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Pennington BRT, Holzer KJ, Fritz BA, Haroutounian S, Xu KY, Tedder A, Kronzer A, Avidan MS, Lenze EJ. Brain-Hazardous Medications and Potential Subadequate Antidepressant Dosing in Older Surgical Patients Receiving Home Antidepressants: An Observational Study of a Large US Health System. Anesth Analg 2024; 139:155-164. [PMID: 38507476 PMCID: PMC11182724 DOI: 10.1213/ane.0000000000006952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Older surgical patients with depression often experience poor postoperative outcomes. Poor outcomes may stem from brain-hazardous medications and subadequate antidepressant dosing. METHODS This was a retrospective, observational cohort study covering the period between January 1, 2021 and December 31, 2021. Patients ≥60 years of age who underwent inpatient surgery and had an overnight stay at an integrated academic health care system comprising 14 hospitals were eligible. We analyzed the prevalence of home central nervous system (CNS)-active potentially inappropriate medication (PIM) and potential subadequate antidepressant dosing in older surgical patients receiving home antidepressants. Univariable and multivariable regression models were used to identify factors associated with home CNS-active PIM prescribing and potential subadequate antidepressant dosing. Additionally, outcomes were compared among patients receiving and not receiving CNS-active PIMs and patients receiving and not receiving subadequate antidepressant dosing. RESULTS A total of 8031 patients were included in this study (47% female, mean age = 70 years) of whom 2087 (26%) were prescribed antidepressants. Roughly one-half (49%, 95% confidence interval [CI], 46.5-50.1) of patients receiving home antidepressants were also receiving ≥1 CNS-active PIM and 29% (95% CI, 27.0-29.3) were receiving a potential subadequate dose. Factors associated with an increased likelihood of receiving a home CNS-active PIM included female sex (adjusted odds ratio [aOR], 1.46), anxiety (aOR, 2.43), asthma or chronic obstructive pulmonary disease (aOR, 1.39), and serotonin-norepinephrine reuptake inhibitor use (aOR, 1.54). Patients aged ≥75 years (aOR, 1.57), black race (aOR, 1.48) and those with congestive heart failure (aOR, 1.33) were more likely to be prescribed a potential subadequate antidepressant dose. Patients receiving potential subadequate antidepressant doses were discharged home less often (64% vs 73%), had a longer hospital length of stay (9 days vs 7 days), and a higher mortality rate (18% vs 10%) compared to patients receiving adequate home antidepressant doses (P-value for all <0.01). No differences in these outcomes were found among patients receiving home antidepressants with or without CNS-active PIMs. CONCLUSIONS Older surgical patients receiving antidepressants are frequently prescribed brain-hazardous medications and potentially subadequate antidepressant doses. Those receiving subadequate antidepressant doses may be at risk for worse postoperative outcomes compared to patients receiving adequate doses. The role of preoperative medication optimization to improve outcomes for older surgical patients should be evaluated.
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Affiliation(s)
| | - Katherine J. Holzer
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Bradley A. Fritz
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Kevin Y. Xu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Amanda Tedder
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Alex Kronzer
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Michael S. Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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Hernandez Poblete N, Gay F, Salvo F, Micoulaud-Franchi JA, Bienvenu T, Coelho J, Aupy J. Resective epilepsy surgery and its impact on depression in adults: a systematic review, meta-analysis, and implications for future research. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-333073. [PMID: 38443157 DOI: 10.1136/jnnp-2023-333073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND How epilepsy surgery influences the bidirectional relationship of epilepsy and depression remains poorly defined. METHOD For a better understanding of this question, we conducted a systematic review and meta-analysis of risk ratio on depression prevalence before and after epilepsy surgery, using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Three databases were comprehensively screened for all studies assessing depression before and after resective surgery in adult epileptic patients until 8 October 2022. Studies were included if depression was assessed before and after epilepsy surgery regardless of the time of follow-up. A total of 1917 studies were screened for eligibility and 91 full-texts up for inclusion; 35 studies were finally included, 25 studies and 2563 patients were included in main meta-analysis and 10 for exploratory analysis. Risk of bias was assessed using Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) from Cochrane. To derive the pooled depression rates before and after surgery, a meta-analysis with inversed-variance was performed using random-effects logistic models with Peto's correction and a 95% CI. Heterogeneity was assessed with Cochran's Q-test along with its derived measure of inconsistency I2. RESULTS Overall, the depression rates before and after resective epilepsy surgery were 0.70 (0.53 to 0.91) 95% CI, suggesting that the rate of depression at last follow-up evaluation tends to decrease after Resective Epilepsy Surgery (RES). Subgroup analysis suggest a positive long-term effect appears with a significant lower rates of depression already 6 months (0.61 (0.38 to 0.98)), after surgery which is maintained over time after 1 year (0.53 (0.31 to 0.90)), and after 2 years (0.62 (0.42 to 0.92)). CONCLUSION This important finding should be taken in consideration before resective surgery for drug-resistant epilepsies. However, prospective studies should be conducted to characterise which patient, at the individual level, might be at risk of de novo or worsening of depression. PROSPERO REGISTRATION NUMBER CRD42022355386.
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Affiliation(s)
| | - Florian Gay
- CERPAD, CH Charles Perrens, Bordeaux, Aquitaine, France
| | - Francesco Salvo
- INSERM, Pharmaco-epidemiology Team, Université de Bordeaux, Bordeaux, France
| | - Jean-Arthur Micoulaud-Franchi
- Clinical Neurosciences, CHU de Bordeaux, Bordeaux, Nouvelle-Aquitaine, France
- CNRS, SANPSY, Université de Bordeaux, Bordeaux, France
| | - Thomas Bienvenu
- CERPAD, CH Charles Perrens, Bordeaux, Aquitaine, France
- INSERM, Neurocentre Magendie, Université de Bordeaux, Bordeaux, France
| | - Julien Coelho
- Clinical Neurosciences, CHU de Bordeaux, Bordeaux, Nouvelle-Aquitaine, France
| | - Jerome Aupy
- Clinical Neurosciences, CHU de Bordeaux, Bordeaux, Nouvelle-Aquitaine, France
- CNRS, IMN, Université de Bordeaux, Bordeaux, France
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Fritz BA, Tellor Pennington BR, Dalton C, Horan C, Palanca BJ, Schweiger JA, Griffin L, Tumwesige W, Willie JT, Farber NB. Ketamine for postoperative avoidance of depressive symptoms: the K-PASS feasibility randomised trial. BJA OPEN 2024; 9:100245. [PMID: 38179107 PMCID: PMC10764255 DOI: 10.1016/j.bjao.2023.100245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024]
Abstract
Background Surgical patients with previous depression frequently experience postoperative depressive symptoms. This study's objective was to determine the feasibility of a placebo-controlled trial testing the impact of a sustained ketamine infusion on postoperative depressive symptoms. Methods This single-centre, triple-blind, placebo-controlled randomised clinical trial included adult patients with depression scheduled for inpatient surgery. After surgery, patients were randomly allocated to receive ketamine (0.5 mg kg-1 over 10 min followed by 0.3 mg kg-1 h-1 for 3 h) or an equal volume of normal saline. Depressive symptoms were measured using the Montgomery-Asberg Depression Rating Scale. On post-infusion day 1, participants guessed which intervention they received. Feasibility endpoints included the fraction of patients approached who were randomised, the fraction of randomised patients who completed the study infusion, and the fraction of scheduled depression assessments that were completed. Results In total, 32 patients were allocated a treatment, including 31/101 patients approached after a protocol change (31%, 1.5 patients per week). The study infusion was completed without interruption in 30/32 patients (94%). In each group, 7/16 participants correctly guessed which intervention they received. Depression assessments were completed at 170/192 scheduled time points (89%). Between baseline and post-infusion day 4 (pre-specified time point of interest), median depressive symptoms decreased in both groups, with difference-in-differences of -1.00 point (95% confidence interval -3.23 to 1.73) with ketamine compared with placebo. However, the between-group difference did not persist at other time points. Conclusions Patient recruitment, medication administration, and clinical outcome measurement appear to be highly feasible, with blinding maintained. A fully powered trial may be warranted. Clinical trial registration NCT05233566.
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Affiliation(s)
- Bradley A. Fritz
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Catherine Dalton
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Christine Horan
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ben J.A. Palanca
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Julie A. Schweiger
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Logan Griffin
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Wilberforce Tumwesige
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jon T. Willie
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Nuri B. Farber
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
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Fritz BA, Tellor Pennington BR, Palanca BJ, Schweiger JA, Willie JT, Farber NB. Protocol for the Ketamine for Postoperative Avoidance of Depressive Symptoms (K-PASS) feasibility study: A randomized clinical trial. F1000Res 2022; 11:510. [PMID: 37483552 PMCID: PMC10362376 DOI: 10.12688/f1000research.121529.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 07/25/2023] Open
Abstract
Background: Postoperative depressive symptoms are associated with pain, readmissions, death, and other undesirable outcomes. Ketamine produces rapid but transient antidepressant effects in the perioperative setting. Longer infusions confer lasting antidepressant activity in patients with treatment-resistant depression, but it is unknown whether a similar approach may produce a lasting antidepressant effect after surgery. This protocol describes a pilot study that will assess the feasibility of conducting a larger scale randomized clinical trial addressing this knowledge gap. Methods: This single-center, double-blind, placebo-controlled pilot trial involves the enrollment of 32 patients aged 18 years or older with a history of depression scheduled for surgery with planned intensive care unit admission. On the first day following surgery and extubation, participants will be randomized to an intravenous eight-hour infusion of either ketamine (0.5 mg kg -1 over 10 minutes followed by a continuous rate of 0.3 mg kg -1 h -1) or an equal volume of normal saline. Depressive symptoms will be quantified using the Montgomery-Asberg Depression Rating Scale preoperatively and serially up to 14 days after the infusion. To detect ketamine-induced changes on overnight sleep architecture, a wireless headband will be used to record electroencephalograms preoperatively, during the study infusion, and after infusion. The primary feasibility endpoints will include the fraction of patients approached who enroll, the fraction of randomized patients who complete the study infusion, and the fraction of randomized patients who complete outcome data collection. Conclusions: This pilot study will evaluate the feasibility of a future large comparative effectiveness trial of ketamine to reduce depressive symptoms in postsurgical patients. Registration: K-PASS is registered on ClinicalTrials.gov: NCT05233566; registered February 10, 2022.
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Affiliation(s)
- Bradley A. Fritz
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
| | | | - Ben J.A. Palanca
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
| | - Julie A. Schweiger
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
| | - Jon T. Willie
- Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
| | - Nuri B. Farber
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
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Gravel V, Boucher O, Citherlet D, Hébert-Seropian B, Bouthillier A, Nguyen DK. Psychological status after insulo-opercular resection in patients with epilepsy: Depression, anxiety, and quality of life. Epilepsy Behav 2021; 118:107919. [PMID: 33770610 DOI: 10.1016/j.yebeh.2021.107919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
Insular epilepsy is increasingly recognized in epilepsy surgery centers. Recent studies suggest that resection of an epileptogenic zone that involves the insula as a treatment for drug-resistant seizures is associated with good outcomes in terms of seizure control. However, despite the existing evidence of a role of the insula in emotions and affective information processing, the long-term psychological outcome of patients undergoing these surgeries remain poorly documented. A group of 27 adults (18 women) who underwent an insulo-opercular resection (in combination with a part of the temporal lobe in 10, and of the frontal lobe in 5) as part of epilepsy surgery at our center between 2004 and 2019 completed psychometric questionnaires to assess depression (Beck Depression Inventory - 2nd edition; BDI-II), anxiety (State-Trait Anxiety Inventory, Trait Version; STAI-T), and quality of life (Patient Weighted Quality of Life In Epilepsy; QOLIE-10-P). Scores were compared to those of patients who had standard temporal lobe epilepsy (TLE) surgery with similar socio-demographic and disease characteristics. Seizure control after insular epilepsy surgery was comparable to that observed after TLE surgery, with a majority of patients reporting being seizure free (insular: 63.0%; temporal: 63.2%) or having rare disabling seizures (insular: 7.4%; temporal: 18.4%) at the time of questionnaire completion. Statistical comparisons revealed no significant group difference on scores of depression, anxiety, or quality of life. Hemisphere or extent of insular resection had no significant effect on the studied variables. In the total sample, employment status and seizure control, but not location of surgery, significantly predicted quality of life. Self-reported long-term psychological status after insulo-opercular resection as part of epilepsy surgery thus appears to be similar to that observed after TLE surgery, which is commonly performed in epilepsy surgery centers.
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Affiliation(s)
- Victoria Gravel
- Département de psychologie, Université de Montréal, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada
| | - Olivier Boucher
- Département de psychologie, Université de Montréal, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada; Service de psychologie, Centre hospitalier de l'Université de Montréal, Canada
| | - Daphné Citherlet
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada; Département de neurosciences, Université de Montréal, Canada
| | - Benjamin Hébert-Seropian
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada; Département de psychologie, Université du Québec à Montréal, Canada
| | - Alain Bouthillier
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada; Service de neurochirurgie, Centre hospitalier de l'Université de Montréal, Canada
| | - Dang Khoa Nguyen
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada; Département de neurosciences, Université de Montréal, Canada; Service de neurologie, Centre hospitalier de l'Université de Montréal, Canada.
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Resective epilepsy surgery in patients aged 50years and older - a retrospective study regarding seizure outcome, memory performance, and psychopathology. Epilepsy Behav 2021; 118:107933. [PMID: 33839451 DOI: 10.1016/j.yebeh.2021.107933] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To assess clinical and demographic characteristics in two cohorts of elderly patients with drug-resistant focal epilepsy, undergoing resective epilepsy surgery (RES). Further, to determine seizure, neuropsychological, and mental health outcomes after RES and evaluate possible influencing factors. METHODS Consecutive patients aged ≥50 years with temporal lobe epilepsy (TLE) who underwent curative RES in the Hamburg epilepsy surgery program (2004-2017) were identified. Data were retrospectively analyzed. Seizure outcome was classified according to ILAE and Engel outcome scales in patients with first-time surgeries and with reoperations. Previously reported predictors of the seizure outcome were evaluated using regression analyses. Changes in verbal memory were assessed for patients with complete pre- and postoperative datasets (n=30) using repeated-measures analysis of variance. For evaluation of possible predictors of psychopathologic changes after RES a regression analysis was conducted. RESULTS Fifty-one elderly patients underwent RES of the temporal lobe, including twelve aged ≥60 years, and five with reoperations. After one year, 65% of the patients with first-time surgeries were seizure free and 91% had a favorable outcome. At last follow-up, 49% were seizure free since surgery. Three reoperated patients had an Engel I outcome. Seizure outcome was not dependent on age at surgery, duration of epilepsy, or other evaluated variables. There was no significant decline in the memory performance after surgery. Significant improvements in mental health were found. CONCLUSION RES for drug-resistant TLE is safe, effective, and improves mental health also in patients aged ≥ 50 years. Thus, it should be evaluated as the treatment of choice also in this age group.
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Reinert J, Parmentier BL. Effect of Perioperative Ketamine on Postoperative Mood and Depression: A Review of the Literature. Expert Rev Clin Pharmacol 2020; 14:25-32. [PMID: 33225765 DOI: 10.1080/17512433.2021.1855142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction: Ketamine is being increasingly utilized in a variety of patient care settings, ranging from high acuity inpatient scenarios to the outpatient management of select mental health diagnoses. Postoperative patients are at an increased risk of developing a depressed state, and though ketamine's ability to improve mood is well documented in the literature, the relationship between perioperative ketamine and postoperative mood has not been fully elucidated. Areas covered: The purpose of this review was to determine ketamine's ability to improve mood and depression scores in the perioperative setting. A comprehensive literature review was conducted using PubMed, MEDLINE, Scopus, ProQuest, Web of Science, and CINAHL using the following search terminology: 'ketamine' AND 'perioperative' OR 'surgery' AND 'mood' OR 'depression.' Seven clinical trials are evaluated in this review. Expert opinion: As the use of ketamine continues to expand, clinicians must be cognizant of the fact that many of its desired effects are likely to overlap. Patients outside of the perioperative setting may benefit from using ketamine as an analgesic or sedative, as appropriate, to mitigate mood and depression. Ketamine, when administered as an anesthetic in the perioperative setting, seemingly has effect on postoperative mood and depression. Further studies that are sufficient.
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Affiliation(s)
- Justin Reinert
- Fisch College of Pharmacy, The University of Texas at Tyler , Tyler, TX, USA
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Lang JD, Grell L, Hagge M, Onugoren MD, Gollwitzer S, Graf W, Schwarz M, Coras R, Blümcke I, Sommer B, Rössler K, Buchfelder M, Schwab S, Stefan H, Hamer HM. Long-term outcome after epilepsy surgery in older adults. Seizure 2018; 57:56-62. [PMID: 29604610 DOI: 10.1016/j.seizure.2018.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/03/2018] [Accepted: 02/22/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The incidence of epilepsy in older adults is growing, as does the incidence of comorbidities. Therefore, when it comes to epilepsy surgery in medically intractable epilepsy, age is often seen as a limiting factor. To investigate the outcome after epilepsy surgery in a population of older adults, we compared the benefit for patients aged 50-59 years with those aged 60 years and older in respect of efficacy and safety. METHOD Patients aged ≥50 years with medically intractable epilepsy who underwent epilepsy surgery from 1990 to 2013 were selected from the database of a German epilepsy center. All of them received a standardised and detailed presurgical diagnostic evaluation. Follow-up included at least four scheduled visits with EEG, MRI and neuropsychological testing. Outcome was assessed using the Engel outcome scale. RESULTS 79 patients aged between 50 and 67 years were followed-up for a median of 4.7 years (2-16 years). 68% of patients were free of disabling seizures (Engel class I, ≥60 years: 75%) and 58% were seizure-free (Engel class IA, ≥60 years: 70%). 90% of our patients suffered from temporal lobe epilepsy (TLE), 9% from frontal lobe epilepsy (FLE) and one occipital lobe epilepsy (OLE). After surgery, 9% discontinued or tapered their medication. Permanent surgical complications occurred in 10% of cases and transient neurological deficits were seen in 11%. Older patients had a higher risk for postoperative hygroma (≥60 years 15%; <60 years 8%) and were more prone to postoperative memory deficits (≥60 years 45%), especially after resection of the dominant temporal lobe. Verbal and figural memory testing did not differ significantly between the groups. CONCLUSIONS The results support the view that in selected older patients, epilepsy surgery shows equal or even higher success rates as compared to younger patients. However, patients of older age may be at greater risk for postoperative hygroma and memory deficits, especially after dominant temporal lobe resections.
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Affiliation(s)
- Johannes D Lang
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
| | - Laura Grell
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Mareike Hagge
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Müjgan Dogan Onugoren
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Stephanie Gollwitzer
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Wolfgang Graf
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Michael Schwarz
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Roland Coras
- Institute of Neuropathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Ingmar Blümcke
- Institute of Neuropathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Björn Sommer
- Department of Neurosurgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Karl Rössler
- Department of Neurosurgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Stefan Schwab
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Hermann Stefan
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Hajo M Hamer
- Epilepsy Centre, Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
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Kasper BS, Vaccarella M. Is epilepsy surgery a threat to a patient's self? A conversation. Epilepsy Behav 2017; 75:264-268. [PMID: 28827042 DOI: 10.1016/j.yebeh.2017.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/19/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Burkhard S Kasper
- Friedrich-Alexander University Erlangen-Nuremberg, Dept. Neurology, Epilepsy Center, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Maria Vaccarella
- Lecturer in Medical Humanities, Department of English, University of Bristol, 3/5 Woodland Road, Bristol, BS8 1TB, United Kingdom.
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d’ Orio P, Pelliccia V, Gozzo F, Cardinale F, Castana L, Lo Russo G, Bottini G, Scarpa P, Cossu M. Epilepsy surgery in patients older than 50 years: Effectiveness, safety, and predictors of outcome. Seizure 2017. [DOI: 10.1016/j.seizure.2017.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Scott AJ, Sharpe L, Hunt C, Gandy M. Anxiety and depressive disorders in people with epilepsy: A meta-analysis. Epilepsia 2017; 58:973-982. [PMID: 28470748 DOI: 10.1111/epi.13769] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Comorbid anxiety and depressive disorders in people with epilepsy (PWE) are highly prevalent and associated with various adverse outcomes. However, the prevalence of anxiety disorders in PWE across studies is highly variable. Our aim was to estimate the prevalence and moderating factors of anxiety and depressive disorders in PWE. METHODS Following prospective registration (PROSPERO; CRD42015027101), electronic databases were searched for studies that reported the prevalence of both anxiety and depressive disorders in samples of PWE up until July 2016. Data extracted included the prevalence of anxiety and depressive disorders, and moderators of interest (e.g., method of diagnosis, prevalence of drug-resistant epilepsy). Meta-analysis of the overall pooled prevalence of anxiety and depressive disorders was conducted. RESULTS The search yielded 8,636 unique articles, with 27 studies meeting final inclusion criteria (3,221 PWE). The pooled prevalence of anxiety and depressive disorders was 20.2% (95% confidence interval [CI] 15.3-26.0%) and 22.9% (95% CI 18.2-28.4%), respectively. Method of diagnosis significantly moderated anxiety disorder prevalence (Q statistic with one degree of freedom [Q1 ] = 36.29, p < 0.0001); the prevalence of anxiety disorders based on unstructured clinician assessment was 8.1% (95% CI 5.7-11.4%), compared to a prevalence of 27.3% (95% CI 22.1-33.3%) based on a structured clinical interview. There were no significant moderators of depressive disorder diagnosis. SIGNIFICANCE Findings suggest the prevalence of anxiety and depressive disorders in PWE are equivalent, and variability in prevalence of anxiety disorders across studies can be attributed partly to the method of diagnosis. These findings also challenge widely held assumptions that psychiatric comorbidity is more common in people with drug-resistant epilepsy. Future research should aim to improve the detection and management of these comorbidities in PWE, particularly anxiety disorders, which have remained relatively neglected.
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Affiliation(s)
- Amelia J Scott
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Caroline Hunt
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Milena Gandy
- Department of Psychology, eCentreClinic, Macquarie University, Sydney, New South Wales, Australia
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Yrondi A, Arbus C, Valton L, Schmitt L. Troubles de l’humeur et chirurgie de l’épilepsie : une revue de la littérature. Encephale 2017; 43:154-159. [DOI: 10.1016/j.encep.2016.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/12/2016] [Accepted: 02/01/2016] [Indexed: 11/08/2022]
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Belcastro V, Pisani LR, Bellocchi S, Casiraghi P, Gorgone G, Mula M, Pisani F. Brain tumor location influences the onset of acute psychiatric adverse events of levetiracetam therapy: an observational study. J Neurol 2017; 264:921-927. [PMID: 28315958 DOI: 10.1007/s00415-017-8463-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
To explore possible correlations among brain lesion location, development of psychiatric symptoms and the use of antiepileptic drugs (AEDs) in a population of patients with brain tumor and epilepsy. The medical records of 283 patients with various types of brain tumor (161 M/122 F, mean age 64.9 years) were analysed retrospectively. Patients with grade III and IV glioma, previous history of epileptic seizures and/or psychiatric disorders were excluded. Psychiatric symptoms occurring after initiation of AED therapy were considered as treatment emergent psychiatric adverse events (TE-PAEs) if they fulfilled the following conditions: (1) onset within 4 weeks after the beginning of AED therapy; (2) disappearance on drug discontinuation; (3) absence of any other identified possible concurrent cause. The possible influence of the following variables were analysed: (a) AED drug and dose; (b) location and neuroradiologic features of the tumor, (c) location and type of EEG epileptic abnormalities, (d) tumor excision already or not yet performed; (e) initiation or not of radiotherapy. TE-PAEs occurred in 27 of the 175 AED-treated patients (15.4%). Multivariate analysis showed a significant association of TE-PAEs occurrence with location of the tumor in the frontal lobe (Odds ratio: 5.56; 95% confidence interval 1.95-15.82; p value: 0.005) and treatment with levetiracetam (Odds ratio: 3.61; 95% confidence interval 1.48-8.2; p value: 0.001). Drug-unrelated acute psychiatric symptoms were observed in 4 of the 108 AED-untreated patients (3.7%) and in 7 of the 175 AED-treated patients (4%). The results of the present study suggest that an AED alternative to levetiracetam should be chosen to treat epileptic seizures in patients with a brain tumor located in the frontal lobe to minimize the possible onset of TE-PAEs.
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Affiliation(s)
| | - Laura Rosa Pisani
- Neurology Unit, "Cutrona Zodda" Hospital, Barcellona Pozzo di Gotto, ME, Italy
| | | | | | | | - Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals, NHS Foundation Trust and Institute of Medical and Biomedical Sciences, St George's University of London, London, UK
| | - Francesco Pisani
- Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
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Left Anterior-Right Temporal Electroconvulsive Therapy for Catatonia After Epilepsy Surgery: A Case Report. J ECT 2017; 33:e4-e6. [PMID: 28009619 PMCID: PMC6645383 DOI: 10.1097/yct.0000000000000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Asadi-Pooya AA, Asadollahi M, Tinker J, Nei M, Sperling MR. Post-epilepsy surgery psychogenic nonepileptic seizures. Epilepsia 2016; 57:1691-1696. [PMID: 27554951 DOI: 10.1111/epi.13513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We investigated the prevalence of post-epilepsy surgery psychogenic nonepileptic seizures (PNES) in patients with drug-resistant epilepsy and the possible influence of risk factors on these seizures. METHODS In this retrospective study, we examined data from all patients with a clinical diagnosis of drug-resistant epilepsy who underwent epilepsy surgery at Graduate Hospital and the Jefferson Comprehensive Epilepsy Center between 1986 and 2016. Postsurgical outcome was identified for up to 15 years after surgery. Diagnosis of PNES was verified in the epilepsy monitoring unit with video-electroencephalography (EEG) ictal recording. Potential associated factors were assessed by comparing patients with or without postoperative PNES. RESULTS A total of 1,105 patients were studied; 697 patients had postoperative seizures, and, of these, 27 patients (3.9%) had documented PNES after surgery. A full-scale intelligence quotient (IQ) <80 was significantly associated with post-epilepsy surgery PNES (odds ratio [OR] 2.89, p = 0.007, 95% confidence interval [CI] 1.33-6.29). A history of a preoperative psychiatric diagnosis was also significantly associated with post-epilepsy surgery PNES (OR 4.67, p = 0.0001, 95% CI 2.01-10.82). Other factors were not significantly associated with post-epilepsy surgery PNES. SIGNIFICANCE Post-epilepsy surgery PNES should be considered when patients report recurrent seizures after epilepsy surgery. Although these seizures probably occur relatively infrequently, attention to factors such as appearance of new ictal behaviors, a preoperative history of a psychiatric disorder, and a low full-scale IQ should raise suspicion and lead to appropriate diagnostic measures.
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Affiliation(s)
- Ali A Asadi-Pooya
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A..
| | - Marjan Asadollahi
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Jennifer Tinker
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Maromi Nei
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Michael R Sperling
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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Tao K, Wang X. The comorbidity of epilepsy and depression: diagnosis and treatment. Expert Rev Neurother 2016; 16:1321-1333. [PMID: 27327645 DOI: 10.1080/14737175.2016.1204233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Kaiyan Tao
- Chongqing Key Laboratory of Neurology, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuefeng Wang
- Chongqing Key Laboratory of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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