakovlev A, Guekht A. Not always that EASI: Validating the Russian version of the epilepsy anxiety survey instrument and its brief counterpart. Epilepsy Behav 2022; 133:108801. [PMID: 35753109 DOI: 10.1016/j.yebeh.2022.108801] [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: 03/14/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop a Russian version of The Epilepsy Anxiety Survey Instrument (EASI) and assess its psychometric properties in a Russian sample of patients with epilepsy (PWE). To compare the brief version of EASI with the General Anxiety Disorder-7 (GAD-7) - the most common tool for a rapid anxiety screening. METHODS The study sample consisted of 181 consecutive Russian-speaking PWE. The Mini-International Neuropsychiatric Interview was used as a gold standard for diagnosing anxiety disorders. All patients completed the set of questionnaires - the Russian version of the GAD-7, The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and the EASI. Internal reliability of the EASI and brEASI, convergent and divergent validity of the brEASI with the GAD-7 and the NDDI-E, and factor structure assessment were performed. RESULTS Among 33.7% of patients with epilepsy diagnosed with any anxiety disorder, 16% had panic disorder, 10.5% had agoraphobia, 8.3% had social anxiety disorder, 21.0% had generalized anxiety disorder, and 13.3% had several comorbid anxiety disorders. The EASI factor structure differed from the original, revealing an additional factor with two items. Nevertheless, the brief version (brEASI) showed excellent screening properties - the AUC to detect any anxiety disorder was 0.916 with the optimal cutoff point > 7 points. CONCLUSION The brEASI performed better than the GAD-7 in our sample and, therefore, may be considered a first-line screening tool for anxiety disorders in PWE.
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Affiliation(s)
- Mikhail Zinchuk
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation.
| | - Georgii Kustov
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Evgenii Pashnin
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Anna Gersamia
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Flora Rider
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Nadezhda Voinova
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Sophia Popova
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Ekaterina Sviatskaia
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation
| | - Alexander Yakovlev
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation; Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova ul., 5A, Moscow, Russian Federation
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Donskaya ul., 43, Moscow, Russian Federation; Pirogov Russian National Research Medical University, Ostrovitianova ul., 1, Moscow, Russian Federation
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Rauh R, Schulze-Bonhage A, Metternich B. Assessment of Anxiety in Patients With Epilepsy: A Literature Review. Front Neurol 2022; 13:836321. [PMID: 35547374 PMCID: PMC9081800 DOI: 10.3389/fneur.2022.836321] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/16/2022] [Indexed: 01/07/2023] Open
Abstract
Objective Approximately 20% of people with epilepsy (PWE) suffer from anxiety. These fears are quite diverse and may manifest periictally or interictally, be part of the seizure's semiology, or an expression of reactive psychological distress from seizures themselves. Our review addresses the question of what screening tools are used in clinical care and epileptological research to capture the complexity of epilepsy-specific anxieties. Method On 2021/11/11, we entered a search string in PubMed that covered our research interest as completely as possible. We also screened the bibliographies of our findings and followed PubMed's recommendations. From the assessments we found in the included studies, we extracted domains that represent the range of manifestations of anxiety, in order to compare the tools and to discuss to what extent they are suitable for assessing epilepsy-specific anxieties. Results We screened 1,621 abstracts. In total, we identified 24 different anxiety assessments. In addition to the psychiatric assessments in use, we found 7 tools that were designed to assess epilepsy-specific anxieties. The latter focus on different aspects of epilepsy-specific anxieties. In some cases, the conceptual frameworks are not sufficiently transparent or divergent. Conclusion Because a diagnosis of epilepsy can result in, or seizures may appear as, anxiety, it is important to better understand this psychological burden and address it therapeutically, if necessary. There is a need for screening tools that integrate specific points of a variety of assessments, so as to cover the broad range of epilepsy-specific fears. None of the assessments we found meets this integrative perspective. At the same time, the appropriate design of such a required tool presupposes a conceptual framework of what should be considered as epilepsy-specific anxiety.
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Affiliation(s)
- Raphael Rauh
- Epilepsy Center, University Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Birgitta Metternich
- Epilepsy Center, University Medical Center, University of Freiburg, Freiburg, Germany
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An aqueous extract of Khaya senegalensis (Desv.) A. Juss. (Meliaceae) prevents seizures and reduces anxiety in kainate-treated rats: modulation of GABA neurotransmission, oxidative stress, and neuronal loss in the hippocampus. Heliyon 2022; 8:e09549. [PMID: 35663738 PMCID: PMC9160348 DOI: 10.1016/j.heliyon.2022.e09549] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/28/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022] Open
Abstract
Ethnopharmacological relevance Temporal lobe epilepsy is the most common form of drug-resistant epilepsy. Therefore, medicinal plants provide an alternative source for the discovery of new antiepileptic drugs. Aim of the study This study was aimed at investigating the antiepileptic- and anxiolytic-like effects of an aqueous extract of Khaya senegalensis (K. senegalensis) in kainate-treated rats. Methods Seventy-two rats received a single dose of kainate (12 mg/kg) intraperitoneally. Those that exhibited two hours of status epilepticus were selected and monitored for the first spontaneous seizure. Then, animals that developed seizures were divided into 6 groups of 8 rats each and treated twice daily for 14 days as follows: negative control group received per os (p.o.) distilled water (10 ml/kg); two positive control groups received either sodium valproate (300 mg/kg, p.o.) or phenobarbital (20 mg/kg, p.o.); and three test groups received different doses of the extract (50, 100, and 200 mg/kg, p.o.). In addition, a group of 8 normal rats (normal control group) received distilled water (10 ml/kg, p.o.). During the treatment period, the animals were video-monitored 12 h/day for behavioral seizures. At the end of the treatment period, animals were subjected to elevated plus-maze and open field tests. Thereafter, rats were euthanized for the analysis of γ-aminobutyric acid (GABA) concentration, oxidative stress status, and neuronal loss in the hippocampus. Results The aqueous extract of K. senegalensis significantly reduced spontaneous recurrent seizures (generalized tonic-clonic seizures) and anxiety-like behavior compared to the negative control group. These effects were more marked than those of sodium valproate or phenobarbital. Furthermore, the extract significantly increased GABA concentration, alleviated oxidative stress, and mitigated neuronal loss in the dentate gyrus of the hippocampus. Conclusion These findings suggest that the aqueous extract of K. senegalensis possesses antiepileptic- and anxiolytic-like effects. These effects were greater than those of sodium valproate or phenobarbital, standard antiepileptic drugs. Furthermore, these effects are accompanied by neuromodulatory and antioxidant activities that may be related to their behavioral effects. These data justify further studies to identify the bioactive molecules present in the extract for possible future therapeutic development and to unravel their mechanisms of action.
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Validation of the Generalized Anxiety Disorder-7 (GAD-7) in Russian people with epilepsy. Epilepsy Behav 2021; 123:108269. [PMID: 34500434 DOI: 10.1016/j.yebeh.2021.108269] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess the capacity of Generalized Anxiety Disorder-7 (GAD-7) to detect anxiety disorders in a Russian sample of patients with epilepsy and to validate this instrument for rapid screening of anxiety in these patients. METHODS Study included 233 patients with epilepsy, both inpatients and outpatients. For all patients Mini-International Neuropsychiatric Interview was conducted as a gold standard for diagnosis of mental disorders. All patients also completed the questionnaires - the Russian version of GAD-7 and Hospital Anxiety and Depression Scale (HADS) to assess convergent validity. Chi-square and Fisher's exact tests were used to compare categorical variables, and the Mann-Whitney test was used for the quantitative ones. Internal consistency was assessed using Cronbach's alpha, Cronbach's alpha at point deletion, and corrected point-to-point correlation. ROC analysis was used to evaluate the properties of the GAD-7 to determine anxiety disorders. RESULTS Among 97 (41.6%) patients with epilepsy diagnosed with any anxiety disorders, 42 (18%) had panic disorder, 37 (15.9%) had agoraphobia, 17 (7.3%) had social anxiety disorder, and 64 (27.5%) had generalized anxiety disorder; 42 patients (18%) showed a combination of several anxiety disorders. The overall GAD-7 score was similar to other epilepsy studies, but higher cutoff scores characterize our sample. The scale performed well in detecting any anxiety disorder with the AUC of 0.866 and the optimal cutoff point > 8 points, and in detecting GAD with AUC = 0.922 and the optimal cutoff point > 9 points, showing overall acceptable sensitivity. CONCLUSION Russian version of the GAD-7 could be used as a screening tool for any anxiety disorders in PWE with the optimal cutoff score > 8 points.
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Microwave-assisted synthesis of 2,5-disubstituted pyrimidine derivatives via Buchwald-Hartwig amination. Tetrahedron Lett 2020. [DOI: 10.1016/j.tetlet.2019.151406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Morano A, Palleria C, Citraro R, Nesci V, De Caro C, Giallonardo AT, De Sarro G, Russo E, Di Bonaventura C. Immediate and controlled-release pregabalin for the treatment of epilepsy. Expert Rev Neurother 2019; 19:1167-1177. [PMID: 31623493 DOI: 10.1080/14737175.2019.1681265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Epilepsy is a common neurological disease requiring complex therapies, which are unable to achieve seizure control in 30% of patients. Poor adherence has been recognized as a possible determinant of drug-resistance. Prolonged-release formulations of antiepileptic drugs might help increase adherence and minimize side effects.Areas covered: Pregabalin (PGB) has peculiar pharmacodynamics and almost ideal pharmacokinetics, except for a short half-life and therefore requiring multiple daily dosing. PGB immediate-release (IR) is effective in focal-onset epilepsy (FOE), neuropathic pain, generalized anxiety disorder, and fibromyalgia, despite some tolerability issues, especially at higher doses. The controlled-release formulation (CR) shares PGB IR advantages and requires slight dose adjustments to guarantee bioavailability. In 2014, PGB CR (165 and 330 mg/day) failed to prove superior to placebo in a randomized placebo-controlled trial on 323 subjects with drug-resistant FOE, although it was just as tolerable. Therefore, PGB CR is not currently licensed for epilepsy.Expert opinion: Considering the disappointing results of the only controlled trial, PGB CR is unlikely to become an established epilepsy treatment anytime soon. Nevertheless, given its peculiar properties and potential advantages, PGB (in either formulation) should be further evaluated in specific populations of patients, especially fragile subjects with several comorbidities and complex polytherapies.
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Affiliation(s)
- Alessandra Morano
- Neurology Unit, Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Caterina Palleria
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Rita Citraro
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Valentina Nesci
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Carmen De Caro
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | | | | | - Emilio Russo
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Carlo Di Bonaventura
- Neurology Unit, Department of Human Neurosciences, "Sapienza" University, Rome, Italy
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Abstract
PURPOSE OF REVIEW To review recent studies which assess comorbidity, that is, prevalence of co-occurrence, relationships and treatment implications between anxiety disorders and various medical illnesses. RECENT FINDINGS The prevalence rates of anxiety disorders in patients with medical illnesses are high, with percentage up to 29% in patients with epilepsy, 48.9% in patients with multiple sclerosis, 30.1% in patients with Parkinson's disease, 30% in patients with cardiovascular disease, 47.0% in patients with diabetes mellitus, and so on. The most prevalent anxiety disorders among individuals with somatic illnesses are generalized anxiety disorder and panic disorder. In addition, various medical illnesses are highly prevalent in samples of patients with anxiety disorders. Anxiety disorders co-occurring with medical illnesses have a number of clinical implications, including a greater severity and negative impact on treatment outcome of both medical illnesses and anxiety disorders. SUMMARY It is important for clinicians to look for possible anxiety disorders among patients with medical illnesses. Further studies need to ascertain how to best treat individuals suffering from both anxiety disorders and medical illnesses, and focus on the issue of causality when these conditions co-occur.
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Yan L, Deng M, Chen A, Li Y, Zhang W, Du ZY, Dong CZ, Meunier B, Chen H. Synthesis of N-pyrimidin[1,3,4]oxadiazoles and N-pyrimidin[1,3,4]-thiadiazoles from 1,3,4-oxadiazol-2-amines and 1,3,4-thiadiazol-2-amines via Pd-catalyzed heteroarylamination. Tetrahedron Lett 2019. [DOI: 10.1016/j.tetlet.2019.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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