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Gonzalez Stivala E, Wolfzun C, Sarudiansky M, Kochen S, Giagante B, Oddo S, Korman G, D'Alessio L. Psychiatric comorbid disorders and impulsivity in patients with drug-resistant temporal and extra-temporal focal epilepsies. Epilepsy Behav 2024; 159:109970. [PMID: 39121750 DOI: 10.1016/j.yebeh.2024.109970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE To analyze patients with drug-resistant focal epilepsy from temporal (TLE) and extra-temporal origin (ETE) and to compare the prevalence of psychiatric comorbid disorders and impulsivity between them and a control group. METHODS Consecutively studied patients with TLE and ETE confirmed with Video-EEG were included. Standardized psychiatric assessment was conducted using the Structured Clinical Interview for Axis I and II diagnosis of DSM-IV (SCID I-II), the Barrat-11 scale for impulsivity, and Beck inventory for depression. Parametric and nonparametric tests were performed. RESULTS Seventy-three patients with temporal lobe epilepsy (TLE), 21 extra-temporal epilepsy (ETE) and 58 healthy control subjects were included. Both groups of patients showed a high frequency of Axis I comorbid psychiatric disorders: Depression was the most frequent disorder followed by Anxiety Disorders. Furthermore, Axis II (Personality disorders) were also diagnosed, similarly in both groups of patients (p > 0.05). In addition, both TLE and ETE groups presented higher impulsivity scores compared with the control group (p < 0.01). ETE showed a tendency to a higher impulsivity in the motor factor (p = 0.05). Among patients with TLE, a left laterality of the epileptogenic zone, and the presence of comorbid psychiatric disorders (depression), were found as independent factors associated with higher impulsivity (p < 0.05). CONCLUSION Comorbid depression associated with higher impulsivity are important issues to consider in behavioral and clinical evaluation of patients with drug-resistant focal epilepsies, with the aim to set up a prompt treatment.
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Affiliation(s)
- Ernesto Gonzalez Stivala
- Universidad de Buenos Aires (UBA), Facultad de Medicina, IBCN (Instituto de Biología Celular y Neurociencias) - Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET), Argentina; Centro de Epilepsia del Hospital El Cruce, Estudios en Neurociencias y Sistemas Complejos (ENyS)-CONICET, Argentina
| | - Camila Wolfzun
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina; Universidad de Buenos Aires (UBA), Facultad de Psicología-CONICET, Argentina
| | - Mercedes Sarudiansky
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina; Universidad de Buenos Aires (UBA), Facultad de Psicología-CONICET, Argentina
| | - Silvia Kochen
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina; Centro de Epilepsia del Hospital El Cruce, Estudios en Neurociencias y Sistemas Complejos (ENyS)-CONICET, Argentina
| | - Brenda Giagante
- Centro de Epilepsia del Hospital El Cruce, Estudios en Neurociencias y Sistemas Complejos (ENyS)-CONICET, Argentina
| | - Silvia Oddo
- Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina; Centro de Epilepsia del Hospital El Cruce, Estudios en Neurociencias y Sistemas Complejos (ENyS)-CONICET, Argentina
| | - Guido Korman
- Universidad de Buenos Aires (UBA), Facultad de Psicología-CONICET, Argentina
| | - Luciana D'Alessio
- Universidad de Buenos Aires (UBA), Facultad de Medicina, IBCN (Instituto de Biología Celular y Neurociencias) - Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET), Argentina; Universidad de Buenos Aires (UBA), Facultad de Medicina, Centro de Epilepsia del Hospital Ramos Mejía, Buenos Aires, Argentina.
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Teichner EM, Subtirelu RC, Patil S, Parikh C, Ashok AB, Talasila S, Anderson VA, Khan T, Su Y, Werner T, Alavi A, Revheim ME. Positron Emission Tomography (PET) in presurgical planning of anterior temporal lobectomy: A systematic review of efficacy and limitations. Clin Neurol Neurosurg 2024; 246:108562. [PMID: 39326280 DOI: 10.1016/j.clineuro.2024.108562] [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: 08/11/2024] [Revised: 09/14/2024] [Accepted: 09/15/2024] [Indexed: 09/28/2024]
Abstract
INTRODUCTION Temporal lobe epilepsy (TLE), a debilitating neurological disorder, necessitates refined diagnostic and treatment strategies. This comprehensive review appraises the potential of positron emission tomography (PET) in enhancing the presurgical planning of Anterior Temporal Lobectomy (ATL) for patients afflicted with TLE. METHODS A comprehensive literature search was conducted using the PubMed, SCOPUS, and ScienceDirect databases from 1985 to 2022, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies investigating PET and ATL. This review studied a range of radiotracers, including FDG, H2O, FMZ, MPPF, and FCWAY, analyzing their efficacy in detecting epileptogenic foci, establishing resection boundaries, and predicting postoperative outcomes. The study paid special attention to cases where MRI findings were inconclusive. RESULTS A total of 52 studies were included in the final analysis. Our analysis revealed that FDG-PET imaging was instrumental in identifying seizure foci and predicting postoperative results. It exhibited significant value in situations where structural abnormalities were absent on MRI scans. Furthermore, newer radiotracers such as 5-HT1A antagonists, FCWAY and MPPF, presented promising potential for localizing seizure foci, particularly in MRI-negative TLE, despite their comparatively limited current usage. CONCLUSION PET imaging, although challenged by issues such as radiation exposure, limited accessibility, and high costs, offers considerable promise. Integration with other imaging modalities, such as EEG and MRI, has contributed to improved localization of epileptogenic foci and subsequently, enhanced surgical outcomes. Further research must focus on establishing the relative efficacy and optimal combinations of these radiotracers in the orchestration of ATL surgical planning and prognostication of postoperative outcomes for TLE patients. Encouragingly, these advancements hold the potential to revolutionize the management of TLE, delivering a better quality of life for patients.
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Affiliation(s)
- Eric M Teichner
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert C Subtirelu
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Shiv Patil
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Chitra Parikh
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Arjun B Ashok
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sahithi Talasila
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Victoria A Anderson
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Talha Khan
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Yvonne Su
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Mona-Elisabeth Revheim
- The Intervention Centre, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Xiao L, Yang J, Zhu H, Zhou M, Li J, Liu D, Tang Y, Feng L, Hu S. [ 18F]SynVesT-1 and [ 18F]FDG quantitative PET imaging in the presurgical evaluation of MRI-negative children with focal cortical dysplasia type II. Eur J Nucl Med Mol Imaging 2024; 51:1651-1661. [PMID: 38182838 DOI: 10.1007/s00259-024-06593-1] [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: 08/29/2023] [Accepted: 01/01/2024] [Indexed: 01/07/2024]
Abstract
PURPOSE MRI-negative children with focal cortical dysplasia type II (FCD II) are one of the most challenging cases in surgical epilepsy management. We aimed to utilize quantitative positron emission tomography (QPET) analysis to complement [18F]SynVesT-1 and [18F]FDG PET imaging and facilitate the localization of epileptogenic foci in pediatric MRI-negative FCD II patients. METHODS We prospectively enrolled 17 MRI-negative children with FCD II who underwent [18F]SynVesT-1 and [18F]FDG PET before surgical resection. The QPET scans were analyzed using statistical parametric mapping (SPM) with respect to healthy controls. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of [18F]SynVesT-1 PET, [18F]FDG PET, [18F]SynVesT-1 QPET, and [18F]FDG QPET in the localization of epileptogenic foci were assessed. Additionally, we developed a multivariate prediction model based on dual trace PET/QPET assessment. RESULTS The AUC values of [18F]FDG PET and [18F]SynVesT-1 PET were 0.861 (sensitivity = 94.1%, specificity = 78.2%, PPV = 38.1%, NPV = 98.9%) and 0.908 (sensitivity = 82.4%, specificity = 99.2%, PPV = 93.3%, NPV = 97.5%), respectively. [18F]FDG QPET showed lower sensitivity (76.5%) and NPV (96.6%) but higher specificity (95.0%) and PPV (68.4%) than visual assessment, while [18F]SynVesT-1 QPET exhibited higher sensitivity (94.1%) and NPV (99.1%) but lower specificity (97.5%) and PPV (84.2%). The multivariate prediction model had the highest AUC value (AUC = 0.996, sensitivity = 100.0%, specificity = 96.6%, PPV = 81.0%, NPV = 100%). CONCLUSIONS The multivariate prediction model based on [18F]SynVesT-1 and [18F]FDG PET/QPET assessments holds promise in noninvasively identifying epileptogenic regions in MRI-negative children with FCD II. Furthermore, the combination of visual assessment and QPET may improve the sensitivity and specificity of diagnostic tests in localizing epileptogenic foci and achieving a preferable surgical outcome in MRI-negative FCD II.
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Affiliation(s)
- Ling Xiao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jinhui Yang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Haoyue Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ming Zhou
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jian Li
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Hue CD, Couper RG, Antaya TC, Herrera M, Parra J, Burneo JG. Depression and suicide after temporal lobe epilepsy surgery: A systematic review. Epilepsy Behav 2022; 134:108853. [PMID: 35905516 DOI: 10.1016/j.yebeh.2022.108853] [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: 05/15/2022] [Revised: 07/09/2022] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
Psychiatric comorbidities, including depression and suicide, contribute substantially to the illness burden of patients with refractory temporal lobe epilepsy (TLE). The aim of this systematic review was to synthesize the existing literature assessing the effect of TLE surgery on (1) depression prevalence and (2) severity, and estimating the incidence of (3) de novo depression and (4) attempted and completed suicide following TLE surgery. A literature search was performed using Ovid Medline, Embase, Clarivate Web of Science, Cochrane Library, and ProQuest Dissertations and Theses. Studies of patients with TLE who underwent TLE surgery and reported estimates of at least one of the following outcomes were included: pre- and postoperative depression prevalence or severity, the incidence of postoperative de novo depression, or attempted or completed suicide. The search yielded 2,127 citations related to TLE surgery and postoperative depression or suicide. After a full-text review of 98 articles, 18 met the final eligibility criteria. Most studies reported a reduced or similar prevalence (n = 12) and severity of depression (n = 5) postoperatively, compared with the preoperative period. Eleven studies reported the incidence of postoperative de novo depression, which ranged from 0 % to 38 % over follow-up periods of three months to nine years. Four studies assessed the incidence of postoperative attempted or completed suicide, with completed suicide incidence ranging from 0 % to 3 % over follow-up periods of one to four years. Overall, the effect of TLE surgery on depression and suicide remains unclear, as many studies did not assess the statistical significance of depression prevalence or severity changes following TLE surgery. Therefore, timely psychosocial follow-up for patients after TLE surgery should be considered. Future longitudinal studies with consistent measures are needed to elucidate the effect of TLE surgery on the prevalence and severity of depression and estimate the incidence of de novo depression and suicide following surgery.
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Affiliation(s)
- Christopher D Hue
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St., London, Ontario N6A 3K7, Canada.
| | - R Grace Couper
- Neuroepidemiology Research Unit, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St., London, Ontario N6A 3K7, Canada.
| | - Tresah C Antaya
- Neuroepidemiology Research Unit, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St., London, Ontario N6A 3K7, Canada.
| | - Manuel Herrera
- Epilepsy Program, Instituto Nacional de Ciencias Neurológicas, Jr. Ancash 1271, Barrios Altos, Lima, Peru
| | - Jaime Parra
- Epilepsy Unit, Hospital San Rafael, C. Serrano, 199, 28016 Madrid, Spain
| | - Jorge G Burneo
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St., London, Ontario N6A 3K7, Canada; Neuroepidemiology Research Unit, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St., London, Ontario N6A 3K7, Canada.
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Hermann BP, Struck AF, Busch RM, Reyes A, Kaestner E, McDonald CR. Neurobehavioural comorbidities of epilepsy: towards a network-based precision taxonomy. Nat Rev Neurol 2021; 17:731-746. [PMID: 34552218 PMCID: PMC8900353 DOI: 10.1038/s41582-021-00555-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 02/06/2023]
Abstract
Cognitive and behavioural comorbidities are prevalent in childhood and adult epilepsies and impose a substantial human and economic burden. Over the past century, the classic approach to understanding the aetiology and course of these comorbidities has been through the prism of the medical taxonomy of epilepsy, including its causes, course, characteristics and syndromes. Although this 'lesion model' has long served as the organizing paradigm for the field, substantial challenges to this model have accumulated from diverse sources, including neuroimaging, neuropathology, neuropsychology and network science. Advances in patient stratification and phenotyping point towards a new taxonomy for the cognitive and behavioural comorbidities of epilepsy, which reflects the heterogeneity of their clinical presentation and raises the possibility of a precision medicine approach. As we discuss in this Review, these advances are informing the development of a revised aetiological paradigm that incorporates sophisticated neurobiological measures, genomics, comorbid disease, diversity and adversity, and resilience factors. We describe modifiable risk factors that could guide early identification, treatment and, ultimately, prevention of cognitive and broader neurobehavioural comorbidities in epilepsy and propose a road map to guide future research.
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Affiliation(s)
- Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,
| | - Aaron F. Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,William S. Middleton Veterans Administration Hospital, Madison, WI, USA
| | - Robyn M. Busch
- Epilepsy Center and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anny Reyes
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Erik Kaestner
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
| | - Carrie R. McDonald
- Department of Psychiatry and Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, USA
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Camargo Camargo L, Tejada Angarita KS, Suarez Marín MM, Fandiño Franky J. Psychiatric alterations after previous temporal lobectomy: Report of cases and review. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 50:301-307. [PMID: 34742698 DOI: 10.1016/j.rcpeng.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 05/25/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. METHODS A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. RESULTS The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. CONCLUSIONS Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.
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Affiliation(s)
- Loida Camargo Camargo
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas-FIRE, Cartagena, Colombia.
| | | | | | - Jaime Fandiño Franky
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas-FIRE, Cartagena, Colombia
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Resting-state brain metabolic fingerprinting clusters (biomarkers) and predictive models for major depression in multiple myeloma patients. PLoS One 2021; 16:e0251026. [PMID: 33956824 PMCID: PMC8101966 DOI: 10.1371/journal.pone.0251026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/17/2021] [Indexed: 01/18/2023] Open
Abstract
Background Major depression is a common comorbidity in cancer patients. Oncology clinics lack practical, objective tools for simultaneous evaluation of cancer and major depression. Fludeoxyglucose F-18 positron emission tomography–computed tomography (FDG PET/CT) is universally applied in modern medicine. Methods We used a retrospective analysis of whole-body FDG PET/CT images to identify brain regional metabolic patterns of major depression in multiple myeloma patients. The study included 134 multiple myeloma (MM) patients, 38 with major depression (group 1) and 96 without major depression (group 2). Results In the current study, Statistic Parameter Mapping (SPM) demonstrated that the major depression patient group (n = 38) had significant regional metabolic differences (clusters of continuous voxels) as compared to the non-major depression group (n = 96) with the criteria of height threshold T = 4.38 and extent threshold > 100 voxels. The five significant hypo- and three hyper-metabolic clusters from the computed T contrast maps were localized on the glass-brain view, consistent with published brain metabolic changes in major depression patients. Subsequently, using these clusters as features for classification learner, the fine tree and medium tree algorithms from 25 classification algorithms best fitted our data (accuracy 0.85%; AUC 0.88; sensitivity 79%; and specificity 88%). Conclusion This study demonstrated that whole-body FDG PET/CT scans could provide added value for screening for major depression in cancer patients in addition to staging and evaluating response to chemoradiation therapies.
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Wu C, Ren C, Teng Z, Li S, Silva F, Wu H, Chen J. Cerebral glucose metabolism in bipolar disorder: A voxel-based meta-analysis of positron emission tomography studies. Brain Behav 2021; 11:e02117. [PMID: 33769704 PMCID: PMC8119802 DOI: 10.1002/brb3.2117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Previous positron emission tomography studies have reported the changes of cerebral glucose metabolism in bipolar disorder. However, the findings across studies remain controversial, containing differing results. METHODS A systematic literature search of the PubMed, Embase, Cochrane Library, and Web of Science databases was conducted. We conducted a voxel-wide meta-analysis of cerebral glucose metabolism studies, using the seed-based mapping approach, in patients with bipolar disorder (BD). RESULTS We identified 7 studies suitable for inclusion, which included a total of 126 individuals with BD and 160 healthy controls. The most consistent and robust findings were an increase in cerebral glucose metabolism in the right precentral gyrus and a decrease in the left superior temporal gyrus, left middle temporal gyrus, and cerebellum. Additionally, the sex distribution and illness duration had significant moderating effects on cerebral glucose metabolism alterations. CONCLUSIONS Cerebral glucose metabolism alterations in these brain regions are likely to reflect the disease-related functional abnormalities such as emotion and cognition. These findings contribute to a better understanding of the neurobiological underpinnings of bipolar disorder. LIMITATIONS This study was done at a study level and cannot be addressed at the patient level. Subgroup analysis of BD I and BD II is not possible due to limited literature data.
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Affiliation(s)
- Chujun Wu
- National Clinical Research Center for Mental Disorders, Department of Psychaitry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chutong Ren
- The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ziwei Teng
- National Clinical Research Center for Mental Disorders, Department of Psychaitry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Sujuan Li
- National Clinical Research Center for Mental Disorders, Department of Psychaitry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Floyd Silva
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Haishan Wu
- National Clinical Research Center for Mental Disorders, Department of Psychaitry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jindong Chen
- National Clinical Research Center for Mental Disorders, Department of Psychaitry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
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Wen JF, Guo XW, Cao XY, Liao JW, Ma P, Hu XS, Pan JY. A PET imaging study of the brain changes of glucose metabolism in patients with temporal lobe epilepsy and depressive disorder. BMC Med Imaging 2021; 21:33. [PMID: 33618703 PMCID: PMC7898449 DOI: 10.1186/s12880-021-00547-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aims to compare the difference of the brain changes of glucose metabolism between temporal lobe epilepsy patients (TLE) with major depressive disorder and temporal TLE without major depressive disorder. METHODS A total of 24 TLE patients, who met the inclusion criteria of our hospital, were enrolled in this study. They were divided into a TLE with depression group (n = 11) and a TLE without depression group (n = 13), according to the results of the HAMD-24 Scale. Two groups patients were examined using 18F-FDG PET brain imaging. RESULTS The low metabolic regions of the TLE with depression group were mainly found in the left frontal lobe, temporal lobe and fusiform gyrus, while the high metabolic regions of the TLE with depression group were mainly located in the right frontal lobe, visual joint cortex and superior posterior cingulate cortex. Both of the TLE groups had high metabolic compensation in the non-epileptic area during the interictal period. CONCLUSIONS There is an uptake difference of 18F-FDG between TLE patients with depression and TLE patients without depression in multiple encephalic regions.
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Affiliation(s)
- Jin-Feng Wen
- Department of Psychiatry, Guangdong, The First Affiliated Hospital of Jinan University, No.613, West Huangpu Avenue, Tianhe District, Guangzhou, 510630, China
- Department of Psychology and Behavior, Guangdong Sanjiu Brain Hospital, Guangzhou, 510510, China
| | - Xin-Wen Guo
- Department of Psychiatry, Guangdong, The First Affiliated Hospital of Jinan University, No.613, West Huangpu Avenue, Tianhe District, Guangzhou, 510630, China
- Department of Psychology and Behavior, Guangdong Sanjiu Brain Hospital, Guangzhou, 510510, China
| | - Xiang-Yi Cao
- Department of Psychology and Behavior, Guangdong Sanjiu Brain Hospital, Guangzhou, 510510, China
| | - Ji-Wu Liao
- Department of Psychiatry, Guangdong, The First Affiliated Hospital of Jinan University, No.613, West Huangpu Avenue, Tianhe District, Guangzhou, 510630, China
| | - Ping Ma
- Department of Psychiatry, Guangdong, The First Affiliated Hospital of Jinan University, No.613, West Huangpu Avenue, Tianhe District, Guangzhou, 510630, China
| | - Xiang-Shu Hu
- Epilepsy Center, Guangdong Sanjiu Brain Hospital, Guangzhou, 510510, China
| | - Ji-Yang Pan
- Department of Psychiatry, Guangdong, The First Affiliated Hospital of Jinan University, No.613, West Huangpu Avenue, Tianhe District, Guangzhou, 510630, China.
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Elkommos S, Mula M. A systematic review of neuroimaging studies of depression in adults with epilepsy. Epilepsy Behav 2021; 115:107695. [PMID: 33348194 DOI: 10.1016/j.yebeh.2020.107695] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Depression is a relatively common comorbidity in people with epilepsy with a lifetime history identified in 1 in 4 individuals. In this paper, we aimed to provide a systematic review of structural and functional brain region-specific group differences of adults with epilepsy and depression and to discuss existing evidence as compared to that in people with depression. METHODS We undertook a systematic review of neuroimaging studies of depression in adults with epilepsy through MEDLINE/PubMed, Embase and PsycInfo searches until June 2020. RESULTS A total of 44 studies were included in the qualitative synthesis: 21 on structural neuroimaging, 9 on functional, and 14 on pharmaco/metabolic neuroimaging. Almost all studies focused on temporal lobe epilepsy (TLE). Patterns of changes in the hippocampi and subcortical structures seem to be different from those reported in depression outside epilepsy. Cortical changes are grossly similar as well as the lack of any laterality effect. Serotonin dysfunction seems to be due to different mechanisms with reduced synaptic availability for depression in epilepsy as compared to reduced 5HT1 receptor density outside epilepsy. Depressive symptoms seem to correlate with a dysfunction in temporolimbic structures contralateral to the epileptogenic zone especially in patients with de novo postsurgical depression. CONCLUSIONS Depression, at least in TLE, seems to be associated with a different pattern of brain changes as compared to major depression, potentially supporting the notion of phenomenological peculiarities of depression in epilepsy.
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Affiliation(s)
- Samia Elkommos
- Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Institute of Medical and Biomedical Education, St George's University of London, United Kingdom.
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Camargo Camargo L, Tejada Angarita KS, Suarez Marin MM, Fandiño Franky J. Psychiatric Alterations after Previous Temporal Lobectomy: Report of Cases and Review. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 50:S0034-7450(20)30066-4. [PMID: 33735060 DOI: 10.1016/j.rcp.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 02/05/2020] [Accepted: 05/25/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. METHODS A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. RESULTS The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. CONCLUSIONS Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.
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Affiliation(s)
- Loida Camargo Camargo
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas-FIRE, Cartagena, Colombia.
| | | | | | - Jaime Fandiño Franky
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas-FIRE, Cartagena, Colombia
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12
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Rivera Bonet CN, Hwang G, Hermann B, Struck AF, J Cook C, A Nair V, Mathis J, Allen L, Almane DN, Arkush K, Birn R, Conant LL, DeYoe EA, Felton E, Maganti R, Nencka A, Raghavan M, Shah U, Sosa VN, Ustine C, Prabhakaran V, Binder JR, Meyerand ME. Neuroticism in temporal lobe epilepsy is associated with altered limbic-frontal lobe resting-state functional connectivity. Epilepsy Behav 2020; 110:107172. [PMID: 32554180 PMCID: PMC7483612 DOI: 10.1016/j.yebeh.2020.107172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 11/18/2022]
Abstract
Neuroticism, a core personality trait characterized by a tendency towards experiencing negative affect, has been reported to be higher in people with temporal lobe epilepsy (TLE) compared with healthy individuals. Neuroticism is a known predictor of depression and anxiety, which also occur more frequently in people with TLE. The purpose of this study was to identify abnormalities in whole-brain resting-state functional connectivity in relation to neuroticism in people with TLE and to determine the degree of unique versus shared patterns of abnormal connectivity in relation to elevated symptoms of depression and anxiety. Ninety-three individuals with TLE (55 females) and 40 healthy controls (18 females) from the Epilepsy Connectome Project (ECP) completed measures of neuroticism, depression, and anxiety, which were all significantly higher in people with TLE compared with controls. Resting-state functional connectivity was compared between controls and groups with TLE with high and low neuroticism using analysis of variance (ANOVA) and t-test. In secondary analyses, the same analytics were performed using measures of depression and anxiety and the unique variance in resting-state connectivity associated with neuroticism independent of symptoms of depression and anxiety identified. Increased neuroticism was significantly associated with hyposynchrony between the right hippocampus and Brodmann area (BA) 9 (region of prefrontal cortex (PFC)) (p < 0.005), representing a unique relationship independent of symptoms of depression and anxiety. Hyposynchrony of connection between the right hippocampus and BA47 (anterior frontal operculum) was associated with high neuroticism and with higher depression and anxiety scores (p < 0.05), making it a shared abnormal connection for the three measures. In conclusion, increased neuroticism exhibits both unique and shared patterns of abnormal functional connectivity with depression and anxiety symptoms between regions of the mesial temporal and frontal lobe.
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Affiliation(s)
| | - Gyujoon Hwang
- Department of Medical Physics, University of Wisconsin-Madison, United States of America
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin-Madison, United States of America
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin-Madison, United States of America
| | - Cole J Cook
- Department of Medical Physics, University of Wisconsin-Madison, United States of America
| | - Veena A Nair
- Department of Radiology, University of Wisconsin-Madison, United States of America
| | - Jedidiah Mathis
- Department of Radiology Froedtert & Medical College of Wisconsin, United States of America
| | - Linda Allen
- Department of Neurology, Medical College of Wisconsin, United States of America
| | - Dace N Almane
- Department of Neurology, University of Wisconsin-Madison, United States of America
| | - Karina Arkush
- Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, United States of America
| | - Rasmus Birn
- Neuroscience Training Program, University of Wisconsin-Madison, United States of America; Department of Medical Physics, University of Wisconsin-Madison, United States of America; Department of Psychiatry, University of Wisconsin-Madison, United States of America
| | - Lisa L Conant
- Department of Neurology, Medical College of Wisconsin, United States of America
| | - Edgar A DeYoe
- Department of Radiology Froedtert & Medical College of Wisconsin, United States of America; Department of Biophysics, Medical College of Wisconsin, United States of America
| | - Elizabeth Felton
- Department of Neurology, University of Wisconsin-Madison, United States of America
| | - Rama Maganti
- Department of Neurology, University of Wisconsin-Madison, United States of America
| | - Andrew Nencka
- Department of Radiology Froedtert & Medical College of Wisconsin, United States of America
| | - Manoj Raghavan
- Department of Neurology, Medical College of Wisconsin, United States of America
| | - Umang Shah
- Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, United States of America
| | - Veronica N Sosa
- Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, United States of America
| | - Candida Ustine
- Department of Neurology, Medical College of Wisconsin, United States of America
| | - Vivek Prabhakaran
- Neuroscience Training Program, University of Wisconsin-Madison, United States of America; Department of Neurology, University of Wisconsin-Madison, United States of America; Department of Radiology, University of Wisconsin-Madison, United States of America
| | - Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, United States of America; Department of Biophysics, Medical College of Wisconsin, United States of America
| | - Mary E Meyerand
- Neuroscience Training Program, University of Wisconsin-Madison, United States of America; Department of Medical Physics, University of Wisconsin-Madison, United States of America; Department of Radiology, University of Wisconsin-Madison, United States of America
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13
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Abstract
The episodic nature of both epilepsy and psychiatric illnesses suggests that the brain switches between healthy and pathological states. The most obvious example of transitions between network states related to epilepsy is the manifestation of ictal events. In addition to seizures, there are more subtle changes in network communication within and between brain regions, which we propose may contribute to psychiatric illnesses associated with the epilepsies. This review will highlight evidence supporting aberrant network activity associated with epilepsy and the contribution to cognitive impairments and comorbid psychiatric illnesses. Further, we discuss potential mechanisms mediating the network dysfunction associated with comorbidities in epilepsy, including interneuron loss and hypothalamic–pituitary–adrenal axis dysfunction. Conceptually, it is necessary to think beyond ictal activity to appreciate the breadth of network dysfunction contributing to the spectrum of symptoms associated with epilepsy, including psychiatric comorbidities.
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Affiliation(s)
- Phillip L W Colmers
- Neuroscience Department, Tufts University School of Medicine, Boston, MA, USA
| | - Jamie Maguire
- Neuroscience Department, Tufts University School of Medicine, Boston, MA, USA
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14
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Morningstar M, Hung A, Mattson WI, Gedela S, Ostendorf AP, Nelson EE. Internalizing symptoms in intractable pediatric epilepsy: Structural and functional brain correlates. Epilepsy Behav 2020; 103:106845. [PMID: 31882324 DOI: 10.1016/j.yebeh.2019.106845] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 01/09/2023]
Abstract
Internalizing disorders (i.e., depression and anxiety) are common comorbidities in people with epilepsy. In adults with epilepsy, comorbid depression or anxiety is associated with worse seizure control and reduced quality of life, and may be linked to specific neural biomarkers. Less is known about brain correlates of internalizing symptoms in pediatric populations. In the current study, we performed a retrospective analysis of 45 youth between the ages of 6 and 18 years old with intractable epilepsy. Individuals were evaluated for internalizing symptoms on the Child Behavior Checklist (CBCL) and underwent magnetic resonance (MR) and fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging as part of the clinical evaluation for surgical treatment of epilepsy. Forty-two percent of patients experienced clinically significant internalizing symptoms based on parent report. Compared with individuals who scored in the normal range, youth with clinical levels of internalizing problems showed overall reductions in cortex volume, as well as widespread reductions in cortical thickness and functional activation in the bilateral occipital/parietal lobe, left temporal regions, and left inferior frontal cortex on MR and PET scans. There were no group differences in amygdala or hippocampus volumes, nor other patient- or illness-related variables such as age, sex, or the type, lateralization, or duration of epilepsy. Results suggest that high rates of internalizing disorders are present in youth with refractory epilepsy. Multifocal reductions in cortical thickness and function may be nonspecific risk factors for clinically meaningful internalizing symptoms in youth with chronic epilepsy. As such, the presence of broad cortical thinning and reduced glucose uptake upon radiological examination may warrant more focused clinical evaluation of psychological symptoms.
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Affiliation(s)
- Michele Morningstar
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America.
| | - Andy Hung
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Whitney I Mattson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Satyanarayana Gedela
- Department of Pediatrics and Neurology, Emory University College of Medicine, Atlanta, GA, United States of America
| | - Adam P Ostendorf
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America; Department of Neurology, Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Eric E Nelson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America
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15
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Nogueira MH, Pimentel da Silva LR, Vasques Moreira JC, de Rezende TJR, Zanão TA, de Campos BM, Yasuda CL, Cendes F. Major Depressive Disorder Associated With Reduced Cortical Thickness in Women With Temporal Lobe Epilepsy. Front Neurol 2020; 10:1398. [PMID: 32010051 PMCID: PMC6979005 DOI: 10.3389/fneur.2019.01398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Major Depressive Disorder (MDD) is highly prevalent in patients with mesial temporal lobe epilepsy (MTLE), especially in women, carrying significant morbidity. This study aimed to investigate the cortical thickness (CT) abnormalities associated with MDD in women with MTLE and hippocampal atrophy (HA). Also, we investigated the impact of MDD upon the volumes of the hippocampus and amygdala in these patients. Methods: We included 50 women with MTLE and HA (20 left, LMTLE; 30 right, RMTLE), 41 healthy women in the control group, and 15 women with MDD without epilepsy. MTLE patients were subdivided into three groups: MTLE-without-MDD (23 MTLE patients without MDD), MTLE-mild-MDD (nine MTLE patients with mild symptoms of MDD), and MTLE-severe-MDD (18 MTLE patients with moderate to severe symptoms of MDD). The five groups were balanced for age (p = 0.56). All participants had high-resolution 3D T1-weighted images in a 3T scanner. We used FreeSurfer 6.0 for volumetry and CT parcellation. All participants were submitted to a clinical psychological evaluation through the Structured Clinical Interview for DSM-IV (SCID-IV) and completed the Beck Depression Inventory (BDI-II). Results: We identified a smaller ipsilateral amygdala volume (p = 0.04) in the MTLE-severe-MDD group when compared to the control group. Our results presented a reduced ipsilateral lateral orbitofrontal cortex (p = 0.02) in the MTLE-severe-MDD in comparison to the MTLE-mild-MDD group. We also identified a thinner ipsilateral fusiform gyrus (p < 0.01) in the MTLE-severe-MDD compared to both MTLE-without-MDD and control groups. A reduced CT of the contralateral superior frontal gyrus (p = 0.02) was observed in the MTLE-severe-MDD in comparison to the MTLE-mild-MDD group. Conclusions: The identification of areas with reduced CT and atrophy of the ipsilateral amygdala in women with MTLE and MDD suggest that the cortical thinning in the network of the paralimbic system is related to the co-occurrence and intensity of depressive symptoms in this group.
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Affiliation(s)
- Mateus Henrique Nogueira
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil.,The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil
| | - Luciana Ramalho Pimentel da Silva
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil.,The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil
| | - José Carlos Vasques Moreira
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil.,The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil
| | - Thiago Junqueira Ribeiro de Rezende
- The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil.,Laboratory of Medical Physics, University of Campinas - UNICAMP, Campinas, Brazil
| | - Tamires Araújo Zanão
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil.,The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil
| | - Brunno Machado de Campos
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil.,The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil
| | - Clarissa Lin Yasuda
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil.,The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil
| | - Fernando Cendes
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas - UNICAMP, Campinas, Brazil.,The Brazilian Institute of Neuroscience and Neurotechnology - BRAINN, University of Campinas - UNICAMP, Campinas, Brazil
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16
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Abstract
Psychiatric illnesses, including depression and anxiety, are highly comorbid with epilepsy (for review see Josephson and Jetté (Int Rev Psychiatry 29:409-424, 2017), Salpekar and Mula (Epilepsy Behav 98:293-297, 2019)). Psychiatric comorbidities negatively impact the quality of life of patients (Johnson et al., Epilepsia 45:544-550, 2004; Cramer et al., Epilepsy Behav 4:515-521, 2003) and present a significant challenge to treating patients with epilepsy (Hitiris et al., Epilepsy Res 75:192-196, 2007; Petrovski et al., Neurology 75:1015-1021, 2010; Fazel et al., Lancet 382:1646-1654, 2013) (for review see Kanner (Seizure 49:79-82, 2017)). It has long been acknowledged that there is an association between psychiatric illnesses and epilepsy. Hippocrates, in the fourth-fifth century B.C., considered epilepsy and melancholia to be closely related in which he writes that "melancholics ordinarily become epileptics, and epileptics, melancholics" (Lewis, J Ment Sci 80:1-42, 1934). The Babylonians also recognized the frequency of psychosis in patients with epilepsy (Reynolds and Kinnier Wilson, Epilepsia 49:1488-1490, 2008). Despite the fact that the relationship between psychiatric comorbidities and epilepsy has been recognized for thousands of years, psychiatric illnesses in people with epilepsy still commonly go undiagnosed and untreated (Hermann et al., Epilepsia 41(Suppl 2):S31-S41, 2000) and systematic research in this area is still lacking (Devinsky, Epilepsy Behav 4(Suppl 4):S2-S10, 2003). Thus, although it is clear that these are not new issues, there is a need for improvements in the screening and management of patients with psychiatric comorbidities in epilepsy (Lopez et al., Epilepsy Behav 98:302-305, 2019) and progress is needed to understand the underlying neurobiology contributing to these comorbid conditions. To that end, this chapter will raise awareness regarding the scope of the problem as it relates to comorbid psychiatric illnesses and epilepsy and review our current understanding of the potential mechanisms contributing to these comorbidities, focusing on both basic science and clinical research findings.
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17
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Miller M, Hogue O, Hogan T, Busch RM. Naming decline after epilepsy surgery is associated with subjective language complaints. Epilepsy Behav 2019; 99:106484. [PMID: 31477537 DOI: 10.1016/j.yebeh.2019.106484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This retrospective, observational study investigated the relationship between objective naming decline and patient report of subjective decline in language functioning following epilepsy surgery. The role of depression in this relationship was also examined. METHODS A total of 429 adults with pharmacoresistant epilepsy completed the Boston Naming Test (BNT) and Memory Assessment Clinics Self-Rating Scale (MAC-S) before and after resective surgery. Multiple regression analyses were used to examine the relationship between objective naming decline and subjective language functioning, while controlling for the confounding effect of depression. RESULTS Individuals who experienced moderate to severe naming decline (≥11 raw points on BNT) following surgery reported a decline in subjective language functioning (p < .001) and endorsed problems with word-retrieval as well as more general semantic abilities. Those who experienced mild naming decline (5-10 raw points) also reported an increase in subjective language problems (p = .006). Complaints in this group were less severe than in those with more marked naming declines and were primarily related to word-retrieval. Both of these relationships remained significant after controlling for the confounding effect of depression (p < .005-.014). CONCLUSIONS Individuals with epilepsy who experience naming decline following surgery perceive these declines in their daily life, regardless of whether or not they are depressed. Findings support the utilization of risk models to predict naming outcome and the importance of counseling patients regarding the risk for naming decline following surgery.
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Affiliation(s)
- Margaret Miller
- Epilepsy Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Thomas Hogan
- Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Department of Neurology, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
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18
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Clinical determinants of psychopathological outcomes after epilepsy surgery. Epilepsy Behav 2019; 97:111-117. [PMID: 31226620 DOI: 10.1016/j.yebeh.2019.04.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES People with refractory epilepsy submitted to surgery may improve or deteriorate their cognitive and emotional functions. The aim of this study was to determine the predictors of longitudinal changes in psychopathological symptomatology, one year after epilepsy surgery, considering clinical and demographic characteristics. METHODS People with refractory epilepsy referred to epilepsy surgery were included in this ambispective study. Psychiatric evaluations were made before surgery and one year after the procedure. Demographic, psychiatric, and neurological data were recorded. Linear regression was used to analyze longitudinal data regarding the Global Severity Index and 9 symptom dimensions of Symptom Checklist-90 (SCL-90). RESULTS Seventy-six people were included. Bilateral epileptogenic zone, lack of remission of disabling seizures, and deep brain stimulation, targeting the anterior nucleus of the thalamus (ANT-DBS), were the most important predictors of an increase in SCL-90 scores, after surgery. CONCLUSION Some individual factors may have an impact on the development or worsening of the previous psychopathology. This study identifies clinical aspects associated with greater psychological distress, after surgery. These patients may benefit from more frequent psychiatric routine assessments for early detection.
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19
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Pope RA, Thompson PJ, Rantell K, Stretton J, Wright MA, Foong J. Frontal lobe dysfunction as a predictor of depression and anxiety following temporal lobe epilepsy surgery. Epilepsy Res 2019; 152:59-66. [DOI: 10.1016/j.eplepsyres.2019.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 11/26/2022]
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20
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van Dijk RM, Di Liberto V, Brendel M, Waldron AM, Möller C, Gildehaus FJ, von Ungern-Sternberg B, Lindner M, Ziegler S, Hellweg R, Gass P, Bartenstein P, Potschka H. Imaging biomarkers of behavioral impairments: A pilot micro-positron emission tomographic study in a rat electrical post-status epilepticus model. Epilepsia 2018; 59:2194-2205. [PMID: 30370531 DOI: 10.1111/epi.14586] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In patients with epilepsy, psychiatric comorbidities can significantly affect the disease course and quality of life. Detecting and recognizing these comorbidities is central in determining an optimal treatment plan. One promising tool in detecting biomarkers for psychiatric comorbidities in epilepsy is positron emission tomography (PET). METHODS Behavioral and biochemical variables were cross-correlated with the results from two μPET scans using the tracers [18 F]fluoro-2-deoxy-D-glucose ([18 F]FDG) and 2'-methoxyphenyl-(N-2'-pyridinyl)-p-18 F-fluoro-benzamidoethylpiperazine ([18 F]MPPF) to explore potential biomarkers for neurobehavioral comorbidities in an electrically induced post-status epilepticus rat model of epilepsy. RESULTS In rats with epilepsy, μPET analysis revealed a local reduction in hippocampal [18 F]FDG uptake, and a local increase in [18 F]MPPF binding. These changes exhibited a correlation with burrowing as a "luxury" behavior, social interaction, and anxiety-associated behavioral patterns. Interestingly, hippocampal [18 F]FDG uptake did not correlate with spontaneous recurrent seizure activity. SIGNIFICANCE In the electrically induced post-status epilepticus rat model, we demonstrated hippocampal hypometabolism and its correlation with a range of neurobehavioral alterations. These findings require further confirmation in other preclinical models and patients with epilepsy and psychiatric disorders to address the value of [18 F]FDG uptake as an imaging biomarker candidate for psychiatric comorbidities in patients as well as for severity assessment in rodent epilepsy models.
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Affiliation(s)
- R Maarten van Dijk
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Valentina Di Liberto
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig Maximilian University of Munich, Munich, Germany.,Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Matthias Brendel
- Department of Nuclear Medicine, University Hospital of Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ann Marie Waldron
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christina Möller
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Franz Josef Gildehaus
- Department of Nuclear Medicine, University Hospital of Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Barbara von Ungern-Sternberg
- Department of Nuclear Medicine, University Hospital of Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Magdalena Lindner
- German Center for Vertigo and Balance Disorders, Ludwig Maximilian University of Munich, Munich, Germany
| | - Sibylle Ziegler
- Department of Nuclear Medicine, University Hospital of Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Rainer Hellweg
- Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
| | - Peter Gass
- Central Institute of Mental Health Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital of Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Heidrun Potschka
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig Maximilian University of Munich, Munich, Germany
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21
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Imaging correlates of behavioral impairments: An experimental PET study in the rat pilocarpine epilepsy model. Neurobiol Dis 2018; 118:9-21. [DOI: 10.1016/j.nbd.2018.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/05/2018] [Accepted: 06/12/2018] [Indexed: 01/04/2023] Open
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22
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Osório CM, Latini A, Leal RB, de Oliveira Thais MER, Vascouto HD, Remor AP, Lopes MW, Linhares MN, Ben J, de Paula Martins R, Prediger RD, Hoeller AA, Markowitsch HJ, Wolf P, Lin K, Walz R. Neuropsychological functioning and brain energetics of drug resistant mesial temporal lobe epilepsy patients. Epilepsy Res 2017; 138:26-31. [PMID: 29040828 DOI: 10.1016/j.eplepsyres.2017.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 09/20/2017] [Accepted: 10/09/2017] [Indexed: 11/19/2022]
Abstract
Interictal hypometabolism is commonly measured by 18-fluoro-deoxyglucose Positron Emission Tomography (FDG-PET) in the temporal lobe of patients with mesial temporal lobe epilepsy (MTLE-HS). Left temporal lobe interictal FDG-PET hypometabolism has been associated with verbal memory impairment, while right temporal lobe FDG-PET hypometabolism is associated with nonverbal memory impairment. The biochemical mechanisms involved in these findings remain unknown. In comparison to healthy controls (n=21), surgically treated patients with MTLE-HS (n=32, left side=17) had significant lower scores in the Rey Auditory Verbal Learning Test (RAVLT retention and delayed), Logical Memory II (LMII), Boston Naming test (BNT), Letter Fluency and Category Fluency. We investigated whether enzymatic activities of the mitochondrial enzymes Complex I (C I), Complex II (C II), Complex IV (C IV) and Succinate Dehydrogenase (SDH) from the resected samples of the middle temporal neocortex (mTCx), amygdala (AMY) and hippocampus (HIP) were associated with performance in the RAVLT, LMII, BNT and fluency tests of our patients. After controlling for the side of hippocampus sclerosis, years of education, disease duration, antiepileptic treatment and seizure outcome after surgery, no independent associations were observed between the cognitive test scores and the analyzed mitochondrial enzymatic activities (p>0.37). Results indicate that memory and language impairment observed in MTLE-HS patients are not strongly associated with the levels of mitochondrial CI, CII, SDH and C IV enzymatic activities in the temporal lobe structures ipsilateral to the HS lesion.
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Affiliation(s)
- Camila Moreira Osório
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Alexandra Latini
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Laboratório de Bioenergética e Estresse Oxidativo, LABOX, Depar tamento de Bioquímica, UFSC, Florianópolis, SC, Brazil
| | - Rodrigo Bainy Leal
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Laboratório de Transdução de Sinal no Sistema Nervoso Central, Departamento de Bioquímica, UFSC, Florianópolis, SC, Brazil
| | | | - Helena Dresch Vascouto
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Aline Pertile Remor
- Laboratório de Bioenergética e Estresse Oxidativo, LABOX, Depar tamento de Bioquímica, UFSC, Florianópolis, SC, Brazil
| | - Mark William Lopes
- Laboratório de Bioenergética e Estresse Oxidativo, LABOX, Depar tamento de Bioquímica, UFSC, Florianópolis, SC, Brazil
| | - Marcelo Neves Linhares
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Divisão de Neurocirurgia, Departamento de Cirurgia, HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurocirurgia, Hospital governador Celso Ramos (HGCR), Florianópolis, SC, Brazil
| | - Juliana Ben
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Laboratório de Transdução de Sinal no Sistema Nervoso Central, Departamento de Bioquímica, UFSC, Florianópolis, SC, Brazil
| | - Roberta de Paula Martins
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Laboratório de Bioenergética e Estresse Oxidativo, LABOX, Depar tamento de Bioquímica, UFSC, Florianópolis, SC, Brazil
| | | | - Alexandre Ademar Hoeller
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | | | - Peter Wolf
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, HU, UFSC, Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark
| | - Kátia Lin
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Epilepsia do Estado de Santa Catarina, CEPESC, HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, HU, UFSC, Florianópolis, SC, Brazil
| | - Roger Walz
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Epilepsia do Estado de Santa Catarina, CEPESC, HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, HU, UFSC, Florianópolis, SC, Brazil.
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Bartnik-Olson BL, Ding D, Howe J, Shah A, Losey T. Glutamate metabolism in temporal lobe epilepsy as revealed by dynamic proton MRS following the infusion of [U 13-C] glucose. Epilepsy Res 2017; 136:46-53. [PMID: 28763722 DOI: 10.1016/j.eplepsyres.2017.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 12/27/2022]
Abstract
Focal metabolic dysfunction commonly observed in temporal lobe epilepsy (TLE), and is associated with the development of medical intractability and neurocognitive deficits. It has not been established if this dysfunction is due to cell loss or biochemical dysfunction in metabolic pathways. To explore this question, dynamic 1H MRS following an infusion of [U13- C] glucose was performed to measure glutamate (Glu) metabolism. Subjects (n=6) showed reduced Glu levels (p<0.01) in the ipsilateral mesial temporal lobe (MTL) compared with controls (n=4). However, the rate of 13C incorporation into Glu did not differ between those with epilepsy and controls (p=0.77). This suggests that reduced Glu concentrations in the region of the seizure focus are not due to disruptions in metabolic pathways, but may instead be due to neuronal loss or simplification.
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Affiliation(s)
| | - Daniel Ding
- School of Medicine, Loma Linda University, Loma Linda CA, United States
| | - John Howe
- School of Medicine, Loma Linda University, Loma Linda CA, United States
| | - Amul Shah
- School of Medicine, Loma Linda University, Loma Linda CA, United States
| | - Travis Losey
- Department of Neurology, Loma Linda University, Loma Linda CA, United States.
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Osório CM, Lin K, Guarnieri R, de Oliveira Thais MER, Dresch Vascouto H, Remor AP, Lopes MW, Linhares MN, Ben J, de Paula Martins R, Hoeller AA, Wolf P, Latini A, Walz R. Mitochondrial respiratory chain complex enzyme activities of limbic structures and psychiatric diagnosis in temporal lobe epilepsy patients: Preliminary results. CNS Neurosci Ther 2017; 23:700-702. [PMID: 28656687 DOI: 10.1111/cns.12715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Camila Moreira Osório
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Kátia Lin
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.,Centro de Epilepsia do Estado de Santa Catarina, CEPESC, HU, UFSC, Florianópolis, SC, Brazil.,Departamento de Clínica Médica, Serviço de Neurologia, HU, UFSC, Florianópolis, SC, Brazil
| | - Ricardo Guarnieri
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.,Centro de Epilepsia do Estado de Santa Catarina, CEPESC, HU, UFSC, Florianópolis, SC, Brazil
| | | | - Helena Dresch Vascouto
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Aline Pertile Remor
- Departamento de Bioquímica, Laboratório de Bioenergética e Estresse Oxidativo, LABOX, UFSC, Florianópolis, SC, Brazil
| | - Mark William Lopes
- Departamento de Bioquímica, Laboratório de Transdução de Sinal no Sistema Nervoso Central, UFSC, Florianópolis, SC, Brazil
| | - Marcelo Neves Linhares
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.,Centro de Epilepsia do Estado de Santa Catarina, CEPESC, HU, UFSC, Florianópolis, SC, Brazil.,Serviço de Neurocirurgia, Hospital governador Celso Ramos (HGCR), Florianópolis, SC, Brazil
| | - Juliana Ben
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Roberta de Paula Martins
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.,Departamento de Bioquímica, Laboratório de Bioenergética e Estresse Oxidativo, LABOX, UFSC, Florianópolis, SC, Brazil
| | - Alexandre Ademar Hoeller
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Peter Wolf
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.,Departamento de Clínica Médica, Serviço de Neurologia, HU, UFSC, Florianópolis, SC, Brazil.,Danish Epilepsy Centre, Dianalund, Denmark
| | - Alexandra Latini
- Departamento de Bioquímica, Laboratório de Bioenergética e Estresse Oxidativo, LABOX, UFSC, Florianópolis, SC, Brazil
| | - Roger Walz
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.,Centro de Epilepsia do Estado de Santa Catarina, CEPESC, HU, UFSC, Florianópolis, SC, Brazil.,Departamento de Clínica Médica, Serviço de Neurologia, HU, UFSC, Florianópolis, SC, Brazil
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Yrondi A, Arbus C, Valton L, Schmitt L. Troubles de l’humeur et chirurgie de l’épilepsie : une revue de la littérature. Encephale 2017; 43:154-159. [DOI: 10.1016/j.encep.2016.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/12/2016] [Accepted: 02/01/2016] [Indexed: 11/08/2022]
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Abstract
This review poses the question: Does disruption to cognitive brain networks in epilepsy contribute to the problem of comorbid depression? Initial evidence suggests that the network disease that gives rise to seizures has a predilection for the same cognition-related networks that regulate mood, with comorbidity reflective of more extensive disease. Framing both epilepsy and its psychiatric comorbidities in terms of dysfunction in overlapping (cognitive) networks raises the possibility that depression can be a primary feature of the disease in some cases and facilitates an epilepsy classification system where behavioral features of the disorder are embedded in a neurobiological mechanism.
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Analysis of glucose metabolism of 18F-FDG in major depression patients using PET imaging: Correlation of salivary cortisol and α-amylase. Neurosci Lett 2016; 629:52-57. [DOI: 10.1016/j.neulet.2016.06.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/22/2016] [Accepted: 06/20/2016] [Indexed: 11/21/2022]
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Mazarati A, Sankar R. Common Mechanisms Underlying Epileptogenesis and the Comorbidities of Epilepsy. Cold Spring Harb Perspect Med 2016; 6:6/7/a022798. [PMID: 27371669 DOI: 10.1101/cshperspect.a022798] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The importance of comorbidities in determining the quality of life of individuals with epilepsy and their families has received increasing attention in the past decade. Along with it has come a recognition that in some individuals, certain comorbidities may have preexisted, and may have contributed to their developing epilepsy. Many mechanisms are capable of interconnecting different dysfunctions that manifest as distinct disorders, often diagnosed and managed by different specialists. We review the human data from the perspective of epidemiology as well as insights gathered from neurodiagnostic and endocrine studies. Animal studies are reviewed to refine our mechanistic understanding of the connections, because they permit the narrowing of variables, which is not possible when studying humans.
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Affiliation(s)
- Andrey Mazarati
- Department of Pediatrics, Division of Pediatric Neurology, David Geffen School of Medicine at UCLA, UCLA Medical Center, Los Angeles, California 90095-1752
| | - Raman Sankar
- Department of Pediatrics, Division of Pediatric Neurology, David Geffen School of Medicine at UCLA, UCLA Medical Center, Los Angeles, California 90095-1752 Department of Neurology, David Geffen School of Medicine at UCLA, UCLA Medical Center, Los Angeles, California 90095-1752
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Abstract
Imaging is pivotal in the evaluation and management of patients with seizure disorders. Elegant structural neuroimaging with magnetic resonance imaging (MRI) may assist in determining the etiology of focal epilepsy and demonstrating the anatomical changes associated with seizure activity. The high diagnostic yield of MRI to identify the common pathological findings in individuals with focal seizures including mesial temporal sclerosis, vascular anomalies, low-grade glial neoplasms and malformations of cortical development has been demonstrated. Positron emission tomography (PET) is the most commonly performed interictal functional neuroimaging technique that may reveal a focal hypometabolic region concordant with seizure onset. Single photon emission computed tomography (SPECT) studies may assist performance of ictal neuroimaging in patients with pharmacoresistant focal epilepsy being considered for neurosurgical treatment. This chapter highlights neuroimaging developments and innovations, and provides a comprehensive overview of the imaging strategies used to improve the care and management of people with epilepsy.
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Stretton J, Pope RA, Winston GP, Sidhu MK, Symms M, Duncan JS, Koepp M, Thompson PJ, Foong J. Temporal lobe epilepsy and affective disorders: the role of the subgenual anterior cingulate cortex. J Neurol Neurosurg Psychiatry 2015; 86:144-51. [PMID: 24876189 PMCID: PMC4316913 DOI: 10.1136/jnnp-2013-306966] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Reduced deactivation within the default mode network (DMN) is common in individuals with primary affective disorders relative to healthy volunteers (HVs). It is unknown whether similar network abnormalities are present in temporal lobe epilepsy (TLE) patients with a history of affective psychopathology. METHODS 17 TLE patients with a lifetime affective diagnosis, 31 TLE patients with no formal psychiatric history and 30 HVs were included. We used a visuo-spatial 'n-back' paradigm to compare working memory (WM) network activation between these groups. Post hoc analyses included voxel-based morphometry and diffusion tensor imaging. The Beck Depression Inventory-Fast Screen and Beck Anxiety Inventory were completed on the day of scanning. FINDINGS Each group activated the fronto-parietal WM networks and deactivated the typical DMN in response to increasing task demands. Group comparison revealed that TLE patients with lifetime affective morbidity showed significantly greater deactivation in subgenual anterior cingulate cortex (sACC) than either the TLE-only or the HVs (p<0.001). This effect persisted after covarying for current psychotropic medication and severity of current depressive/anxiety symptoms (all p<0.001). Correlational analysis revealed that this finding was not driven by differences in task performance. There were no significant differences in grey matter volume or structural connectivity between the TLE groups. CONCLUSIONS Our results provide novel evidence suggesting that affective psychopathology in TLE has a neurobiological correlate, and in this context the sACC performs differently compared with network activity in primary affective disorders.
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Affiliation(s)
- J Stretton
- Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK MRC Cognition and Brain Science Unit, Cambridge, UK
| | - R A Pope
- Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK Clinical Psychopharmacology Unit, University College London, London, UK
| | - G P Winston
- Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| | - M K Sidhu
- Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| | - M Symms
- Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| | - J S Duncan
- Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| | - M Koepp
- Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| | - P J Thompson
- Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| | - J Foong
- Epilepsy Society MRI Unit, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
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Giovagnoli AR. The importance of theory of mind in epilepsy. Epilepsy Behav 2014; 39:145-53. [PMID: 24970620 DOI: 10.1016/j.yebeh.2014.05.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/15/2014] [Accepted: 05/23/2014] [Indexed: 11/15/2022]
Abstract
Recent studies have shown that frontal and temporal lobe epilepsy, the most common forms of focal epilepsy, may impair theory of mind (ToM) by impacting on key zones of ToM's underlying neural network. Clinical research has characterized the severity and specificity of ToM impairments, as well as model methods of assessment, thereby extending the potential of ToM to expand the scope of the neuropsychology of epilepsy. Theory of mind deficits have been linked to self-rating and coping styles, suggesting a role for ToM in awareness and subjective well-being. The study of ToM in epilepsy is important not only for advancing understanding of its underlying neural network but also for clinical care. A task for the future is to identify patients with and without impaired ToM and the subsequent associations with personality complications and vulnerability to psychiatric comorbidities. Knowledge of the type and direction of the relationship between ToM, personality, and behavior might contribute to characterizing the neurobehavioral consequences of specific epilepsy syndromes as well as planning nonpharmacological treatments for alleviating psychobehavioral distress and social maladjustment.
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Affiliation(s)
- Anna Rita Giovagnoli
- Department of Diagnostics and Applied Technology, Fondazione IRCCS Istituto Neurologico C. Besta, Via Celoria 11, 20133 Milano, Italy.
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Kwon OY, Park SP. Depression and anxiety in people with epilepsy. J Clin Neurol 2014; 10:175-88. [PMID: 25045369 PMCID: PMC4101093 DOI: 10.3988/jcn.2014.10.3.175] [Citation(s) in RCA: 183] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 02/19/2014] [Accepted: 02/21/2014] [Indexed: 11/17/2022] Open
Abstract
Many recent epidemiological studies have found the prevalence of depression and anxiety to be higher in people with epilepsy (PWE) than in people without epilepsy. Furthermore, people with depression or anxiety have been more likely to suffer from epilepsy than those without depression or anxiety. Almost one-third of PWE suffer from depression and anxiety, which is similar to the prevalence of drug-refractory epilepsy. Various brain areas, including the frontal, temporal, and limbic regions, are associated with the biological pathogenesis of depression in PWE. It has been suggested that structural abnormalities, monoamine pathways, cerebral glucose metabolism, the hypothalamic-pituitary-adrenal axis, and interleukin-1b are associated with the pathogenesis of depression in PWE. The amygdala and the hippocampus are important anatomical structures related to anxiety, and γ-aminobutyric acid and serotonin are associated with its pathogenesis. Depression and anxiety may lead to suicidal ideation or attempts and feelings of stigmatization. These experiences are also likely to increase the adverse effects associated with antiepileptic drugs and have been related to poor responses to pharmacological and surgical treatments. Ultimately, the quality of life is likely to be worse in PWE with depression and anxiety than in PWE without these disorders, which makes the early detection and appropriate management of depression and anxiety in PWE indispensable. Simple screening instruments may be helpful for in this regard, particularly in busy epilepsy clinics. Although both medical and psychobehavioral therapies may ameliorate these conditions, randomized controlled trials are needed to confirm that.
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Affiliation(s)
- Oh-Young Kwon
- Department Neurology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sung-Pa Park
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
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Abstract
The last decade has witnessed a significant shift on our understanding of the relationship between psychiatric disorders and epilepsy. While traditionally psychiatric disorders were considered as a complication of the underlying seizure disorder, new epidemiologic data, supported by clinical and experimental research, have suggested the existence of a bidirectional relation between the two types of conditions: not only are patients with epilepsy at greater risk of experiencing a psychiatric disorder, but patients with primary psychiatric disorders are at greater risk of developing epilepsy. Do these data suggest that some of the pathogenic mechanisms operant in psychiatric comorbidities play a role in epileptogenesis? The aim of this article is to review the epidemiologic data that demonstrate that primary psychiatric disorders are more frequent in people who develop epilepsy, before the onset of the seizure disorder than among controls. The next question looks at the available data of pathogenic mechanisms of primary mood disorders and their potential for facilitating the development and/or exacerbation in the severity of epileptic seizures. Finally, we review data derived from experimental studies in animal models of depression and epilepsy that support a potential role of pathogenic mechanisms of mood disorders in the development of epileptic seizures and epileptogenesis. The data presented in this article do not yet establish conclusive evidence of a pathogenic role of psychiatric comorbidities in epileptogenesis, but raise important research questions that need to be investigated in experimental, clinical, and population-based epidemiologic research studies.
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Affiliation(s)
- Andres M Kanner
- Department of Neurology, University of Miami, Miller School of Medicine, 1120 NW, 14th Street, Room 1324, Miami, FL, 33136, USA,
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Pope RA, Centeno M, Flügel D, Symms MR, Koepp M, Thompson PJ, Foong J. Neural correlates of de novo depression following left temporal lobe epilepsy surgery: a voxel based morphometry study of pre-surgical structural MRI. Epilepsy Res 2013; 108:517-25. [PMID: 24438916 DOI: 10.1016/j.eplepsyres.2013.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/04/2013] [Accepted: 12/15/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate cerebral grey matter (GM) volumetric abnormalities in temporal lobe epilepsy (TLE) patients who develop de novo depression following TLE surgery using voxel-based morphometry (VBM). METHODS We retrospectively examined pre-surgical grey matter (GM) volumes in 30 patients with TLE due to unilateral left-sided hippocampal sclerosis using 1.5-T MRI scan, which were segmented with optimised VBM parameters and normalised to a sample template using DARTEL, with SPM8 software. Voxel-wise GM differences between patients that developed de novo post-surgical depression (n=5) were compared with patients with no pre- or postoperative psychiatric diagnoses (n=25), using independent samples t-tests with age, gender and secondary generalised tonic-clonic seizures (SGTCS) as covariates (p<.001, unc). KEY FINDINGS Reduced preoperative bilateral GM in orbitofrontal cortices (OFC) and ipsilateral cingulate gyrus and thalamus were significantly associated with the development of de novo depression within 4 years postoperatively. Further analyses revealed no differences in seizure freedom (ILAE 1 vs 2-6) or postoperative memory decline between the groups. SIGNIFICANCE Although the development of postoperative de novo depression following TLE surgery is likely to be multi-factorial, our results suggest that bilateral OFC and ipsilateral cingulate gyrus and thalamic atrophy in left-sided TLE patients may play a modulatory role. Abnormalities in these areas have also been implicated in primary mood disorders. Prospective neuroimaging studies with larger cohorts are warranted to replicate these results, and further elucidate the neural correlates of de novo depression.
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Affiliation(s)
- Rebecca Anne Pope
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3BG, UK.
| | - Maria Centeno
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; Institute of Child Health, University College London, London WC1N 1EH, UK
| | | | - Mark Robert Symms
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK
| | - Matthias Koepp
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 2BG, UK
| | - Pamela Jane Thompson
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 2BG, UK
| | - Jacqueline Foong
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 2BG, UK
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Cataldi M, Avoli M, de Villers-Sidani E. Resting state networks in temporal lobe epilepsy. Epilepsia 2013; 54:2048-59. [PMID: 24117098 DOI: 10.1111/epi.12400] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 12/17/2022]
Abstract
Temporal lobe epilepsy (TLE) is typically described as a neurologic disorder affecting a cerebral network comprising the hippocampus proper and several anatomically related extrahippocampal regions. A new level of complexity was recently added to the study of this disorder by the evidence that TLE also appears to chronically alter the activity of several brain-wide neural networks involved in the control of higher order brain functions and not traditionally linked to epilepsy. Recently developed brain imaging techniques such as functional magnetic resonance imaging (fMRI) analysis of resting state connectivity, have greatly contributed to these observations by allowing the precise characterization of several brain networks with distinct functional signatures in the resting brain, and therefore also known as "resting state networks." These significant advances in imaging represent an opportunity to investigate the still elusive origins of the disabling cognitive and psychiatric manifestations of TLE, and could have important implications for its pathophysiology and, perhaps, its therapy. Herein we review recent studies in this field by focusing on resting state networks that have been implicated in the pathophysiology of psychiatric disorders and cognitive impairment in patients with epilepsy: the default mode network, the attention network, and the reward/emotion network.
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Affiliation(s)
- Mauro Cataldi
- Division of Pharmacology, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, Federico II University of Naples, Naples, Italy
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Changes in functional integration with the non-epileptic temporal lobe of patients with unilateral mesiotemporal epilepsy. PLoS One 2013; 8:e67053. [PMID: 23818976 PMCID: PMC3688582 DOI: 10.1371/journal.pone.0067053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/14/2013] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate epilepsy-induced changes in effective connectivity between the non-epileptic amygdalo-hippocampal complex (AHC) and the rest of the brain in patients with unilateral mesiotemporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS). Methods Thirty-three patients with unilateral MTLE associated with HS (20 females, mean age: 36 years, 19 left HS) and 33 adult controls matched for age and gender underwent 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET). Right-HS patients' FDG-PET data were flipped to obtain a left–epileptic–focus–lateralized group of patients. Voxels of interest (VOI) were selected within the cytoarchitectonic probabilistic maps of the non-epileptic AHC (probability level = 100%, SPM8 Anatomy toolbox v1.7). Patients and controls were compared using VOI metabolic activity as covariate of interest to search for epilepsy-induced changes in the contribution of the non-epileptic AHC to the level of metabolic activity in other brain areas. Age, gender, duration of epilepsy, seizure type and frequency were used as covariates of no-interest for connectivity analyses. Key findings Significant decrease in effective connectivity was found between the non-epileptic AHC and ventral prefrontal cortical areas bilaterally, as well as with the temporal pole and the posterior cingulate cortex contralateral to HS. Significant increase in connectivity was found between the non-epileptic AHC and midline structures, such as the anterior cingulate and dorsal medial prefrontal cortices, as well as the temporo-parietal junction bilaterally. Connectivity analyses also revealed a preserved positive connectivity between the non-epileptic and the epileptic AHC in the patients' group. Significance This study evidences epilepsy-induced changes in connectivity between the non-epileptic AHC and some limbic and default mode network areas. These changes in connectivity probably account for emotional, cognitive and decision-making impairments frequently observed in MTLE patients. The preserved neurometabolic connectivity between the non-epileptic and the epileptic AHC in MTLE patients is pivotal to explain the epilepsy-induced changes found in this study.
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Kandratavicius L, Ruggiero RN, Hallak JE, Garcia-Cairasco N, Leite JP. Pathophysiology of mood disorders in temporal lobe epilepsy. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 34 Suppl 2:S233-45. [PMID: 23429849 DOI: 10.1016/j.rbp.2012.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE There is accumulating evidence that the limbic system is pathologically involved in cases of psychiatric comorbidities in temporal lobe epilepsy (TLE) patients. Our objective was to develop a conceptual framework describing how neuropathological, neurochemical and electrophysiological aspects might contribute to the development of psychiatric symptoms in TLE and the putative neurobiological mechanisms that cause mood disorders in this patient subgroup. METHODS In this review, clinical, experimental and neuropathological findings, as well as neurochemical features of the limbic system were examined together to enhance our understanding of the association between TLE and psychiatric comorbidities. Finally, the value of animal models in epilepsy and mood disorders was discussed. CONCLUSIONS TLE and psychiatric symptoms coexist more frequently than chance would predict. Alterations and neurotransmission disturbance among critical anatomical networks, and impaired or aberrant plastic changes might predispose patients with TLE to mood disorders. Clinical and experimental studies of the effects of seizures on behavior and electrophysiological patterns may offer a model of how limbic seizures increase the vulnerability of TLE patients to precipitants of psychiatric symptoms.
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Affiliation(s)
- Ludmyla Kandratavicius
- Department of Neurosciences and Behavior, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil.
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Cleary RA, Baxendale SA, Thompson PJ, Foong J. Predicting and preventing psychopathology following temporal lobe epilepsy surgery. Epilepsy Behav 2013; 26:322-34. [PMID: 23246146 DOI: 10.1016/j.yebeh.2012.09.038] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 09/22/2012] [Indexed: 11/17/2022]
Abstract
Less than 3% of temporal lobe epilepsy (TLE) surgical outcome studies have investigated the psychiatric sequelae and morbidity associated with surgery. This is disproportionate to the extent of the problem. Variable prevalence rates have been reported for post-surgical depression, anxiety, and interictal psychosis. Until recently, very few studies distinguished de novo postoperative presentations from pre-existing conditions, making it difficult to accurately assess the impact of TLE surgery on psychiatric morbidity. Predictors of de novo postoperative presentations have proved elusive. This current review summarizes the findings from a systematic literature review of the psychiatric morbidity associated with TLE surgery including newly published follow-up data from our own series of 280 surgical patients. A framework for future research, possible pathophysiological mechanisms, and translational models are also discussed.
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Affiliation(s)
- Rebecca A Cleary
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London WC1N 3BG, UK.
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Kim H, Kim IJ, Kim SJ, Song SH, Pak K, Kim K. Quantification of Tc-99m-ethyl cysteinate dimer brain single photon emission computed tomography images using statistical probabilistic brain atlas in depressive end-stage renal disease patients: Correlation with disease severity and symptom factors. Neural Regen Res 2012; 7:2151-9. [PMID: 25558229 PMCID: PMC4281418 DOI: 10.3969/j.issn.1673-5374.2012.27.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 06/10/2012] [Indexed: 11/18/2022] Open
Abstract
This study adapted a statistical probabilistic anatomical map of the brain for single photon emission computed tomography images of depressive end-stage renal disease patients. This research aimed to investigate the relationship between symptom clusters, disease severity, and cerebral blood flow. Twenty-seven patients (16 males, 11 females) with stages 4 and 5 end-stage renal disease were enrolled, along with 25 healthy controls. All patients underwent depressive mood assessment and brain single photon emission computed tomography. The statistical probabilistic anatomical map images were used to calculate the brain single photon emission computed tomography counts. Asymmetric index was acquired and Pearson correlation analysis was performed to analyze the correlation between symptom factors, severity, and regional cerebral blood flow. The depression factors of the Hamilton Depression Rating Scale showed a negative correlation with cerebral blood flow in the left amygdale. The insomnia factor showed negative correlations with cerebral blood flow in the left amygdala, right superior frontal gyrus, right middle frontal gyrus, and left middle frontal gyrus. The anxiety factor showed a positive correlation with cerebral glucose metabolism in the cerebellar vermis and a negative correlation with cerebral glucose metabolism in the left globus pallidus, right inferior frontal gyrus, both temporal poles, and left parahippocampus. The overall depression severity (total scores of Hamilton Depression Rating Scale) was negatively correlated with the statistical probabilistic anatomical map results in the left amygdala and right inferior frontal gyrus. In conclusion, our results demonstrated that the disease severity and extent of cerebral blood flow quantified by a probabilistic brain atlas was related to various brain areas in terms of the overall severity and symptom factors in end-stage renal disease patients.
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Affiliation(s)
- Heeyoung Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - In Joo Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea ; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Seong-Jang Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea ; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Sang Heon Song
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea ; Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
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Cleary RA, Thompson PJ, Fox Z, Foong J. Predictors of psychiatric and seizure outcome following temporal lobe epilepsy surgery. Epilepsia 2012; 53:1705-12. [DOI: 10.1111/j.1528-1167.2012.03604.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Adams SJ, Velakoulis D, Kaye AH, Corcoran NM, O’Brien TJ. Psychiatric history does not predict seizure outcome following temporal lobectomy for mesial temporal sclerosis. Epilepsia 2012; 53:1700-4. [DOI: 10.1111/j.1528-1167.2012.03569.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kanner AM, Schachter SC, Barry JJ, Hesdorffer DC, Mula M, Trimble M, Hermann B, Ettinger AE, Dunn D, Caplan R, Ryvlin P, Gilliam F, LaFrance WC. Depression and epilepsy: epidemiologic and neurobiologic perspectives that may explain their high comorbid occurrence. Epilepsy Behav 2012; 24:156-68. [PMID: 22632406 DOI: 10.1016/j.yebeh.2012.01.007] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2012] [Indexed: 12/25/2022]
Abstract
Depression is the most frequent psychiatric comorbidity in people with epilepsy (PWE) with lifetime prevalence rates ranging between 30 and 35%. Multifactorial variables play a pathogenic role in the high comorbid occurrence of these two disorders. These variables were critically examined during an international symposium held in Chicago in September 2010, the results of which are presented in two companion manuscripts. The first manuscript summarizes new epidemiologic data highlighting the bidirectional relation between depression and epilepsy and related methodological issues in studying this relationship. An examination of the neurobiologic aspects of primary mood disorders, mood disorders in PWE and pathogenic mechanisms of epilepsy derived from studies in animal models and humans is allowing a better understanding of the complex relation between the two conditions. In the first manuscript, we review data from animal models of epilepsy in which equivalent symptoms of depression and anxiety disorders develop and, conversely, animal models of depression in which the kindling process is facilitated. Data from structural and functional neuroimaging studies in humans provide a further understanding of potential common pathogenic mechanisms operant in depression and epilepsy that may explain their high comorbidity. The negative impact of depression on the control of seizure disorders has been documented in various studies. In this manuscript, these data are reviewed and potential mechanisms explaining this phenomenon are proposed.
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Affiliation(s)
- Andres M Kanner
- Department of Neurological Sciences, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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Psychiatric comorbidity in patients with pharmacoresistant focal epilepsy and psychiatric outcome after epilepsy surgery. Epilepsy Behav 2012; 23:272-9. [PMID: 22341961 DOI: 10.1016/j.yebeh.2011.12.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 11/29/2011] [Accepted: 12/01/2011] [Indexed: 11/23/2022]
Abstract
There are only a few studies in which both preoperative psychiatric comorbidity in pharmacoresistant focal epilepsy and its outcome after epilepsy surgery have been investigated. In this study, 144 patients evaluated for epilepsy surgery received psychiatric examination, 84 proceeding to intervention were reassessed postoperatively. Preoperatively, 60% met criteria for ICD-10- or epilepsy-specific psychiatric diagnosis. Twenty-seven percent, predominantly female, suffered from dysphoric disorder (DD) associated with temporal epileptogenic foci. Prevalence of DD correlated with complex partial seizure frequency and presence of ictal fear suggesting limbic-cortical dysregulation. Psychotic syndromes were linked to a history of febrile convulsions and left-sided temporomesial epileptogenic foci. High seizure frequency and early epilepsy onset predisposed to the development of personality disorders. Postoperative assessment revealed 18% of patients with "de novo" interictal affective disorders after surgery. Symptoms in 48% of patients with preoperative affective syndromes and 60% of patients with DD remitted after surgery. Seizure freedom and improved psychosocial status predicted remission of preoperative psychopathology.
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The detection of mood and anxiety in people with epilepsy using two-phase designs: Experiences from a tertiary care centre in Oman. Epilepsy Res 2012; 98:174-81. [DOI: 10.1016/j.eplepsyres.2011.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 09/16/2011] [Accepted: 09/17/2011] [Indexed: 11/22/2022]
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Butler T, Blackmon K, McDonald CR, Carlson C, Barr WB, Devinsky O, Kuzniecky R, DuBois J, French J, Halgren E, Thesen T. Cortical thickness abnormalities associated with depressive symptoms in temporal lobe epilepsy. Epilepsy Behav 2012; 23:64-7. [PMID: 22099527 PMCID: PMC3259282 DOI: 10.1016/j.yebeh.2011.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 09/28/2011] [Accepted: 10/01/2011] [Indexed: 01/28/2023]
Abstract
Depression in patients with temporal lobe epilepsy (TLE) is highly prevalent and carries significant morbidity and mortality. Its neural basis is poorly understood. We used quantitative, surface-based MRI analysis to correlate brain morphometry with severity of depressive symptoms in 38 patients with TLE and 45 controls. Increasing severity of depressive symptoms was associated with orbitofrontal cortex (OFC) thinning in controls, but with OFC thickening in TLE patients. These results demonstrate distinct neuroanatomical substrates for depression with and without TLE, and suggest a unique role for OFC, a limbic region for emotional processing strongly interconnected with medial temporal structures, in TLE-related depressive symptoms.
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Affiliation(s)
- Tracy Butler
- Comprehensive Epilepsy Center, Department of Neurology, New York University, New York, NY 10016, USA.
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Giovagnoli AR, Franceschetti S, Reati F, Parente A, Maccagnano C, Villani F, Spreafico R. Theory of mind in frontal and temporal lobe epilepsy: Cognitive and neural aspects. Epilepsia 2011; 52:1995-2002. [DOI: 10.1111/j.1528-1167.2011.03215.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Busch RM, Dulay MF, Kim KH, Chapin JS, Jehi L, Kalman CC, Naugle RI, Najm IM. Pre-Surgical Mood Predicts Memory Decline after Anterior Temporal Lobe Resection for Epilepsy. Arch Clin Neuropsychol 2011; 26:739-45. [DOI: 10.1093/arclin/acr067] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bonora A, Benuzzi F, Monti G, Mirandola L, Pugnaghi M, Nichelli P, Meletti S. Recognition of emotions from faces and voices in medial temporal lobe epilepsy. Epilepsy Behav 2011; 20:648-54. [PMID: 21459049 DOI: 10.1016/j.yebeh.2011.01.027] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 01/25/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
Abstract
Patients with chronic medial temporal lobe epilepsy (MTLE) can be impaired in different tasks that evaluate emotional or social abilities. In particular, the recognition of facial emotions can be affected (Meletti S, Benuzzi F, Rubboli G, et al. Neurology 2003;60:426-31. Meletti S, Benuzzi F, Cantalupo G, Rubboli G, Tassinari CA, Nichelli P. Epilepsia 2009;50:1547-59). To better understand the nature of emotion recognition deficits in MTLE we investigated the decoding of basic emotions in the visual (facial expression) and auditory (emotional prosody) domains in 41 patients. Results showed deficits in the recognition of both facial and vocal expression of emotions, with a strong correlation between performances across the two tasks. No correlation between emotion recognition and measures of IQ, quality of life (QOLIE-31), and depression (Beck Depression Inventory) was significant, except for a weak correlation between prosody recognition and IQ. These data suggest that emotion recognition impairment in MTLE is not dependent on the sensory channel through which the emotional stimulus is transmitted. Moreover, these findings support the notion that emotional processing is at least partly independent of measures of cognitive intelligence.
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Affiliation(s)
- Annalisa Bonora
- Department of Neuroscience, Nuovo Ospedale Civile Sant'Agostino Estense, University of Modena e Reggio Emilia, Modena, Italy
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