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Crespo Pimentel B, Kuchukhidze G, Xiao F, Caciagli L, Hoefler J, Rainer L, Kronbichler M, Vollmar C, Duncan JS, Trinka E, Koepp MJ, Wandschneider B. Quantitative MRI Measures and Cognitive Function in People With Drug-Resistant Juvenile Myoclonic Epilepsy. Neurology 2024; 103:e209802. [PMID: 39303180 DOI: 10.1212/wnl.0000000000209802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neuroimaging studies have so far identified structural changes in individuals with juvenile myoclonic epilepsy (JME) when compared with controls. However, the underlying mechanisms of drug-resistant JME remain unknown. In this study, we aimed at characterizing the structural underpinnings of drug-resistant JME using MRI-derived cortical morphologic markers. METHODS In this prospective cross-sectional 2-center study, T1-weighted MRI and neuropsychological measures of verbal memory and executive function were obtained in individuals with drug-resistant and drug-responsive JME recruited from epilepsy outpatient clinics and healthy controls. We performed vertexwise measurements of cortical thickness, surface area, and local gyrification index (LGI). Vertexwise group comparisons were corrected for multiple comparisons at a familywise error (FWE) of 0.05. The neuropsychological profile of disease subgroups was analyzed through principal component analysis. RESULTS We studied 42 individuals with drug-resistant JME (mean age 29 ± 11 years, 50% female), 37 with drug-responsive JME (mean age 34 ± 10, years, 59% female), and 71 healthy controls (mean age 21 ± 9 years, 61% female). Surface area was increased in participants with drug-resistant JME in the left temporal lobe (Cohen d = 0.82 [-0.52 to -1.12], pFWE < 0.05) when compared with the drug-responsive group. Although no cortical thickness changes were observed between disease subgroups, drug-resistant and drug-sensitive participants showed discrete cortical thinning against controls (Cohen d = -0.42 [-0.83 to -0.01], pFWE < 0.05; Cohen d = -0.57 [-1.03 to -0.11], pFWE < 0.05, respectively). LGI was increased in the left temporal and occipital lobes in drug-resistant participants (Cohen d = 0.60 [0.34-0.86], pFWE < 0.05) when contrasting against drug-sensitive participants, but not controls. The composite executive function score was reduced in drug-resistant individuals compared with controls and drug-sensitive individuals (-1.74 [-2.58 to -0.90], p < 0.001 and -1.29 [-2.25 to -0.33], p < 0.01, respectively). Significant correlations were observed between executive function impairment and increased surface area in the precuneus and medial prefrontal regions (r = -0.79, pFWE < 0.05) in participants with drug-resistant JME. DISCUSSION We identified a developmental phenotype in individuals with drug-resistant JME characterized by changes in cortical surface area and folding complexity, the extent of which correlates with executive dysfunction. No association was observed between cortical thickness and disease severity. Our findings support a neurodevelopmental basis for drug resistance and cognitive impairment in JME.
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Affiliation(s)
- Bernardo Crespo Pimentel
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Giorgi Kuchukhidze
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Fenglai Xiao
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Lorenzo Caciagli
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Julia Hoefler
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Lucas Rainer
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Martin Kronbichler
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Christian Vollmar
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - John S Duncan
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Eugen Trinka
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Matthias J Koepp
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
| | - Britta Wandschneider
- From the Department of Neurology, Neurointensive Care and Neurorehabilitation (B.C.P., G.K., J.H., L.R., E.T.), Neuroscience Institute (B.C.P., G.K., J.H., M.K., E.T.), and Department of Child and Adolescent Psychiatry (L.R.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Austria; Department of Clinical & Experimental Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy (B.C.P., F.X., L.C., J.S.D., M.J.K., B.W.), Chalfont St. Peter, United Kingdom; Department of Neurology (L.C.), Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Switzerland; Department of Psychology (M.K.), University of Salzburg, Austria; Department of Neurology (C.V.), Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Germany; Department of Public Health, Health Services Research and Health Technology Assessment (E.T.), UMIT-University of Health Sciences, Medical Informatics and Technology, Hall in Tirol; and Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg, Austria
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Djordjević I, Djordjević S, Kosać A, Vučinić D, Ivanović Radović N, Ždraljević M, Mijajlović M. Transcranial brain parenchyma sonography in patients with juvenile myoclonic epilepsy. Acta Neurol Belg 2024; 124:1335-1342. [PMID: 38644442 DOI: 10.1007/s13760-024-02561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/15/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION There are rising evidences that subcortical structures, including the basal ganglia, are affected in patients with epilepsy. These structures are thought to influence the modulation and phenotypic expression of epileptic seizures. Our study aimed to evaluate the presence of structural abnormalities in subcortical structures in patients with juvenile myoclonic epilepsy (JME). METHODS This cross-sectional study included 51 patients who were diagnosed with JME and who were monitored on an outpatient basis at the Clinic for Neurology and Psychiatry for Children and Youth in Belgrade from January 1985 to October 2017. All patients underwent transcranial parenchymal sonography (TCS) from October 2015 to October 2017. Relation of clinical parameters (seizure control andcognitive functioning,) with TCS results was assessed. RESULTS Hyperechogenicity of the substantia nigra (SN) was detected in 37.2% of JME subjects and it was significantly more common in patients with JME than in the control group. The marked echogenicity of the red nucleus (RN) was detected in 17.6% of cases, while 11.8% of subjects had hyperechogenic RN. The presence of hyperechogenic RN (both right and left) was significantly more frequent in the group of patients with JME compared to the control group. The third ventricle diameter was larger in patients with JME than in controls. CONCLUSION Structural changes of certain subcortical structures, primarily SN and RN, detected in JME patients indicate additional non-lesional abnormalities of the basal ganglia and midbrain structures in these patients.
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Affiliation(s)
- Ivana Djordjević
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Stefan Djordjević
- University Children's Hospital, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Kosać
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Vučinić
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Nelica Ivanović Radović
- Institute for Children's Diseases, Clinical Center of Montenegro, Podgorica, Montenegro
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Mirjana Ždraljević
- University Clinical Center of Serbia, Neurology Clinic, 6, Dr Subotica Street, 11000, Belgrade, Serbia
| | - Milija Mijajlović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
- University Clinical Center of Serbia, Neurology Clinic, 6, Dr Subotica Street, 11000, Belgrade, Serbia.
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Elshetihy A, Nergiz L, Cloppenborg T, Woermann FG, Müffelmann B, Bien CG. A complex case with generalized epilepsy, probable focal seizures, and functional seizures. Epilepsy Behav Rep 2024; 27:100684. [PMID: 38953098 PMCID: PMC11215947 DOI: 10.1016/j.ebr.2024.100684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
In this patient, now 42 years old, genetic generalized epilepsy (juvenile myoclonic epilepsy) manifested itself at the age of 13. At the age of 39, she experienced a status episode with prolonged ICU treatment. She was left with a left-sided hippocampal sclerosis and probably focal seizures. In addition, since the age of 24, the patient also experiences functional seizures on the background of a borderline personality disorder. While generalized epileptic seizures could be controlled with antiseizure medication (ASM), the patient was multiple times admitted to Emergency Departments for her functional seizures with subsequent intensive care treatments, including intubation. As a complication, the patient developed critical illness polyneuropathy and myopathy, resulting in wheelchair dependence. Additionally, she acquired a complex regional pain syndrome after extravasation of ASM. The report demonstrates the uncommon development of hippocampal sclerosis after a generalized tonic-clonic status epilepticus and the poor treatability of functional seizures as compared to generalized and focal seizures.
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Affiliation(s)
- Ahmed Elshetihy
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
| | - Lema Nergiz
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
| | - Thomas Cloppenborg
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
| | - Friedrich G. Woermann
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany
| | - Birgitt Müffelmann
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
| | - Christian G. Bien
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
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Viola V, Bisulli F, Cornaggia CM, Ferri L, Licchetta L, Muccioli L, Mostacci B. Personality disorders in people with epilepsy: a review. Front Psychiatry 2024; 15:1404856. [PMID: 38800062 PMCID: PMC11116589 DOI: 10.3389/fpsyt.2024.1404856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Epileptologists and psychiatrists have long observed a correlation between epilepsy and personality disorders (PDs) in their clinical practice. We conducted a comprehensive PubMed search looking for evidence on PDs in people with epilepsy (PwE). Out of over 600 results obtained without applying any time restriction, we selected only relevant studies (both analytical and descriptive) limited to English, Italian, French and Spanish languages, with a specific focus on PDs, rather than traits or symptoms, thus narrowing our search down to 23 eligible studies. PDs have been investigated in focal epilepsy (predominantly temporal lobe epilepsy - TLE), juvenile myoclonic epilepsy (JME) and psychogenic non-epileptic seizures (PNES), with heterogeneous methodology. Prevalence rates of PDs in focal epilepsy ranged from 18 to 42% in surgical candidates or post-surgical individuals, with Cluster C personality disorders or related traits and symptoms being most common. In JME, prevalence rates ranged from 8 to 23%, with no strong correlation with any specific PDs subtype. In PNES, prevalence rates ranged from 30 to 60%, with a notable association with Cluster B personality disorders, particularly borderline personality disorder. The presence of a PD in PwE, irrespective of subtype, complicates treatment management. However, substantial gaps of knowledge exist concerning the neurobiological substrate, effects of antiseizure medications and epilepsy surgery on concomitant PDs, all of which are indeed potential paths for future research.
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Affiliation(s)
- Veronica Viola
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Bisulli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | | | - Lorenzo Ferri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | - Laura Licchetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | - Lorenzo Muccioli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
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Rainer LJ, Kuchukhidze G, Trinka E, Braun M, Kronbichler M, Langthaler P, Zimmermann G, Kronbichler L, Said-Yürekli S, Kirschner M, Zamarian L, Schmid E, Jokeit H, Höfler J. Recognition and perception of emotions in juvenile myoclonic epilepsy. Epilepsia 2023; 64:3319-3330. [PMID: 37795683 DOI: 10.1111/epi.17783] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Perception and recognition of emotions are fundamental prerequisites of human life. Patients with juvenile myoclonic epilepsy (JME) may have emotional and behavioral impairments that might influence socially desirable interactions. We aimed to investigate perception and recognition of emotions in patients with JME by means of neuropsychological tests and functional magnetic resonance imaging (fMRI). METHODS Sixty-five patients with JME (median age = 27 years, interquartile range [IQR] = 23-34) were prospectively recruited at the Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria. Patients were compared to 68 healthy controls (median age = 24 years, IQR = 21-31), matched for sex, age, and education. All study participants underwent the Networks of Emotion Processing test battery (NEmo), an fMRI paradigm of "dynamic fearful faces," a structured interview for psychiatric and personality disorders, and comprehensive neuropsychological testing. RESULTS JME patients versus healthy controls demonstrated significant deficits in emotion recognition in facial and verbal tasks of all emotions, especially fear. fMRI revealed decreased amygdala activation in JME patients as compared to healthy controls. Patients were at a higher risk of experiencing psychiatric disorders as compared to healthy controls. Cognitive evaluation revealed impaired attentional and executive functioning, namely psychomotor speed, tonic alertness, divided attention, mental flexibility, and inhibition of automated reactions. Duration of epilepsy correlated negatively with parallel prosodic and facial emotion recognition in NEmo. Deficits in emotion recognition were not associated with psychiatric comorbidities, impaired attention and executive functions, types of seizures, and treatment. SIGNIFICANCE This prospective study demonstrated that as compared to healthy subjects, patients with JME had significant deficits in recognition and perception of emotions as shown by neuropsychological tests and fMRI. The results of this study may have importance for psychological/psychotherapeutic interventions in the management of patients with JME.
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Affiliation(s)
- Lucas Johannes Rainer
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience Salzburg, member of the European Reference Network EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Salzburg, Austria
- Department of Child and Adolescent Psychiatry, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience Salzburg, member of the European Reference Network EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience Salzburg, member of the European Reference Network EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria
- Karl-Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Mario Braun
- Center for Cognitive Neuroscience/Department of Psychology, Faculty of Natural Sciences, Paris Lodron University, Salzburg, Austria
| | - Martin Kronbichler
- Neuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Salzburg, Austria
- Center for Cognitive Neuroscience/Department of Psychology, Faculty of Natural Sciences, Paris Lodron University, Salzburg, Austria
| | - Patrick Langthaler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience Salzburg, member of the European Reference Network EpiCARE, Salzburg, Austria
- Department of Mathematics, Faculty of Natural Sciences, Paris Lodron University, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, Lab for Intelligent Data Analytics Salzburg, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
| | - Lisa Kronbichler
- Neuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience, Salzburg, Austria
- Department of Child and Adolescent Psychiatry, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Sarah Said-Yürekli
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience Salzburg, member of the European Reference Network EpiCARE, Salzburg, Austria
- Center for Cognitive Neuroscience/Department of Psychology, Faculty of Natural Sciences, Paris Lodron University, Salzburg, Austria
| | - Margarita Kirschner
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience Salzburg, member of the European Reference Network EpiCARE, Salzburg, Austria
| | - Laura Zamarian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Schmid
- Department of Child and Adolescent Psychiatry, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | | | - Julia Höfler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience Salzburg, member of the European Reference Network EpiCARE, Salzburg, Austria
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Peña-Ceballos J, Moloney PB, Valentin A, O'Donnell C, Colleran N, Liggan B, Staunton-Grufferty B, Ennis P, Grogan R, Mullins G, Costello DJ, Doherty CP, Sweeney KJ, El Naggar H, Kilbride RD, Widdess-Walsh P, O'Brien D, Delanty N. Vagus nerve stimulation in refractory idiopathic generalised epilepsy: An Irish retrospective observational study. Seizure 2023; 112:98-105. [PMID: 37778300 DOI: 10.1016/j.seizure.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/05/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE Refractory idiopathic generalised epilepsy (IGE; also known as genetic generalised epilepsy) is a clinical challenge due to limited available therapeutic options. While vagus nerve stimulation (VNS) is approved as an adjunctive treatment for drug-resistant focal epilepsy, there is limited evidence supporting its efficacy for refractory IGE. METHODS We conducted a single-centre retrospective analysis of adult IGE patients treated with VNS between January 2003 and January 2022. We analysed the efficacy, safety, tolerability, stimulation parameters and potential clinical features of VNS response in this IGE cohort. RESULTS Twenty-three IGE patients were implanted with VNS between January 2003 and January 2022. Twenty-two patients (95.65%) were female. The median baseline seizure frequency was 30 per month (interquartile range [IQR]= 140), including generalised tonic-clonic seizures (GTCS), absences, myoclonus, and eyelid myoclonia with/without absences. The median number of baseline anti-seizure medications (ASM) was three (IQR= 2). Patients had previously failed a median of six ASM (IQR= 5). At the end of the study period, VNS therapy remained active in 17 patients (73.9%). amongst patients who continued VNS, thirteen (56.5% of the overall cohort) were considered responders (≥50% seizure frequency reduction). Amongst the clinical variables analysed, only psychiatric comorbidity correlated with poorer seizure outcomes, but was non-significant after applying the Bonferroni correction. Although 16 patients reported side-effects, none resulted in the discontinuation of VNS therapy. SIGNIFICANCE Over half of the patients with refractory IGE experienced a positive response to VNS therapy. VNS represents a viable treatment option for patients with refractory IGE, particularly for females, when other therapeutic options have been exhausted.
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Affiliation(s)
| | - Patrick B Moloney
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland
| | - Antonio Valentin
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Cara O'Donnell
- Department of Clinical Neurophysiology, Beaumont Hospital, Dublin, Ireland
| | - Niamh Colleran
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Brenda Liggan
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | | | - Patricia Ennis
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Roger Grogan
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Gerard Mullins
- Department of Clinical Neurophysiology, Beaumont Hospital, Dublin, Ireland
| | - Daniel J Costello
- FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland; Department of Neurology, Cork University Hospital, Cork, Ireland
| | - Colin P Doherty
- FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland; Department of Neurology, St. James's Hospital, Dublin, Ireland; Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Hany El Naggar
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland
| | - Ronan D Kilbride
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Neurophysiology, Beaumont Hospital, Dublin, Ireland
| | - Peter Widdess-Walsh
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Neurophysiology, Beaumont Hospital, Dublin, Ireland
| | - Donncha O'Brien
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Norman Delanty
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland.
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Roshan S, Shukla T, Todi VK, Gupta S, Duggal AK, Khwaja GA, Dhamija K. Impact of JME on quality of life: Does a well-controlled epilepsy also hamper the psychological wellbeing? Epilepsy Res 2023; 194:107184. [PMID: 37421712 DOI: 10.1016/j.eplepsyres.2023.107184] [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: 04/16/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Epilepsy is a stigmatizing disorder and its diagnosis can have important psychosocial consequences on individuals, severely impacting their quality of life(QOL). There are numerous studies which have seen an adverse impact on the psychosocial aspects of life in patients with intractable epilepsy. The aim of this study was to assess the QOL in adult and adolescent patients with JME, which is largely a well-controlled form of epilepsy. METHODOLOGY This was a hospital based cross-sectional observational study comprising of 50 JME patients. QOLIE-31-P and QOLIE-AD-48 questionnaires were used to assess QOL in adults & adolescents(11-17 years) respectively. The Mini international neuropsychiatric interview-version 7.0.2 and Brief psychiatric rating scale were used for screening of underlying psychopathology and if, the screening tests were positive then they were further evaluated and classified using DSM V and ICD 10. RESULTS The mean QOLIE-31-P score was 64.65 ± 15.74. Majority of the adult patients had fair QOL (poor, fair and good QOL scores in 18 %, 54 % and 28 % respectively). Subscale scores in poor category were for the medication effects and pertaining to seizure worry.Among adolescent patients, the mean QOLIE 48 AD score was 69.15 ± 13.13. 50 % had fair QOL. Amongst those with poor QOL, majority of poor scores were for the attitude towards epilepsy. The QOL scores were significantly poorer in patients with uncontrolled seizures. 78 % of the patients had comorbid anxiety and depression, however syndromic psychiatric diagnosis was seen in 10.25 % and 2.56 % for anxiety and depression respectively. Presence of psychiatric symptoms did not influence QOL scores. CONCLUSION QOL, in well controlled JME, is fair in majority of patients. QOL might improve if seizure worry is addressed and patients are educated about medication effects at the time of initial diagnosis. Vast majority of patients may experience minor psychiatric issues, which do need addressal for formulating a holistic and individualized treatment plan.
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Affiliation(s)
- Sujata Roshan
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi 110002, India
| | - Tanvi Shukla
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi 110002, India
| | - Vineet Kumar Todi
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi 110002, India
| | - Swapan Gupta
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi 110002, India
| | - Ashish Kumar Duggal
- Department of Neurology, ABVIMS and Dr. RML Hospital, New Delhi 110002, India
| | - Geeta Anjum Khwaja
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi 110002, India
| | - Kamakshi Dhamija
- Department of Neurology, ABVIMS and Dr. RML Hospital, New Delhi 110002, India.
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Mangaard S, Gesche J, Krøigård T, Beier CP. Association of symptoms of psychiatric disease and electroencephalographic patterns in idiopathic generalized epilepsy. Epilepsy Behav 2023; 145:109293. [PMID: 37315408 DOI: 10.1016/j.yebeh.2023.109293] [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: 03/16/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Idiopathic generalized epilepsies (IGE) are genetic epilepsies with alterations of thalamo-frontocortical circuits that play a major role in seizure generation and propagation. Psychiatric diseases and drug resistance are strongly associated, but it remains unknown if they are symptoms of the same pathophysiological process. Hypothesizing that the same network alterations are associated with the frequency of epileptic discharges (ED) and psychiatric symptoms, we here tested the association of self-reported psychiatric symptoms and IGE severity estimated by electroencephalographic (EEG) biomarkers. METHODS Idiopathic generalized epilepsies patients were asked to fill out four validated psychiatric screening tools assessing symptoms of personality disorders (Standard Assessment of Personality- Abbreviated Scale), depression (Major Depression Inventory), impulsiveness (Barratt Impulsiveness Scale), and anxiety (brief Epilepsy Anxiety Survey Instrument). Blinded to results and clinical data on the patients, we analyzed the patients' EEGs, assessed, and quantified ED. The number and duration of ED divided by the duration of the EEG served as a proxy for the severity of IGE that was correlated with the results of the psychiatric screening. RESULTS Paired data from 64 patients were available for analysis. The duration of EDs per minute EEG was inversely associated with the time since the last seizure. The number of patients with generalized polyspike trains (n = 2), generalized paroxysmal fast activity (n = 3), and prolonged epileptiform discharges (n = 10) were too low for statistically meaningful analyses. Self-reported symptoms of depression, personality disorder, and impulsivity were not associated with EDs. In contrast, the duration of EDs per minute EEG was associated with self-reported symptoms of anxiety in univariate analyses, not significant, however, following adjustment for time since the last seizure in regression models. SIGNIFICANCE Self-reported symptoms of psychiatric diseases were not strongly associated with EDs as the best available quantifiable biomarker of IGE severity. As expected, the duration of EDs per minute and anxiety was inversely associated with time since the last seizure. Our data argue against a direct link between the frequency of EDs - as an objective proxy of IGE severity - and psychiatric symptoms.
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Affiliation(s)
- Sofie Mangaard
- Department of Neurology, Odense University Hospital, Denmark
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Thomas Krøigård
- Department of Neurophysiology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; OPEN, University of Southern Denmark, Denmark.
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Panda PK, Ramachandran A, Tomar A, Elwadhi A, Kumar V, Sharawat IK. Prevalence, nature, and severity of the psychiatric comorbidities and their impact on quality of life in adolescents with Juvenile myoclonic epilepsy. Epilepsy Behav 2023; 142:109216. [PMID: 37088064 DOI: 10.1016/j.yebeh.2023.109216] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Adults with Juvenile myoclonic epilepsy (JME) are at increased risk for psychiatric comorbidities, personality traits, and abnormality in executive function. But studies on adolescents and their impact on quality of life are scarce in the literature. MATERIALS AND METHODS This cross-sectional study was performed between August 2019 and October 2022 to compare the prevalence of psychiatric comorbidities in adolescents with JME and age and gender-matched healthy controls. After completing DSM-5 Structured Clinical Interview (SCID-5) initially in all patients, we measured the severity of individual psychiatric problems like anxiety, depression, and somatic symptoms by using an appropriate psychometric scale. We also measured both groups' intelligence quotient (IQ), executive function, and quality of life. RESULTS One hundred patients with JME (14.3 ± 2.5 years, 48 boys) and 100 controls were enrolled. Psychiatric disorders were observed in 46% of JME and 6% of controls (p < 0.01). Psychiatric comorbidities noted in the patients with JME were: somatic symptom and related disorders(n = 14), anxiety (n = 13), adjustment disorders (n = 12), depression (n = 11), oppositional defiant disorder (n = 6), conduct disorder (n = 5), anorexia nervosa (n = 3), narcissistic (n = 3), histrionic (n = 1), substance-related disorder (n = 1), borderline (n = 2) and antisocial personality disorder (n = 2). The prevalence of depressive disorders, anxiety disorders, adjustment disorders, somatic symptoms, related disorders, and any personality disorder was significantly more in the JME group (p < 0.01 for all). Female gender, higher Epilepsy Stigma Scale score, and lower Epilepsy Outcome Expectancy Scale were significantly associated with depressive disorders (p = 0.04, 0.03, 0.03 respectively). Similarly, for anxiety, only female gender and lower Epilepsy Outcome Expectancy Scale were significant associated factors (p = 0.03, 0.02 respectively). CONCLUSIONS Psychiatric disorders like anxiety, depression, and personality disorders are more frequent in adolescents with JME than in controls.
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Affiliation(s)
- Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Aparna Ramachandran
- Department of Neurology, IQRAA International Hospital and Research Centre, Kozhikode, Kerala 673009, India
| | - Apurva Tomar
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Aman Elwadhi
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Vinod Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India.
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Trinka E, Rainer LJ, Granbichler CA, Zimmermann G, Leitinger M. Mortality, and life expectancy in Epilepsy and Status epilepticus-current trends and future aspects. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1081757. [PMID: 38455899 PMCID: PMC10910932 DOI: 10.3389/fepid.2023.1081757] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/31/2023] [Indexed: 03/09/2024]
Abstract
Patients with epilepsy carry a risk of premature death which is on average two to three times higher than in the general population. The risk of death is not homogenously distributed over all ages, etiologies, and epilepsy syndromes. People with drug resistant seizures carry the highest risk of death compared to those who are seizure free, whose risk is similar as in the general population. Most of the increased risk is directly related to the cause of epilepsy itself. Sudden unexplained death in epilepsy patients (SUDEP) is the most important cause of epilepsy-related deaths especially in the young and middle-aged groups. Population based studies with long-term follow up demonstrated that the first years after diagnosis carry the highest risk of death, while in the later years the mortality decreases. Improved seizure control and being exposed to a specialized comprehensive care centre may help to reduce the risk of death in patients with epilepsy. The mortality of status epilepticus is substantially increased with case fatality rates between 4.6% and 39%, depending on its cause and duration, and the age of the population studied. The epidemiological data on overall and cause specific mortality as well as their determinants and risk factors are critically reviewed and methodological issues pertinent to the studies on mortality of epilepsy and Status epilepticus are discussed.
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Affiliation(s)
- Eugen Trinka
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Institute of Public Health, Medical Decision-Making and HTA, UMIT – Private University for Health Sciences, Medical Informatics and Technology, Hall In Tyrol, Austria
| | - Lucas J. Rainer
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARE, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
| | | | - Georg Zimmermann
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARE, Salzburg, Austria
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
| | - Markus Leitinger
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of EpiCARE, Salzburg, Austria
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Rainer LJ, Kronbichler M, Kuchukhidze G, Trinka E, Langthaler PB, Kronbichler L, Said-Yuerekli S, Kirschner M, Zimmermann G, Höfler J, Schmid E, Braun M. Emotional Word Processing in Patients With Juvenile Myoclonic Epilepsy. Front Neurol 2022; 13:875950. [PMID: 35720080 PMCID: PMC9201996 DOI: 10.3389/fneur.2022.875950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objective According to Panksepp's hierarchical emotion model, emotion processing relies on three functionally and neuroanatomically distinct levels. These levels comprise subcortical networks (primary level), the limbic system (secondary level), and the neocortex (tertiary level) and are suggested to serve differential emotional processing. We aimed to validate and extend previous evidence of discrete and dimensional emotion processing in patient with juvenile myoclonic epilepsy (JME). Methods We recorded brain activity of patients with JME and healthy controls in response to lexical decisions to words reflecting the discrete emotion fear and the affective dimension negativity previously suggested to rely on different brain regions and to reflect different levels of processing. In all study participants, we tested verbal cognitive functions, as well as the relationship of psychiatric conditions, seizure types and duration of epilepsy and emotional word processing. Results In support of the hierarchical emotion model, we found an interaction of discrete emotion and affective dimensional processing in the right amygdala likely to reflect secondary level processing. Brain activity related to affective dimensional processing was found in the right inferior frontal gyrus and is suggested to reflect tertiary level processing. Psychiatric conditions, type of seizure nor mono- vs. polytherapy and duration of epilepsy within patients did not have any effect on the processing of emotional words. In addition, no differences in brain activity or response times between patients and controls were observed, despite neuropsychological testing revealed slightly decreased verbal intelligence, verbal fluency and reading speed in patients with JME. Significance These results were interpreted to be in line with the hierarchical emotion model and to highlight the amygdala's role in processing biologically relevant stimuli, as well as to suggest a semantic foundation of affective dimensional processing in prefrontal cortex. A lack of differences in brain activity of patients with JME and healthy controls in response to the emotional content of words could point to unaffected implicit emotion processing in patients with JME.
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Affiliation(s)
- Lucas Johannes Rainer
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Martin Kronbichler
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Psychology, Naturwissenschaftliche Fakultaet, Centre for Cognitive Neuroscience, Paris-Lodron University, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT–University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Karl-Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Patrick Benjamin Langthaler
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Department of Mathematics, Paris-Lodron University, Naturwissenschaftliche Fakultaet, Salzburg, Austria
| | - Lisa Kronbichler
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Sarah Said-Yuerekli
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Department of Psychology, Naturwissenschaftliche Fakultaet, Centre for Cognitive Neuroscience, Paris-Lodron University, Salzburg, Austria
| | - Margarita Kirschner
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Elisabeth Schmid
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Mario Braun
- Department of Psychology, Naturwissenschaftliche Fakultaet, Centre for Cognitive Neuroscience, Paris-Lodron University, Salzburg, Austria
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School performance and psychiatric comorbidity in juvenile absence epilepsy and juvenile myoclonic epilepsy: a Danish population-based cohort study. J Neurol 2022; 269:4997-5007. [PMID: 35595971 DOI: 10.1007/s00415-022-11147-2] [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: 02/03/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND We aimed to determine school performance and psychiatric comorbidity in juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and generalized tonic-clonic seizures (GTCS) alone. METHODS All children (< 18 years) fulfilled International League Against Epilepsy criteria after review of their medical records. Control groups were the pediatric background population or children with non-neurological chronic disease. Outcomes were on school performance and psychiatric comorbidity. We compared mean grade point averages using linear regression and estimated hazard ratios using Cox regression in the remaining analyses. We adjusted for the child's sex, age, and year of birth; and parental highest education, receipt of cash benefits or early retirement. RESULTS We included 92 JAE, 190 JME, 27 GTCS alone, 15,084 non-neurological chronic disease controls, and population controls. JAE had two times increased hazard for special needs education compared with age-matched population controls (hazard ratio 2.2, 95% CI = 1.1‒4.6, p = 0.03); this was not seen in JME. Compared with population controls, both JAE and JME had lower grade point average in secondary and high school (JME: 9th grade: - 0.5 points, 95% CI = -0.9 to -0.06, p = 0.03; high school: - 0.6 points, 95% CI = -1.3 to -0.1, p = 0.04), and 8% fewer JME and 15% fewer JAE attended high school. Both JME and JAE had higher hazard for redeeming sleep medication compared with non-neurological chronic disease; additionally, JAE had increased hazard for ADHD medicine redemptions. CONCLUSIONS Both JAE and JME had marginally poorer school performance; performance seemed worse in JAE than in JME. Both JAE and JME had increased use of sleep medication.
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13
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Maggu G, Dhamija S, Chaudhury S, Rohatgi S, Saldanha D, Jain S. Behavioral presentations of focal onset seizures: A case series. Ind Psychiatry J 2021; 30:S204-S209. [PMID: 34908691 PMCID: PMC8611604 DOI: 10.4103/0972-6748.328869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/17/2021] [Accepted: 06/19/2021] [Indexed: 11/04/2022] Open
Abstract
Seizures can have varied presentations and may have different etiological factors. A multidisciplinary approach should be used to treat them. It becomes difficult to diagnose seizures if they have an atypical presentation, particularly so when they manifest as behavioral disturbances. This case series demonstrates four cases with different psychiatric and behavioral manifestations of seizures where the diagnosis had to be done in a multi-disciplinary approach. Two of the cases highlight the fact that in the light of normal investigations, paying attention to detailed history is of prime importance.
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Affiliation(s)
- Gaurav Maggu
- Department of Psychiatry, NTR University, Vijaywada, Uttar Pradesh, India
| | - Sana Dhamija
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India.,Department of Neurology, Dr. D. Y. Patil Medical College, Hospital, Pune, Maharashtra, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India.,Department of Neurology, Dr. D. Y. Patil Medical College, Hospital, Pune, Maharashtra, India
| | - Shalesh Rohatgi
- Department of Neurology, Dr. D. Y. Patil Medical College, Hospital, Pune, Maharashtra, India
| | - Daniel Saldanha
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India.,Department of Neurology, Dr. D. Y. Patil Medical College, Hospital, Pune, Maharashtra, India
| | - Shobhit Jain
- Department of Psychiatry, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
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14
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Mangaard S, Gesche J, Delcomyn L, Beier CP. The burden of disease of idiopathic/genetic generalized epilepsy - A nationwide online survey. Epilepsy Behav 2021; 123:108232. [PMID: 34416520 DOI: 10.1016/j.yebeh.2021.108232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/07/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
The aim of the study was to assess the self-reported burden of disease in people with idiopathic/genetic generalized epilepsy and risk factors associated with high disease burden. We performed a nationwide online survey on epilepsy characteristics/treatment, quality of life/daily living followed by Standardized Assessment of Personality-Abbreviated Scale, Major Depression Inventory, Barratt Impulsiveness Scale (brief) and the brief Epilepsy Anxiety Survey Instrument. The survey was sent to 275 representative patients with IGE ('Funen cohort') and later publicly distributed via the Danish Epilepsy Association. The characteristics of the responders of the 'Funen cohort' (n = 119) did not differ from non-responders and previously assessed data. Out of 753 persons accessing the public survey, 167 had probable IGE. As compared to the 'Funen cohort', patients from the public survey reported similar age, time since last seizure, years with disease, seizure types, and IGE syndromes but more current and previously tried anti-seizure medications (ASMs). In both cohorts, patients had higher scores for depression, impulsivity, and personality disorders as compared to Danish normal values irrespective of seizure control or medication. Higher depression and anxiety scores but neither impulsivity nor personality disorders were associated with ongoing seizures. Overall health condition was estimated as bad by 28%. In the last four weeks, 20.4% reported limitations of activities of daily living due to epilepsy; 27.8% felt fed up because of their epilepsy. Patients with high subjective disease burden had more current ASMs, shorter time since last seizure and increased scores for depression, anxiety, impulsivity, and personality disorders. In conclusion, having IGE was associated with higher scores for impulsivity, depression, and personality disorders irrespective of seizure control and current treatment. High subjective disease burden was common and associated with ongoing seizures, absence/myoclonic seizures and high scores for impulsivity, depression, anxiety, and personality disorders.
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Affiliation(s)
- Sofie Mangaard
- Department of Neurology, Odense University Hospital, Denmark
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Denmark
| | - Line Delcomyn
- Department of Neurology, Odense University Hospital, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; OPEN, Odense Patient data Explorative Network, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark.
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15
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PERMIT study: a global pooled analysis study of the effectiveness and tolerability of perampanel in routine clinical practice. J Neurol 2021; 269:1957-1977. [PMID: 34427754 PMCID: PMC8940799 DOI: 10.1007/s00415-021-10751-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 12/22/2022]
Abstract
The PERaMpanel pooled analysIs of effecTiveness and tolerability (PERMIT) study was a pooled analysis of data from 44 real-world studies from 17 countries, in which people with epilepsy (PWE; focal and generalized) were treated with perampanel (PER). Retention and effectiveness were assessed after 3, 6, and 12 months, and at the last visit (last observation carried forward). Effectiveness assessments included 50% responder rate (≥ 50% reduction in seizure frequency from baseline) and seizure freedom rate (no seizures since at least the prior visit); in PWE with status epilepticus, response was defined as seizures under control. Safety and tolerability were assessed by evaluating adverse events (AEs) and discontinuation due to AEs. The Full Analysis Set included 5193 PWE. Retention, effectiveness and safety/tolerability were assessed in 4721, 4392 and 4617, respectively. Retention on PER treatment at 3, 6, and 12 months was 90.5%, 79.8%, and 64.2%, respectively. Mean retention time on PER treatment was 10.8 months. The 50% responder rate was 58.3% at 12 months and 50.0% at the last visit, and the corresponding seizure freedom rates were 23.2% and 20.5%, respectively; 52.7% of PWE with status epilepticus responded to PER treatment. Overall, 49.9% of PWE reported AEs and the most frequently reported AEs (≥ 5% of PWE) were dizziness/vertigo (15.2%), somnolence (10.6%), irritability (8.4%), and behavioral disorders (5.4%). At 12 months, 17.6% of PWEs had discontinued due to AEs. PERMIT demonstrated that PER is effective and generally well tolerated when used to treat people with focal and/or generalized epilepsy in everyday clinical practice.
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16
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Pietrafusa N, La Neve A, de Palma L, Boero G, Luisi C, Vigevano F, Specchio N. Juvenile myoclonic epilepsy: Long-term prognosis and risk factors. Brain Dev 2021; 43:688-697. [PMID: 33781581 DOI: 10.1016/j.braindev.2021.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Our goal was to investigate the long-term clinical course of juvenile myoclonic epilepsy (JME) in a cohort of patients and to identify prognostic factors for refractoriness and seizure relapse after anti-seizure medications (ASMs) withdrawal. A literature review is also presented to consolidate and compare our findings with the previously reported cases. METHODS We retrospectively studied a series of patients diagnosed with JME with 15 years or more of evolution. We collected clinical, neurophysiological and neuroimaging data from patients who met defined inclusion and exclusion criteria. RESULTS Study involved 61 patients (65.5% female) with mean age at study of 37.6 years, and mean age at its outset of 14.8 years. Median follow-up was 31.0 years (mean 28.9, range 15-53). They presented more frequently with a combination of myoclonic and generalized tonic-clonic seizures (GTCS) (65.6%). Sixty-five percent of patients (n = 40) had a 5-year terminal remission with a mean age at last seizure of 27.4 years. Thirty-two percent of seizure-free patients (n = 13) withdrew ASMs: 6 out of 13 had a recurrence of the seizures while 7 remained seizure-free (mean age at ASMs withdrawal 21.0 versus 35.7 years, p < 0.05). In the multivariate model, a high GTCS frequency at onset (p = 0.026) was a prognostic factor of drug resistance. CONCLUSION JME is often regarded as a benign epileptic syndrome, although a quarter of the individuals have refractory epilepsy. The possibility of withdrawing ASMs in patients who have been free of seizures over an extended time seems feasible.
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Affiliation(s)
- Nicola Pietrafusa
- Department of Neurological Sciences, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| | - Angela La Neve
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari 70124, Italy
| | - Luca de Palma
- Department of Neurological Sciences, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| | - Giovanni Boero
- Complex Structure of Neurology, SS. Annunziata Hospital, Taranto, Italy
| | | | - Federico Vigevano
- Department of Neurological Sciences, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy
| | - Nicola Specchio
- Department of Neurological Sciences, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Rome, Italy.
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17
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Ascoli M, Mastroianni G, Gasparini S, Striano P, Cianci V, Neri S, Bova V, Mammì A, Gambardella A, Labate A, Aguglia U, Ferlazzo E. Diagnostic and therapeutic approach to drug-resistant juvenile myoclonic epilepsy. Expert Rev Neurother 2021; 21:1265-1273. [PMID: 33993822 DOI: 10.1080/14737175.2021.1931126] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Juvenile myoclonic epilepsy (JME), also known as Janz syndrome, is a common form of generalized epilepsy of presumed genetic origin representing up to 10% of all epilepsy cases. Despite adequate anti-seizure medication (ASM) treatment, seizures persist in one-third of JME patients. AREAS COVERED A literature search was conducted using Pubmed search on the topics of drug-resistant JME. EXPERT OPINION About 30% of JME patients are drug-resistant. Valproate (VPA) is considered the first-choice drug. In women of childbearing potential, levetiracetam (LEV) should represent the first-choice treatment. Alternative monotherapy or add-on therapy should be considered in subjects with resistant seizures after the exclusion of pseudo-drug resistance. The choice of the add-on ASM depends on the predominant seizure type. In subjects with persistent bilateral tonic-clonic seizures, LEV or lamotrigine should be firstly considered. In patients with difficult-to-treat myoclonic seizures, clonazepam or LEV are recommended. In case of persistent absences, ethosuximide should be considered. With appropriate selection and safeguards in place, VPA should remain available as an option in women of childbearing potential whose seizures are resistant to other treatments.
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Affiliation(s)
- Michele Ascoli
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Giovanni Mastroianni
- Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Pasquale Striano
- Paediatric Neurology and Muscular Disease Unit, IRCCS Institute "Giannina Gaslini", Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Sabrina Neri
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Valentina Bova
- Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy
| | - Anna Mammì
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Angelo Labate
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Viale Europa, Catanzaro, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio, Calabria, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Viale Europa, Catanzaro, Italy
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18
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YAŞAR AB, SAYMAN C, ERDOĞAN TAYCAN S, ÇETİNKAYA Y, GÜNDÜZ A, TİRELİ H. The association between temperament features and childhood traumas in patients with juvenile myoclonic epilepsy. Turk J Med Sci 2020; 50:1314-1322. [PMID: 32512675 PMCID: PMC7491261 DOI: 10.3906/sag-1912-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/06/2020] [Indexed: 11/04/2022] Open
Abstract
Background/aim Epilepsy is a common chronic neurological problem that impairs daily activities, functionality, and quality of life. Childhood traumas (CTs) are known to be critical factors in the onset or development of many psychiatric and medical disorders. They also play a critical role in the development of temperament and personality. This study aimed to investigate the association between CTs and common temperament patterns and features seen in epilepsy patients. Materials and methods The study included 38 patients who were diagnosed with juvenile myoclonic epilepsy (JME) and volunteered to participate in the study. In addition to the sociodemographic form and questions on disease features, Structured Clinical Interview for DSM-IV Axis I Disorders, Temperament Evaluation of Memphis, Pisa, Paris and San Diego Questionnaire (TEMPS-A), Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were administered to all participants. In the present study, a cut-off value of 35 was used for the CTQ scale. The patients with CTQ scores lower than 35 (50%, n = 19, Group 1) and the patients with CTQ scores above 35 (50%, n = 19, Group 2) were compared. Results The comparison of TEMPS-A and its subscale scores in the JME patients in the groups with CTQ scores above or below a cut-off value detected significant differences between the groups in depressive and irritable temperament scores. The mean BDI scores were also different between the two groups. Furthermore, a significant positive correlation was detected between the disease duration, anxiety, and depression scores in the JME patients. A significant relationship was detected between the emotional neglect subscale score of the JME patients and the BDI scores. A significant positive correlation was found between the total disease duration, BDI, and BAI. Significant moderate-level relationships were found between the BDI score and irritable, depressive, cyclothymic, and anxious temperaments and between the BAI score and irritable, depressive, cyclothymic, and anxious temperaments. Conclusion Several temperamental features of JME patients are related to CTs. More depressive symptoms are seen in JME patients with higher disease durations.
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Affiliation(s)
| | - Ceyhun SAYMAN
- Department of Norology, Haydarpaşa Numune Training and Research Hospital, İstanbulTurkey
| | - Serap ERDOĞAN TAYCAN
- Department of Psychiatry, Haydarpaşa Numune Training and Research Hospital, İstanbulTurkey
| | - Yılmaz ÇETİNKAYA
- Department of Norology, Haydarpaşa Numune Training and Research Hospital, İstanbulTurkey
| | - Anıl GÜNDÜZ
- Department of Clinical Psychology, İstanbul Kent University, İstanbulTurkey
| | - Hülya TİRELİ
- Department of Norology, Haydarpaşa Numune Training and Research Hospital, İstanbulTurkey
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19
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Smith A, Syvertsen M, Pal DK. Meta-analysis of response inhibition in juvenile myoclonic epilepsy. Epilepsy Behav 2020; 106:107038. [PMID: 32240946 DOI: 10.1016/j.yebeh.2020.107038] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/20/2020] [Accepted: 03/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with juvenile myoclonic epilepsy (JME) show evidence of cognitive impulsivity that may be linked to later adverse psychosocial outcomes. Here, we quantify the strength of association and estimate effect size (ES) of response inhibition by pooling available evidence in a meta-analysis. METHODS We conducted a systematic review of the literature using Ovid MEDLINE and Ovid EMBASE databases (covering 2001-2019) with a search strategy using combinations of the specific Medical Subject Headings (MeSH) terms 'juvenile myoclonic epilepsy, cognitive impulsivity, response inhibition, Stroop, cognition, personality, traits' using the 'explode' feature where possible. We also searched within references of retrieved articles. We included studies reporting ESs describing established measures of response inhibition in teenage and adult patients with JME. RESULTS Using the ESs pooled from 16 studies comprising 1047 patients and controls, we found ESs for response inhibition to be homogeneous with a significant moderate mean ES of d = 0.50 (95% confidence interval [CI]: 0.37-0.63). CONCLUSIONS We confirm that reduced response inhibition is a consistently observed homogeneous trait in patients with JME.
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Affiliation(s)
- Anna Smith
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Marte Syvertsen
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Deb K Pal
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom; King's College Hospital, London, United Kingdom; Evelina London Children's Hospital, London, United Kingdom.
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20
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Paiva ML, Rzezak P, Santos B, Lima EM, Moschetta SP, Vincentiis S, Alessi R, Mendoza M, Valente KD. Dissociation between decision making under ambiguity and risk in patients with juvenile myoclonic epilepsy. Epilepsy Behav 2019; 101:106548. [PMID: 31678809 DOI: 10.1016/j.yebeh.2019.106548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Decision making (DM) is one aspect of impulsivity that can be defined by the ability to decide between two or more options in a given situation. To date, there are at least two types of DM that differ in the level of uncertainty, and how much information about consequences is provided. In this study, we aimed to evaluate the two domains of DM - under risk and ambiguous - with a comprehensive evaluation in a group of patients with juvenile myoclonic epilepsy (JME), and correlate with patients' characteristics, clinical variables, and neuropsychological evaluation for executive functions. METHODS We evaluated 35 patients with JME and 39 healthy controls using the Iowa Gambling Task for DM under ambiguity and the Game Dice Task for DM under risk. We assessed the performance in Iowa Gambling Task and Game Dice Task through net scores, safe and risky choices, besides the type of decisions across time. RESULTS Patients with JME had a higher number of risky choices compared to controls in the Game Dice Task. There was no significant difference between patients and controls in the Iowa Gambling Task. However, patients with higher seizure frequency had worse scores on decks C and D (safe choices) from the Iowa Gambling Task. CONCLUSION Patients with JME have worse performance on DM under risk. The same was not observed for DM under ambiguity. Epilepsy-related factors and the presence of psychiatric disorders, but not executive dysfunction, were associated with a lower tendency for safe choices. These findings showed a dissociation between DM processes in patients with JME and a tendency to make disadvantageous decisions with measurable risks.
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Affiliation(s)
- Maria L Paiva
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Patricia Rzezak
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Bernardo Santos
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Ellen M Lima
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Sylvie P Moschetta
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Silvia Vincentiis
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Rudá Alessi
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Melanie Mendoza
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Kette D Valente
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
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21
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Aygun H, Ayyildiz M, Agar E. Effects of vitamin D and paricalcitol on epileptogenesis and behavioral properties of WAG/Rij rats with absence epilepsy. Epilepsy Res 2019; 157:106208. [PMID: 31581040 DOI: 10.1016/j.eplepsyres.2019.106208] [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] [Received: 06/01/2019] [Revised: 08/10/2019] [Accepted: 09/14/2019] [Indexed: 10/26/2022]
Abstract
AIM Vitamin D (Vit D) has been considered as a neurosteroid and has a pivotal role in neuroprotection including epilepsy. Vit D regulator acts via a Vit D receptor (VDR). WAG/Rij rats have a genetically epileptic model of absence epilepsy with comorbidity of depression. The aim of the present study was to investigate the effect of Vit D and paricalcitol (PRC) on WAG/Rij rats. MATERIAL AND METHODS Sixty-three male WAG/Rij rats and seven male Wistar rats were used. The effects of acute and chronic treatment with Vit D (5.000 and 60.000 IU/kg, i.p) and PRC (0.5, 5 and 10 μg/kg, i.p) on absence seizures, and related psychiatric comorbidity were investigated in WAG/Rij rats. Depression-like behavior was assayed by using the forced swimming test (FST) and; anxiety-like behavior by using the open field test (OFT). RESULTS Acute Vit D treatments (5.000 and 60.000 IU/kg) similarly reduced the number and duration of spike-wave discharges (SWDs) and showed anxiolytic-antidepressive effect whereas there were no significant changes in other measured parameters between the daily and the bolus dose of Vit D. Acute administration of PRC (0.5, 5 and 10 μg/kg) showed anti-convulsive and anxiolytic-antidepressive effect. The dose (0.5 μg/kg) of PRC was the most effective dose. Chronic treatment was more effective than acute therapy in all parameters. CONCLUSION The results of the present study demonstrate that Vit D and PRC have antiepileptic and anxiolytic-antidepressive effects on the absence epilepsy in WAG/Rij rats.
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Affiliation(s)
- Hatice Aygun
- Department of Physiology, Faculty of Medicine, University of Tokat Gaziosmanpasa, Tokat, Turkey.
| | - Mustafa Ayyildiz
- Department of Physiology, Faculty of Medicine, University of Ondokuz Mayis, Samsun, Turkey
| | - Erdal Agar
- Department of Physiology, Faculty of Medicine, University of Ondokuz Mayis, Samsun, Turkey
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22
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Kuchukhidze G, Höfler J, Kronbichler M, Schmid E, Kirschner M, Rainer L, Kronbichler L, Gaggl J, Trinka E. Emotion recognition and social cognition in juvenile myoclonic epilepsy. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2019. [DOI: 10.1007/s10309-019-0261-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Syvertsen M, Selmer K, Enger U, Nakken KO, Pal DK, Smith A, Koht J. Psychosocial complications in juvenile myoclonic epilepsy. Epilepsy Behav 2019; 90:122-128. [PMID: 30530133 DOI: 10.1016/j.yebeh.2018.11.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 02/06/2023]
Abstract
Juvenile myoclonic epilepsy (JME) constitutes about 10% of all epilepsies. Because of executive dysfunction, people with JME may be prone to impulsivity and risk-taking behavior. Our aim was to investigate whether psychosocial issues associated with impulsivity are more prominent in people with JME than in those with other types of genetic generalized epilepsy (GGE). Patients with GGE were recruited retrospectively through the Drammen Hospital records in Buskerud County, Norway, 1999-2013. They were invited to a semi-structured interview, either at the hospital or at home. Ninety-two patients with JME and 45 with other types of GGE were interviewed. Variables were evaluated in terms of their association with JME versus other GGE diagnosis using a logistic regression model. Juvenile myoclonic epilepsy was associated with use of illicit recreational drugs and police charges, although with borderline significance (odds ratio [OR] 3.4, p = 0.087 and OR 4.2, p = 0.095); JME was also associated with being examined for attention-deficit hyperactivity disorder (ADHD) in females (OR 15.5, p = 0.015), a biological parent with challenges like addiction or violent behavior (OR 3.5, p = 0.032), and use of levetiracetam (OR 5.1, p = 0.014). After controlling for group differences, we found psychosocial complications to be associated with JME, potentially influencing the lives of the individuals and their families to a greater extent than the seizures per se. Thus, JME should be considered a disorder of the brain in a broader sense than a condition with seizures only.
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Affiliation(s)
- Marte Syvertsen
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Kaja Selmer
- Department of Medical Genetics, Oslo University Hospital and University of Oslo, Oslo, Norway; National Center for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Ulla Enger
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Karl O Nakken
- National Center for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Deb K Pal
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom; King's College Hospital, London, United Kingdom; Evelina London Children's Hospital, London, United Kingdom
| | - Anna Smith
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jeanette Koht
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Abnormal Hippocampal Melatoninergic System: A Potential Link between Absence Epilepsy and Depression-Like Behavior in WAG/Rij Rats? Int J Mol Sci 2018; 19:ijms19071973. [PMID: 29986414 PMCID: PMC6073874 DOI: 10.3390/ijms19071973] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 12/31/2022] Open
Abstract
Absence epilepsy and depression are comorbid disorders, but the molecular link between the two disorders is unknown. Here, we examined the role of the melatoninergic system in the pathophysiology of spike and wave discharges (SWDs) and depression-like behaviour in the Wistar Albino Glaxo from Rijswijk (WAG/Rij) rat model of absence epilepsy. In WAG/Rij rats, SWD incidence was higher during the dark period of the light-dark cycle, in agreement with previous findings. However, neither pinealectomy nor melatonin administration had any effect on SWD incidence, suggesting that the melatoninergic system was not involved in the pathophysiology of absence-like seizures. Endogenous melatonin levels were lower in the hippocampus of WAG/Rij rats as compared to non-epileptic control rats, and this was associated with higher levels of melatonin receptors in the hippocampus, but not in the thalamus. In line with the reduced melatonin levels, cell density was lower in the hippocampus of WAG/Rij rats and was further reduced by pinealectomy. As expected, WAG/Rij rats showed an increased depression-like behaviour in the sucrose preference and forced swim tests, as compared to non-epileptic controls. Pinealectomy abolished the difference between the two strains of rats by enhancing depression-like behaviour in non-epileptic controls. Melatonin replacement displayed a significant antidepressant-like effect in both WAG/Rij and control rats. These findings suggest that a defect of hippocampal melatoninergic system may be one of the mechanisms underlying the depression-like phenotype in WAG/Rij rats and that activation of melatonin receptors might represent a valuable strategy in the treatment of depression associated with absence epilepsy.
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Vidaurre J, Twanow JDE. Attention Deficit Hyperactivity Disorder and Associated Cognitive Dysfunction in Pediatric Epilepsy. Semin Pediatr Neurol 2017; 24:282-291. [PMID: 29249508 DOI: 10.1016/j.spen.2017.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most common neuropsychiatric comorbidity associated with childhood epilepsy, affecting about a third of children with epilepsy. In contrast, ADHD in the general population occurs in 4%-12% of school-aged children. The cause of this association remains unclear. It is likely that common mechanisms underlie the vulnerability for both executive deficits and epileptogenesis. There are characteristics unique to children with ADHD and epilepsy. The inattentive type of ADHD is more prevalent than the combined presentation in children with epilepsy, while the combined type is more common in the general population. Interestingly, there is an equal sex distribution of ADHD in patients with epilepsy, while in the general population, ADHD is 3-7 times more prevalent in boys. Specific features of ADHD seen in different epilepsy syndromes are frequently associated with executive deficits. Early screening of ADHD symptoms in children with epilepsy is essential, as timely interventions can improve academic and social function and outcomes. The mainstays of therapy include behavioral interventions and pharmacotherapy, with evidence demonstrating that stimulants are both safe and effective in children with ADHD and epilepsy.
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Affiliation(s)
- Jorge Vidaurre
- From the Pediatric Neurology-Epilepsy Division, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
| | - Jaime Dawn E Twanow
- From the Pediatric Neurology-Epilepsy Division, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
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Poleon S, Szaflarski JP. Photosensitivity in generalized epilepsies. Epilepsy Behav 2017; 68:225-233. [PMID: 28215998 DOI: 10.1016/j.yebeh.2016.10.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 10/26/2016] [Accepted: 10/29/2016] [Indexed: 11/24/2022]
Abstract
Photosensitivity, which is the hallmark of photosensitive epilepsy (PSE), is described as an abnormal EEG response to visual stimuli known as a photoparoxysmal response (PPR). The PPR is a well-recognized phenomenon, occurring in 2-14% of patients with epilepsy but its pathophysiology is not clearly understood. PPR is electrographically described as 2-5Hz spike, spike-wave, or slow wave complexes with frontal and paracentral prevalence. Diagnosis of PPR is confirmed using intermittent photic stimulation (IPS) as well as video monitoring. The PPR can be elicited by certain types of visual stimuli including flicker, high contrast gratings, moving patterns, and rapidly modulating luminance patterns which may be encountered during e.g., watching television, playing video games, or attending discotheques. Photosensitivity may present in different idiopathic (genetic) epilepsy syndromes e.g. juvenile myoclonic epilepsy (JME) as well as non-IGE syndromes e.g. severe myoclonic epilepsy of infancy. Consequently, PPR is present in patients with diverse seizure types including absence, myoclonic, and generalized tonic-clonic (GTC) seizures. Across syndromes, abnormalities in structural connectivity, functional connectivity, cortical excitability, cortical morphology, and behavioral and neuropsychological function have been reported. Treatment of photosensitivity includes antiepileptic drug administration, and the use of non-pharmacological agents, e.g. tinted or polarizing glasses, as well as occupational measures, e.g. avoidance of certain stimuli.
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Affiliation(s)
- Shervonne Poleon
- University of Alabama at Birmingham, Department of Neurology and UAB Epilepsy Center, Birmingham, AL, USA.
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham, Department of Neurology and UAB Epilepsy Center, Birmingham, AL, USA
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Karlov VA, Zolovkina VS. Problems of juvenile myoclonic epilepsy. A view through the prism of time. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:24-33. [DOI: 10.17116/jnevro20171179224-33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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A Systematic Review of Psychiatric and Psychosocial Comorbidities of Genetic Generalised Epilepsies (GGE). Neuropsychol Rev 2016; 26:364-375. [DOI: 10.1007/s11065-016-9333-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 09/21/2016] [Indexed: 11/25/2022]
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Phenotyping juvenile myoclonic epilepsy. Praxis induction as a biomarker of unfavorable prognosis. Seizure 2015; 32:62-8. [DOI: 10.1016/j.seizure.2015.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 11/21/2022] Open
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Joshi PA, Poduri A, Kothare SV. Juvenile myoclonic epilepsy and narcolepsy: A series of three cases. Epilepsy Behav 2015; 51:163-5. [PMID: 26283305 DOI: 10.1016/j.yebeh.2015.07.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This paper sets out to demonstrate the coexistence of juvenile myoclonic epilepsy (JME) and narcolepsy that raises the possibility of a shared genetic predisposition to both conditions. METHODS The electronic medical records (EMRs) were searched for narcolepsy and JME over 10years. RESULTS We identified three young adult women diagnosed with JME in their teenage years, with myoclonic, generalized tonic-clonic, and absence seizure semiologies, along with psychiatric comorbidity, well managed on lamotrigine and/or levetiracetam. Our patients were also found to have disturbed sleep preceding the diagnosis of JME by many years, including excessive daytime sleepiness (EDS), fragmented nocturnal sleep, hypnagogic vivid hallucinations, and REM behavior disorder along with daytime cataplexy. They were ultimately diagnosed with coexisting narcolepsy, confirmed by sleep studies and multiple sleep latency testing, along with positive genetic testing for HLA-DQB1*0602 in all three patients. Stimulants, selective serotonin receptor inhibitors, and/or sodium oxybate were used to successfully treat their narcolepsy. SIGNIFICANCE The coexistence of JME and narcolepsy has not been well recognized and may be clinically relevant. In addition, it raises the possibility of a shared genetic predisposition to both conditions.
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Affiliation(s)
- Puja Aggarwal Joshi
- Department of Neurology, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Annapurna Poduri
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA
| | - Sanjeev V Kothare
- Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Medical Center, New York, NY 10016, USA.
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Esmail EH, Labib DM, Rabie WA. Association of serotonin transporter gene (5HTT) polymorphism and juvenile myoclonic epilepsy: a case-control study. Acta Neurol Belg 2015; 115:247-51. [PMID: 25481722 DOI: 10.1007/s13760-014-0400-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/27/2014] [Indexed: 11/24/2022]
Abstract
Serotonin levels might alter susceptibility to seizures. Serotonin transporter (5HTT) gene polymorphisms were found to be associated with some forms of epilepsy. Here, we attempted to examine an association between 5HTT VNTR allele variants in a serotonin transporter gene and epileptogenesis in juvenile myoclonic epilepsy (JME) cases. We conducted a case-control candidate gene study evaluating the frequencies of 5HTT VNTR allele variants using SYBR green real-time PCR with melting curve analysis in JME patients and healthy subjects. Forty patients with JME were selected from the Epilepsy Outpatient Clinic of Kasr Al Ainy Hospital, Cairo University, who had been classified according to the electroclinical classification of the ILAE. The control group consisted of 40 healthy Egyptian subjects. The less efficient transcriptional genotypes for 5-HTT polymorphisms were more frequent in JME patients (OR 9.33, CI 2.85-30.60; p value < 0.001). In our study we detected an association between the presence of 5-HTTVNTR with less transcriptional efficient genotypes and JME, which suggests that modulation of the serotoninergic system might be indicated in epileptogenesis in JME.
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Affiliation(s)
- Eman H Esmail
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt,
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Wolf P, Yacubian EMT, Avanzini G, Sander T, Schmitz B, Wandschneider B, Koepp M. Juvenile myoclonic epilepsy: A system disorder of the brain. Epilepsy Res 2015; 114:2-12. [DOI: 10.1016/j.eplepsyres.2015.04.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/14/2015] [Indexed: 12/28/2022]
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Niso G, Carrasco S, Gudín M, Maestú F, Del-Pozo F, Pereda E. What graph theory actually tells us about resting state interictal MEG epileptic activity. NEUROIMAGE-CLINICAL 2015; 8:503-15. [PMID: 26106575 PMCID: PMC4475779 DOI: 10.1016/j.nicl.2015.05.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 05/07/2015] [Accepted: 05/19/2015] [Indexed: 01/21/2023]
Abstract
Graph theory provides a useful framework to study functional brain networks from neuroimaging data. In epilepsy research, recent findings suggest that it offers unique insight into the fingerprints of this pathology on brain dynamics. Most studies hitherto have focused on seizure activity during focal epilepsy, but less is known about functional epileptic brain networks during interictal activity in frontal focal and generalized epilepsy. Besides, it is not clear yet which measures are most suitable to characterize these networks. To address these issues, we recorded magnetoencephalographic (MEG) data using two orthogonal planar gradiometers from 45 subjects from three groups (15 healthy controls (7 males, 24 ± 6 years), 15 frontal focal (8 male, 32 ± 16 years) and 15 generalized epileptic (6 male, 27 ± 7 years) patients) during interictal resting state with closed eyes. Then, we estimated the total and relative spectral power of the largest principal component of the gradiometers, and the degree of phase synchronization between each sensor site in the frequency range [0.5–40 Hz]. We further calculated a comprehensive battery of 15 graph-theoretic measures and used the affinity propagation clustering algorithm to elucidate the minimum set of them that fully describe these functional brain networks. The results show that differences in spectral power between the control and the other two groups have a distinctive pattern: generalized epilepsy presents higher total power for all frequencies except the alpha band over a widespread set of sensors; frontal focal epilepsy shows higher relative power in the beta band bilaterally in the fronto-central sensors. Moreover, all network indices can be clustered into three groups, whose exemplars are the global network efficiency, the eccentricity and the synchronizability. Again, the patterns of differences were clear: the brain network of the generalized epilepsy patients presented greater efficiency and lower eccentricity than the control subjects for the high frequency bands, without a clear topography. Besides, the frontal focal epileptic patients showed only reduced eccentricity for the theta band over fronto-temporal and central sensors. These outcomes indicate that functional epileptic brain networks are different to those of healthy subjects during interictal stage at rest, with a unique pattern of dissimilarities for each type of epilepsy. Further, when properly selected, three network indices suffice to provide a comprehensive description of these differences. Yet, since such uniqueness in the pattern of differences is also evident in the power spectrum, we conclude that the added value of the graph theory approach in this context should not be overestimated. We study MEG activity during interictal resting state with closed eyes. Generalized epilepsy presents higher total power over a widespread set of sensors. Frontal epilepsy shows higher relative power in beta band on fronto-central sensors. We also found altered functional brain networks in epilepsy using graph theory. The pattern of differences from control subjects is unique for each type of epilepsy.
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Affiliation(s)
- Guiomar Niso
- Center for Biomedical Technology, Technical University of Madrid, Madrid, Spain ; McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Sira Carrasco
- Teaching General Hospital of Ciudad Real, Ciudad Real, Spain
| | - María Gudín
- Teaching General Hospital of Ciudad Real, Ciudad Real, Spain
| | - Fernando Maestú
- Center for Biomedical Technology, Technical University of Madrid, Madrid, Spain ; Biomedical Research Networking Center in Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Francisco Del-Pozo
- Center for Biomedical Technology, Technical University of Madrid, Madrid, Spain ; Biomedical Research Networking Center in Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Ernesto Pereda
- Dept. of Industrial Engineering, Electrical Engineering and Bioengineering Group, Institute of Biomedical Technology (ITB-CIBICAN), University of La Laguna, Tenerife, Spain
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Höfler J, Unterberger I, Dobesberger J, Kuchukhidze G, Walser G, Trinka E. Seizure outcome in 175 patients with juvenile myoclonic epilepsy – A long-term observational study. Epilepsy Res 2014; 108:1817-24. [DOI: 10.1016/j.eplepsyres.2014.09.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 09/02/2014] [Accepted: 09/06/2014] [Indexed: 12/01/2022]
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Holtkamp M, Senf P, Kirschbaum A, Janz D. Psychosocial long-term outcome in juvenile myoclonic epilepsy. Epilepsia 2014; 55:1732-8. [DOI: 10.1111/epi.12751] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg; Department of Neurology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Philine Senf
- Department of Psychosomatics; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Andrea Kirschbaum
- Epilepsy-Center Berlin-Brandenburg; Department of Neurology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Dieter Janz
- Epilepsy-Center Berlin-Brandenburg; Department of Neurology; Charité - Universitätsmedizin Berlin; Berlin Germany
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Factors associated with lack of response to valproic acid monotherapy in juvenile myoclonic epilepsy. Seizure 2014; 23:527-32. [DOI: 10.1016/j.seizure.2014.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 11/21/2022] Open
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Jayalakshmi S, Padmaja G, Vooturi S, Bogaraju A, Surath M. Impact of family support on psychiatric disorders and seizure control in patients with juvenile myoclonic epilepsy. Epilepsy Behav 2014; 37:7-10. [PMID: 24949575 DOI: 10.1016/j.yebeh.2014.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 05/18/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Psychiatric disorders (PDs) are frequently observed in patients with juvenile myoclonic epilepsy (JME). In this study, we aimed to assess factors associated with PDs in patients with JME. METHODS Retrospective analysis of data of 90 consecutive patients with JME was performed. Assessment of DSM-IV Axis I clinical disorders was done using Structured Clinical Interview for Axis I. Diagnosis of PDs is made when the score exceeds the threshold provided by the DSM-IV. We also applied the Global Assessment of Functioning (GAF) scale which is part of the multiaxial evaluation of the DSM-IV (Axis-V). Using seizure frequency score at presentation, we classified subjects into controlled and uncontrolled groups. RESULTS In the current cohort, 29 (32.2%) patients were diagnosed with PDs. Fewer patients with PDs had family support (48.3% vs. 83.6%; p=0.001). Lifetime prevalence of PDs was higher among patients with current PDs (96.6% vs. 18.0%; p<0.0001). Subthreshold illness was not different between the groups (17.2% vs. 27.9%; p=0.204). Mean GAF was higher in patients without PDs than in patients with PDs (89.19±6.92 vs. 64.22±9.76; p<0.0001). Patients with PDs had lower seizure control (7.8% vs. 73.1%; p<0.0001) compared with patients without PDs. Logistic regression analysis for factors associated with diagnosis of PDs revealed that none of the factors significantly affected the odds of seizure control. Patients with lack of family support had poor seizure control (0% vs. 36.9%; p<0.0001); 51.7% of patients with JME with PDs reported lack of family support. Patients with family support had lower lifetime prevalence of PDs (30.8% vs. 76.0%; p<0.0001), whereas patients with JME without family support had lower levels of education (8.0% vs. 35.4%; p=0.009). CONCLUSION Lack of family support is associated with poor seizure control and higher incidence of PDs in patients with JME. Lack of family support increases neither the odds of PDs nor seizure control.
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Affiliation(s)
- Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-03, Andhra Pradesh, India.
| | - Gaddamanugu Padmaja
- Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India
| | - Sudhindra Vooturi
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-03, Andhra Pradesh, India
| | | | - Mohandas Surath
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-03, Andhra Pradesh, India
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Walsh J, Thomas RH, Church C, Rees MI, Marson AG, Baker GA. Executive functions and psychiatric symptoms in drug-refractory juvenile myoclonic epilepsy. Epilepsy Behav 2014; 35:72-7. [PMID: 24820514 DOI: 10.1016/j.yebeh.2014.03.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 03/25/2014] [Accepted: 03/31/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The pattern of executive dysfunction reported in juvenile myoclonic epilepsy (JME) resembles that of patients with cluster B personality disorders. This study examined whether executive dysfunction and maladaptive behavior reported in patients with JME are related. METHOD Sixty patients with drug-refractory JME were administered tests of intellect, memory, and executive dysfunction. Anxiety, depression, personality traits, impact of epilepsy, and perceived cognitive effects of antiepileptic drugs were measured. RESULTS Half of the cohort exhibited moderate to severe anxiety symptoms. The patients performed most poorly on naming ability and inhibition switching. Duration of epilepsy exacerbated poor performance on inhibition switching. Females presented with pathological scores for neurotic and introvert traits and males for introvert traits. Abnormal personality traits and psychiatric disorders were associated with worse intellectual and executive functioning. People with extreme Eysenck Personality Scale - Brief Version (EPQ-BV) scores demonstrated the greatest level of executive impairment. Furthermore, the same degree of dysfunction was not seen in any individual with unremarkable EPQ-BV scores. CONCLUSION This study indicates that specific patterns of executive dysfunction are related to maladaptive behavior in JME. Distinct behavioral patterns may be used to identify functional and anatomical differences between people with JME and for stratification to enable gene discovery.
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Affiliation(s)
- Jordana Walsh
- Department of Clinical and Molecular Pharmacology, University of Liverpool, Liverpool, UK.
| | - Rhys H Thomas
- College of Medicine, Institute of Life Science, Swansea University, Swansea, UK; Wales Epilepsy Research Network (WERN), College of Medicine, Swansea University, Swansea, UK
| | - Carla Church
- Department of Clinical and Molecular Pharmacology, University of Liverpool, Liverpool, UK
| | - Mark I Rees
- College of Medicine, Institute of Life Science, Swansea University, Swansea, UK; Wales Epilepsy Research Network (WERN), College of Medicine, Swansea University, Swansea, UK
| | - Anthony G Marson
- Department of Clinical and Molecular Pharmacology, University of Liverpool, Liverpool, UK
| | - Gus A Baker
- Department of Clinical and Molecular Pharmacology, University of Liverpool, Liverpool, UK
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Kay BP, Holland SK, Privitera MD, Szaflarski JP. Differences in paracingulate connectivity associated with epileptiform discharges and uncontrolled seizures in genetic generalized epilepsy. Epilepsia 2014; 55:256-63. [PMID: 24447031 DOI: 10.1111/epi.12486] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Patients with genetic generalized epilepsy (GGE) frequently continue to have seizures despite appropriate clinical management. GGE is associated with changes in the resting-state networks modulated by clinical factors such as duration of disease and response to treatment. However, the effect of generalized spike and wave discharges (GSWDs) and/or seizures on resting-state functional connectivity (RSFC) is not well understood. METHODS We investigated the effects of GSWD frequency (in GGE patients), GGE (patients vs. healthy controls), and seizures (uncontrolled vs. controlled) on RSFC using seed-based voxel correlation in simultaneous electroencephalography (EEG) and resting-state functional magnetic resonance imaging (fMRI) (EEG/fMRI) data from 72 GGE patients (23 with uncontrolled seizures) and 38 healthy controls. We used seeds in paracingulate cortex, thalamus, cerebellum, and posterior cingulate cortex to examine changes in cortical-subcortical resting-state networks and the default mode network (DMN). We excluded from analyses time points surrounding GSWDs to avoid possible contamination of the resting state. RESULTS (1) Higher frequency of GSWDs was associated with an increase in seed-based voxel correlation with cortical and subcortical brain regions associated with executive function, attention, and the DMN; (2) RSFC in patients with GGE, when compared to healthy controls, was increased between paracingulate cortex and anterior, but not posterior, thalamus; and (3) GGE patients with uncontrolled seizures exhibited decreased cerebellar RSFC. SIGNIFICANCE Our findings in this large sample of patients with GGE (1) demonstrate an effect of interictal GSWDs on resting-state networks, (2) provide evidence that different thalamic nuclei may be affected differently by GGE, and (3) suggest that cerebellum is a modulator of ictogenic circuits.
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Affiliation(s)
- Benjamin P Kay
- Neuroscience Graduate Program, University of Cincinnati, Cincinnati, Ohio, U.S.A; Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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Schneider-von Podewils F, Gasse C, Geithner J, Wang ZI, Bombach P, Berneiser J, Herzer R, Kessler C, Runge U. Clinical predictors of the long-term social outcome and quality of life in juvenile myoclonic epilepsy: 20-65 years of follow-up. Epilepsia 2014; 55:322-30. [DOI: 10.1111/epi.12491] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2013] [Indexed: 12/01/2022]
Affiliation(s)
| | - Christina Gasse
- Department of Neurology; Epilepsy Center; University of Greifswald; Greifswald Germany
| | | | - Zhong I. Wang
- Epilepsy Center; Neurological Institute; Cleveland Clinic Foundation; Cleveland Ohio U.S.A
| | - Paula Bombach
- Department of Neurology; Epilepsy Center; University of Greifswald; Greifswald Germany
| | - Julia Berneiser
- Department of Neurology; Epilepsy Center; University of Greifswald; Greifswald Germany
| | - Rosemarie Herzer
- Department of Neurology; Epilepsy Center; University of Greifswald; Greifswald Germany
| | - Christof Kessler
- Department of Neurology; Epilepsy Center; University of Greifswald; Greifswald Germany
| | - Uwe Runge
- Department of Neurology; Epilepsy Center; University of Greifswald; Greifswald Germany
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Masino SA, Kawamura M, Ruskin DN. Adenosine receptors and epilepsy: current evidence and future potential. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2014; 119:233-55. [PMID: 25175969 PMCID: PMC6026023 DOI: 10.1016/b978-0-12-801022-8.00011-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Adenosine receptors are a powerful therapeutic target for regulating epileptic seizures. As a homeostatic bioenergetic network regulator, adenosine is perfectly suited to establish or restore an ongoing balance between excitation and inhibition, and its anticonvulsant efficacy is well established. There is evidence for the involvement of multiple adenosine receptor subtypes in epilepsy, but in particular the adenosine A1 receptor subtype can powerfully and bidirectionally regulate seizure activity. Mechanisms that regulate adenosine itself are increasingly appreciated as targets to thus influence receptor activity and seizure propensity. Taken together, established evidence for the powerful potential of adenosine-based epilepsy therapies and new strategies to influence receptor activity can combine to capitalize on this endogenous homeostatic neuromodulator.
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Affiliation(s)
- Susan A Masino
- Department of Psychology and Neuroscience Program, Trinity College, Hartford, Connecticut, USA.
| | - Masahito Kawamura
- Department of Pharmacology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - David N Ruskin
- Department of Psychology and Neuroscience Program, Trinity College, Hartford, Connecticut, USA
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Crespel A, Gelisse P, Reed RC, Ferlazzo E, Jerney J, Schmitz B, Genton P. Management of juvenile myoclonic epilepsy. Epilepsy Behav 2013; 28 Suppl 1:S81-6. [PMID: 23756489 DOI: 10.1016/j.yebeh.2013.01.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 10/16/2012] [Indexed: 10/26/2022]
Abstract
Juvenile myoclonic epilepsy (JME) is a common form of epilepsy and a fairly lifelong disorder that may significantly lower a patient's expectations and potential for a full life. Luckily, it is also a highly treatable disorder, and up to 85% of patients with JME will enjoy satisfactory seizure control. Among anticonvulsants, valproate still stands out as the most efficacious drug, but may be poorly tolerated by some, and is considered unsafe for the fetuses of pregnant women. Alternatives have emerged in recent years, especially levetiracetam, but also topiramate, zonisamide or lamotrigine. In some cases, combination therapy may be useful or even required. One should not forget the potential aggravation induced not only by some commonly used anticonvulsants, especially carbamazepine and oxcarbazepine, but also, in some patients, by lamotrigine. In special settings, older drugs like benzodiazepines and barbiturates may be useful. But the management of JME should also include intervention in lifestyle, with strict avoidance of sleep deprivation and the management of copathologies, including the cognitive and psychiatric problems that are often encountered. With adequate management, there will only remain a small proportion of patients with uncontrolled epilepsy and all of its related problems. Juvenile myoclonic epilepsy is a condition in which the clinician has a fair chance of significantly helping the patient with medication and counseling.
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Affiliation(s)
- Arielle Crespel
- Epilepsy Unit, Hôpital Gui de Chauliac, Montpellier, France; Research Unit "Movement Disorders" (URMA), Department of Neurobiology, Institute of Functional Genomics, Montpellier, France.
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de Araujo Filho GM, Yacubian EMT. Juvenile myoclonic epilepsy: psychiatric comorbidity and impact on outcome. Epilepsy Behav 2013; 28 Suppl 1:S74-80. [PMID: 23756487 DOI: 10.1016/j.yebeh.2013.03.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 03/17/2013] [Accepted: 03/23/2013] [Indexed: 11/16/2022]
Abstract
Juvenile myoclonic epilepsy (JME) is a well-defined age-related idiopathic epilepsy syndrome. Past studies have emphasized the difficulties in the treatment of patients with JME, which have been attributed to some specific psychiatric, psychological, and psychosocial characteristics. These aspects have aroused a significant amount of interest in the last two decades. In this article, the available studies that investigated the prevalence of psychiatric disorders (PDs) in JME and its impact on seizure outcome were reviewed in order to provide an update to clinicians about these two important aspects associated with this common epilepsy syndrome. The review disclosed a high prevalence of PDs in patients with JME, particularly mood, anxiety, and personality disorders. In addition, most recent studies have also observed that overall prevalence of PDs in JME has not shown statistically significant differences when compared with TLE, an epilepsy syndrome where the psychiatric aspects are most frequently studied. Taken together, data regarding the prevalence of PDs and their possible consequences on seizure outcome on JME indicate that special attention should be directed to psychological disturbances and psychiatric symptoms in this epilepsy syndrome. The early recognition and treatment of psychiatric symptoms, as well as psychological disturbances and psychosocial difficulties, should be considered fundamental to JME prognosis.
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de Araujo Filho GM, de Araujo TB, Sato JR, Silva ID, Lin K, Júnior HC, Yacubian EMT, Jackowski AP. Personality traits in juvenile myoclonic epilepsy: evidence of cortical abnormalities from a surface morphometry study. Epilepsy Behav 2013; 27:385-92. [PMID: 23510795 DOI: 10.1016/j.yebeh.2013.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 01/04/2023]
Abstract
Cluster B personality disorders (PD), characterized as emotional instability, immaturity, lack of discipline, and rapid mood changes, have been observed among patients with juvenile myoclonic epilepsy (JME) and have been associated with a worse seizure outcome. Proper understanding of the neurobiology of PD associated with JME could contribute to understanding the basis for earlier and more effective interventions. In the present study, volumetric and geometric features of cortical structure were assessed through an automated cortical surface reconstruction method aiming to verify possible structural cortical alterations among patients with JME. Twenty-two patients with JME with cluster B PD, 44 patients with JME without psychiatric disorders, and 23 healthy controls were submitted to a psychiatric evaluation through SCID I and SCID II and to an MRI scan. Significant cortical alterations in mesiofrontal and frontobasal regions, as well as in other limbic and paralimbic regions, were observed mainly in patients with JME with PD. The present study adds evidence to the hypothesis of frontal and limbic involvement in the pathophysiology of cluster B PD in JME, regions linked to mood and affective regulation, as well as to impulsivity and social behavior. Moreover, a multidimensional pattern of frontal, limbic, and paralimbic changes was observed through a method of structural analysis which offers different and simultaneous geometric features, allowing the elaboration of important pathophysiologic insights about cluster B PD in JME.
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Affiliation(s)
- Gerardo Maria de Araujo Filho
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Department of Psychiatry, Universidade Federal de São Paulo/UNIFESP, São Paulo, Brazil.
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46
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Zamarian L, Höfler J, Kuchukhidze G, Delazer M, Bonatti E, Kemmler G, Trinka E. Decision making in juvenile myoclonic epilepsy. J Neurol 2012; 260:839-46. [DOI: 10.1007/s00415-012-6715-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/27/2012] [Accepted: 10/11/2012] [Indexed: 11/28/2022]
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Accounting for comorbidity in assessing the burden of epilepsy among US adults: results from the National Comorbidity Survey Replication (NCS-R). Mol Psychiatry 2012; 17:748-58. [PMID: 21577213 PMCID: PMC3165095 DOI: 10.1038/mp.2011.56] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although epilepsy is associated with substantial role impairment, it is also highly comorbid with other physical and mental disorders, making unclear the extent to which impairments associated with epilepsy are actually due to comorbidities. This issue was explored in the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey of 5692 US adults. Medically recognized epilepsy was ascertained with self-report, comorbid physical disorders with a chronic conditions checklist, and comorbid DSM-IV mental disorders with the Composite International Diagnostic Interview. Lifetime epilepsy prevalence was estimated at 1.8%. Epilepsy was comorbid with numerous neurological and general medical conditions and with a sporadic cluster of mental comorbidities (panic, PTSD, conduct disorder and substance use disorders). Although comorbid disorders explain part of the significant gross associations of epilepsy with impairment, epilepsy remains significantly associated with work disability, cognitive impairment and days of role impairment after controlling comorbidities. The net association of epilepsy with days of role impairment after controlling for comorbidities is equivalent to an annualized 89.4 million excess role impairment days among US adults with epilepsy, arguing that role impairment is a major component of the societal costs of epilepsy per se rather than merely due to disorders comorbid with epilepsy. This estimated burden is likely conservative as some parts of the effects of epilepsy are presumably mediated by secondary comorbid disorders.
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48
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Helmstaedter C, Witt JA. Clinical neuropsychology in epilepsy: theoretical and practical issues. HANDBOOK OF CLINICAL NEUROLOGY 2012; 107:437-459. [PMID: 22938988 DOI: 10.1016/b978-0-444-52898-8.00036-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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49
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Patients with epilepsy and patients with psychogenic non-epileptic seizures: Video-EEG, clinical and neuropsychological evaluation. Seizure 2011; 20:706-10. [DOI: 10.1016/j.seizure.2011.07.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 06/30/2011] [Accepted: 07/02/2011] [Indexed: 11/22/2022] Open
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Sarkisova K, van Luijtelaar G. The WAG/Rij strain: a genetic animal model of absence epilepsy with comorbidity of depression [corrected]. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:854-76. [PMID: 21093520 DOI: 10.1016/j.pnpbp.2010.11.010] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 09/28/2010] [Accepted: 11/09/2010] [Indexed: 01/02/2023]
Abstract
A great number of clinical observations show a relationship between epilepsy and depression. Idiopathic generalized epilepsy, including absence epilepsy, has a genetic basis. The review provides evidence that WAG/Rij rats can be regarded as a valid genetic animal model of absence epilepsy with comorbidity of depression. WAG/Rij rats, originally developed as an animal model of human absence epilepsy, share many EEG and behavioral characteristics resembling absence epilepsy in humans, including the similarity of action of various antiepileptic drugs. Behavioral studies indicate that WAG/Rij rats exhibit depression-like symptoms: decreased investigative activity in the open field test, increased immobility in the forced swimming test, and decreased sucrose consumption and preference (anhedonia). In addition, WAG/Rij rats adopt passive strategies in stressful situations, express some cognitive disturbances (reduced long-term memory), helplessness, and submissiveness, inability to make choice and overcome obstacles, which are typical for depressed patients. Elevated anxiety is not a characteristic (specific) feature of WAG/Rij rats; it is a characteristic for only a sub-strain of WAG/Rij rats susceptible to audiogenic seizures. Interestingly, WAG/Rij rats display a hyper-response to amphetamine similar to anhedonic depressed patients. WAG/Rij rats are sensitive only to chronic, but not acute, antidepressant treatments, suggesting that WAG/Rij rats fulfill a criterion of predictive validity for a putative animal model of depression. However, more and different antidepressant drugs still await evaluation. Depression-like behavioral symptoms in WAG/Rij rats are evident at baseline conditions, not exclusively after stress. Experiments with foot-shock stress do not point towards higher stress sensitivity at both behavioral and hormonal levels. However, freezing behavior (coping deficits) and blunted response of 5HT in the frontal cortex to uncontrollable sound stress, increased c-fos expression in the terminal regions of the meso-cortico-limbic brain systems and greater DA response of the mesolimbic system to forced swim stress suggest that WAG/Rij rats are vulnerable to some, but not to all types of stressors. We propose that genetic absence epileptic WAG/Rij rats have behavioral depression-like symptoms, are vulnerable to stress and might represent a model of chronic low-grade depression (dysthymia). Both 5HT and DAergic abnormalities detected in the brain of WAG/Rij rats are involved in modulation of vulnerability to stress and provocation of behavioral depression-like symptoms. The same neurotransmitter systems modulate SWDs as well. Recent studies suggest that the occurrence and repetition of absence seizures are a precipitant of depression-like behavior. Whether the neurochemical changes are primary to depression-like behavioral alterations remains to be determined. In conclusion, the WAG/Rij rats can be considered as a genetic animal model for absence epilepsy with comorbidity of dysthymia. This model can be used to investigate etiology, pathogenic mechanisms and treatment of a psychiatric comorbidity, such as depression in absence epilepsy, to reveal putative genes contributing to comorbid depressive disorder, and to screen novel psychotropic drugs with a selective and/or complex (dual) action on both pathologies.
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Affiliation(s)
- Karine Sarkisova
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerov str. 5a, Moscow 117485, Russia.
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