1
|
Bensken WP. Women Veterans with Epilepsy and Psychiatric Comorbidities: A Call to Action. J Womens Health (Larchmt) 2024; 33:273-274. [PMID: 38170187 DOI: 10.1089/jwh.2023.0965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
2
|
Marinho AMDN, Lobão-Soares B, Targino HAS, Vasconcellos YJF, Guarnieri R, Carlotti CG. Decreased hippocampal serotonin 5HT 1A expression in mesial temporal lobe of epilepsy patients. Epilepsy Behav 2022; 129:108574. [PMID: 35189481 DOI: 10.1016/j.yebeh.2022.108574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) is a surgically remediable epilepsy with a relatively high prevalence and psychiatric comorbidities. Depressive disorders may occur in up to 25% of MTLE-HS patients suggesting a common molecular mechanism underlying both conditions. OBJECTIVE To compare the gene expression comprising serotonin 5HT1A and 5HT2A, noradrenaline (NA) ADRA1A, and ADRA2A receptors in the hippocampus of MTLE-HS patients with and without major depression. METHODS A cross-sectional study allocated 31 patients in three groups: MTLE-HS without psychiatric diagnosis (MTLE-HS group), MTLE-HS with major depression (MTLE-HS-D group) and a control group consisting of healthy volunteers without any neurological or psychiatric disorders. Demographic and clinical characteristics were compared among groups. Gene expression of receptors were analyzed using general linear mixed models (GLMM), with an unstructured matrix, normal link. RESULTS The three groups showed a similar distribution regarding age, gender (p > 0.16), history of initial precipitating injury, family history of epilepsy, monthly frequency of seizures, side of hippocampal sclerosis, interictal spike distribution and anti-seizure medications did not differ between MTLE-HS and MTLE-HS-D groups (p > 0.05). We observed a greater expression of the 5HT1A receptor in the control group when compared to the MTLE-HS (P = .004) and MTLE-HS-D (P = .007). Nevertheless, we did not observe any difference when MTLE-HS and MTLE-HS-D groups were compared to the controls for the ADRA1A (P = .931; P = .931), ADRA2A (P = .120; P = .121) and 5HT2A (P = .638; P = .318, respectively) gene expression. CONCLUSION Mesial temporal lobe epilepsy related to hippocampal sclerosis and MTLE-HS-D patients showed a lowered expression of the 5HT1A receptors when compared with the controls adjusted for age and schooling. Data suggest that temporal lobe epilepsy plasticity may affect serotonin receptors, which may lead to more frequent cases of major depression in this population. More studies comprising wider samples are necessary to confirm these results; they also should investigate serotonin reuptake drugs as an adjuvant therapeutic option for MTLE-HS disorder.
Collapse
Affiliation(s)
| | - Bruno Lobão-Soares
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte (DBF - UFRN), Brazil.
| | | | | | | | - Carlos Gilberto Carlotti
- Department of Surgery, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, (FMRP-USP), Brazil
| |
Collapse
|
3
|
João RB, Nogueira MH, Morita-Sherman ME, Alvim MKM, Johnny S, Pereira H, Pinheiro HP, Cendes F, Yasuda CL. The Relationship Between Depression and Anxiety Symptoms of Adult PWE and Caregivers in a Tertiary Center. Front Neurol 2022; 13:766009. [PMID: 35356450 PMCID: PMC8959587 DOI: 10.3389/fneur.2022.766009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 02/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Although several studies have emphasized the association between epilepsy and psychiatric disorders, fewer have investigated the impact of epilepsy on caregivers' emotional status, mainly in adult people with epilepsy (PWE). Here we investigated depressive symptoms, suicidal ideation, and anxiety symptoms in a large group of adult PWE and their caregivers. Methods We analyzed symptoms of depression [with the Beck Depression Inventory-II (BDI-II)], suicidal ideation (with BDI-II item 9), and anxiety symptoms (with the Beck Anxiety Inventory) in a large group of adult PWE [N = 548 (60% women; median age 41)] and caregivers [N = 191 (72% women; median age 47)] from a Brazilian tertiary center, considering sociodemographic and clinical aspects. We also applied the Liverpool Adverse Events Profile to assess anti-seizure drugs adverse events. Results While the presence (p = 0.026) (and intensity, p = 0.007) of depressive symptoms and suicidal ideation (p = 0.02) were higher in PWE compared to caregivers, the proportion of clinical anxiety symptoms (p = 0.32) (and the intensity, p = 0.13) was similar in both groups. Although the rates of suicidal ideation were higher in focal epilepsy (20%), both generalized genetic epilepsy and caregivers also presented elevated frequencies (11%) of suicidal ideation. The analyses of 120 patient-caregiver dyads revealed that the intensity of depressive symptoms in PWE (but not anxiety) correlated with the intensity of depressive (r = 0.35; p < 0.001) and anxiety (r = 0.25; p = 0.01) symptoms in their caregivers. In the multivariate analyses of PWE, focal epilepsy (compared to GGE) was associated with clinical depressive symptoms (odds ratio, OR 2.1) and suicidal ideation (OR 3.2), while recurrent seizures (compared to the seizure-free group) were associated with suicidal ideation (OR 2.6) and anxiety symptoms (OR 2.1). Also, caregivers with anxiety symptoms were 8 times more likely to exhibit depressive symptoms, and those with depressive symptoms were 8 times more likely to present anxiety symptoms. Conclusion Our study suggests that specific attention for the caregivers' mental health is as essential as PWE. There is an urgent need for more studies involving caregivers to identify their emotional distress and provide adequate treatment.
Collapse
Affiliation(s)
- Rafael Batista João
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Mateus Henrique Nogueira
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Márcia Elisabete Morita-Sherman
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Marina Koutsodontis Machado Alvim
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Steven Johnny
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Haryton Pereira
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Hildete Prisco Pinheiro
- Institute of Mathematics, Statistics and Scientific Computing, University of Campinas, Campinas, Brazil
| | - Fernando Cendes
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Clarissa Lin Yasuda
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
- *Correspondence: Clarissa Lin Yasuda
| |
Collapse
|
4
|
Bensken WP, Fernandez-Baca Vaca G, Jobst BC, Williams SM, Stange KC, Sajatovic M, Koroukian SM. Burden of Chronic and Acute Conditions and Symptoms in People With Epilepsy. Neurology 2021; 97:e2368-e2380. [PMID: 34706975 PMCID: PMC8673720 DOI: 10.1212/wnl.0000000000012975] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/29/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES People with epilepsy, one-third of whom in the United States are on Medicaid, experience a wide range of chronic and physical comorbidities that influence their care and outcomes. In this study, we examine the burden and racial/ethnic disparities of chronic and acute conditions, injuries, and symptoms in a large and diverse group of people with epilepsy on Medicaid. METHODS Using 5 years of Medicaid claims data, we identified adults with epilepsy and used all available claims and diagnoses to identify each person's Clinical Classification Codes groups diagnosed during the study period. Using association rule mining, we identified the top combinations of conditions and stratified these by race/ethnicity to identify potential prevalence disparities. We examined the top combinations of conditions in high utilizers; that is, individuals in the top quartile of hospitalizations and emergency department visits. RESULTS Among 81,963 patients, the most common conditions were anxiety and mood disorders (46.5%), hypertension (36.9%), back problems (35.2%), developmental disorders (31.6%), and headache (29.5%). When examining combinations of conditions, anxiety and mood disorders continued to have an outsized prevalence, appearing in nearly every combination. There were notable disparities in disease burden, with American Indians and Alaskan Natives having a substantially higher prevalence of developmental disorders, while Black individuals had a higher prevalence of hypertension. These disparities persisted to the higher-order combinations that included these conditions. High utilizers had a much higher disease burden, with 75.8% having an anxiety or mood disorder, as well as a higher burden of injuries. DISCUSSION This study shows a high prevalence of psychiatric and physical conditions and identifies racial and ethnic disparities affecting people with epilepsy. Targeting interventions to consider the comorbidities, race, and ethnicity has potential to improve clinical care and reduce disparities.
Collapse
Affiliation(s)
- Wyatt P Bensken
- From the Department of Population and Quantitative Health Sciences, School of Medicine (W.P.B., S.M.W., K.C.S., S.M.K.), Departments of Neurology (G.F.-B.V., M.S.) and Psychiatry (M.S.), University Hospitals Cleveland Medical Center and School of Medicine, and Center for Community Health Integration, Departments of Family Medicine and Community Health and Sociology, Case Comprehensive Cancer Center (K.C.S.), Case Western Reserve University, Cleveland, OH; and Department of Neurology and Geisel School of Medicine (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Guadalupe Fernandez-Baca Vaca
- From the Department of Population and Quantitative Health Sciences, School of Medicine (W.P.B., S.M.W., K.C.S., S.M.K.), Departments of Neurology (G.F.-B.V., M.S.) and Psychiatry (M.S.), University Hospitals Cleveland Medical Center and School of Medicine, and Center for Community Health Integration, Departments of Family Medicine and Community Health and Sociology, Case Comprehensive Cancer Center (K.C.S.), Case Western Reserve University, Cleveland, OH; and Department of Neurology and Geisel School of Medicine (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Barbara C Jobst
- From the Department of Population and Quantitative Health Sciences, School of Medicine (W.P.B., S.M.W., K.C.S., S.M.K.), Departments of Neurology (G.F.-B.V., M.S.) and Psychiatry (M.S.), University Hospitals Cleveland Medical Center and School of Medicine, and Center for Community Health Integration, Departments of Family Medicine and Community Health and Sociology, Case Comprehensive Cancer Center (K.C.S.), Case Western Reserve University, Cleveland, OH; and Department of Neurology and Geisel School of Medicine (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Scott M Williams
- From the Department of Population and Quantitative Health Sciences, School of Medicine (W.P.B., S.M.W., K.C.S., S.M.K.), Departments of Neurology (G.F.-B.V., M.S.) and Psychiatry (M.S.), University Hospitals Cleveland Medical Center and School of Medicine, and Center for Community Health Integration, Departments of Family Medicine and Community Health and Sociology, Case Comprehensive Cancer Center (K.C.S.), Case Western Reserve University, Cleveland, OH; and Department of Neurology and Geisel School of Medicine (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kurt C Stange
- From the Department of Population and Quantitative Health Sciences, School of Medicine (W.P.B., S.M.W., K.C.S., S.M.K.), Departments of Neurology (G.F.-B.V., M.S.) and Psychiatry (M.S.), University Hospitals Cleveland Medical Center and School of Medicine, and Center for Community Health Integration, Departments of Family Medicine and Community Health and Sociology, Case Comprehensive Cancer Center (K.C.S.), Case Western Reserve University, Cleveland, OH; and Department of Neurology and Geisel School of Medicine (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Martha Sajatovic
- From the Department of Population and Quantitative Health Sciences, School of Medicine (W.P.B., S.M.W., K.C.S., S.M.K.), Departments of Neurology (G.F.-B.V., M.S.) and Psychiatry (M.S.), University Hospitals Cleveland Medical Center and School of Medicine, and Center for Community Health Integration, Departments of Family Medicine and Community Health and Sociology, Case Comprehensive Cancer Center (K.C.S.), Case Western Reserve University, Cleveland, OH; and Department of Neurology and Geisel School of Medicine (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Siran M Koroukian
- From the Department of Population and Quantitative Health Sciences, School of Medicine (W.P.B., S.M.W., K.C.S., S.M.K.), Departments of Neurology (G.F.-B.V., M.S.) and Psychiatry (M.S.), University Hospitals Cleveland Medical Center and School of Medicine, and Center for Community Health Integration, Departments of Family Medicine and Community Health and Sociology, Case Comprehensive Cancer Center (K.C.S.), Case Western Reserve University, Cleveland, OH; and Department of Neurology and Geisel School of Medicine (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| |
Collapse
|
5
|
Bhoopathy RM, Arthy B, Vignesh SS, Ruckmani S, Srinivasan AV. Involvement of Incomplete Hippocampal Inversion in Intractable Epilepsy: Evidence from Neuropsychological Studies. Neurol India 2021; 69:842-846. [PMID: 34507399 DOI: 10.4103/0028-3886.323886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The age of onset of seizure, seizure types, frequency of seizure, structural abnormalities in the brain, and antiepileptic medication (polytherapy) causes increased incidence of anxiety and depression in intractable epilepsy patients. Aim To compare the anxiety and depression levels in intractable epileptic patients with structural abnormalities [malformations of cortical development (MCD) and incomplete hippocampal inversion (IHI)] and without structural abnormalities. Materials and Methods Participants were selected from (239 males and 171 females) intractable epilepsy patients. They were grouped into four groups; Group 1: 51 nonepileptic age-matched controls, Group 2: 41 intractable epilepsy patients without any brain abnormality, Group 3: 17 intractable epilepsy patients with MCD, and Group 4: 30 intractable epilepsy patients with isolated IHI. Neuropsychiatric tools used were Multiphasic Personality Questionnaire and Weschlers Adult Intelligence Scale to assess anxiety, depression, and intelligence. Groups were classified using 1.5T conventional magnetic resonance imaging and hippocampal volumetric studies. Group comparison design was used. Results Demographic variables of intractable epilepsy, including seizure types, the frequency of seizure, the age of seizure onset, and antiepileptic drug therapies, did not show significant association between the groups using Chi-square P value. Analysis of variance showed significant anxiety and depression in epileptic patients than the control group (P < 0.01). Post hoc analysis using Tukey's B test showed significant difference in anxiety and depression scores between group value. In group 3 and 4, anxiety scores were significantly different but not depression scores. Conclusion The present study concludes high prevalence of anxiety and depression in intractable seizure. Anxiety is observed predominantly when there is IHI along with depression. We emphasize the need to identify IHI in intractable epilepsy and assess anxiety and depression to treat them effectively.
Collapse
Affiliation(s)
- R M Bhoopathy
- Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India
| | - B Arthy
- Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India
| | - S S Vignesh
- Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India
| | - Smitha Ruckmani
- Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India
| | - A V Srinivasan
- Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India
| |
Collapse
|
6
|
Vincentiis S, Alcantara JA, Rzezak P, Kerr DS, Gattaz WF, van der Linden H, Dos Santos B, Arruda F, Chaim-Avancini T, Serpa MH, Fernandes F, Moreno RA, Busatto GF, Alessi R, Demarque R, Valente KD. Genetic polymorphisms of the serotonin transporter are not related with depression in temporal lobe epilepsy caused by hippocampal sclerosis. Epilepsy Behav 2021; 117:107854. [PMID: 33639436 DOI: 10.1016/j.yebeh.2021.107854] [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: 01/11/2021] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mood disorders are the most frequent psychiatric disorders in patients with temporal lobe epilepsy caused by hippocampal sclerosis (TLE-HS). The pathophysiological mechanisms in common between TLE and mood disorders include abnormalities in the serotonergic pathway. We aimed to evaluate the association between serotonin transporter genetic polymorphisms - 5-HTTLPR and 5-HTTVNTR - and the presence of mood disorders in patients with TLE-HS. METHODS We evaluated 119 patients with TLE-HS, with and without psychiatric disorder; 146 patients diagnosed with major depressive disorder (MDD), and 113 healthy volunteers. Individuals were genotyped for the 5-HTTLPR and 5-HTTVNTR polymorphisms. RESULTS No difference was observed between the TLE-HS groups, healthy controls, and MDD without epilepsy. There was a correlation between the 12-allele of the 5-HTTVNTR and the family history of patients with epilepsy with TLE-HS (p = 0.013). CONCLUSIONS In this study conducted in two Brazilian centers, the serotonin transporter polymorphisms evaluated cannot be associated with depressive disorder in patients with TLE-HS. Still, they do have some influence over some clinical characteristics of epilepsy in TLE-HS. These data may not be reproduced in other populations with distinct ethnic characteristics.
Collapse
Affiliation(s)
- Silvia Vincentiis
- Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Rua Dr. Ovidio Pires de Campos, 785, Cerqueira Cesar, Sao Paulo, SP 05403-010, Brazil.
| | - Juliana A Alcantara
- Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Rua Dr. Ovidio Pires de Campos, 785, Cerqueira Cesar, Sao Paulo, SP 05403-010, Brazil
| | - Patricia Rzezak
- Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Rua Dr. Ovidio Pires de Campos, 785, Cerqueira Cesar, Sao Paulo, SP 05403-010, Brazil
| | - Daniel S Kerr
- Laboratory of Neuroscience (LIM-27), Department of Psychiatry, Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Rua Dr. Ovidio Pires de Campos, 785, Cerqueira Cesar, Sao Paulo, SP 05403-010, Brazil
| | - Wagner F Gattaz
- Laboratory of Neuroscience (LIM-27), Department of Psychiatry, Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Rua Dr. Ovidio Pires de Campos, 785, Cerqueira Cesar, Sao Paulo, SP 05403-010, Brazil.
| | - Helio van der Linden
- Goiania Neurological Institute, Praça Gilson Alves de Souza, 140, Setor Bueno, Goiania, GO 74210-250, Brazil
| | - Bernardo Dos Santos
- Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Rua Dr. Ovidio Pires de Campos, 785, Cerqueira Cesar, Sao Paulo, SP 05403-010, Brazil
| | - Francisco Arruda
- Goiania Neurological Institute, Praça Gilson Alves de Souza, 140, Setor Bueno, Goiania, GO 74210-250, Brazil
| | - Tiffany Chaim-Avancini
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Rua Dr. Ovidio Pires de Campos, 785, Cerqueira Cesar, Sao Paulo, SP 05403-010, Brazil
| | - Mauricio H Serpa
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Rua Dr. Ovidio Pires de Campos, 785, Cerqueira Cesar, Sao Paulo, SP 05403-010, Brazil
| | - Fernando Fernandes
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Rua Dr. Ovidio Pires de Campos, 785, Cerqueira Cesar, Sao Paulo, SP 05403-010, Brazil
| | - Ricardo A Moreno
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Rua Dr. Ovidio Pires de Campos, 785, Cerqueira Cesar, Sao Paulo, SP 05403-010, Brazil
| | - Geraldo F Busatto
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Rua Dr. Ovidio Pires de Campos, 785, Cerqueira Cesar, Sao Paulo, SP 05403-010, Brazil
| | - Ruda Alessi
- Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Rua Dr. Ovidio Pires de Campos, 785, Cerqueira Cesar, Sao Paulo, SP 05403-010, Brazil
| | - Renata Demarque
- Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Rua Dr. Ovidio Pires de Campos, 785, Cerqueira Cesar, Sao Paulo, SP 05403-010, Brazil
| | - Kette D Valente
- Laboratory of Clinical Neurophysiology, Institute and Department of Psychiatry, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Rua Dr. Ovidio Pires de Campos, 785, Cerqueira Cesar, Sao Paulo, SP 05403-010, Brazil.
| |
Collapse
|
7
|
Bjørke AB, Østby Y, Grahl SG, Larsson PG, Olsen KB, Johansen Nævra MC, Ringstad GA, Bjørnerud A, Gjerstad L, Taubøll E, Heuser K. Cognition in adult patients with newly diagnosed non-lesional temporal lobe epilepsy. Epilepsy Behav 2021; 116:107771. [PMID: 33545650 DOI: 10.1016/j.yebeh.2021.107771] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate whether cognitive performance is affected in newly diagnosed temporal lobe epilepsy (TLE) and to determine the most vulnerable cognitive domains. METHODS In this baseline longitudinal study, differences in memory and non-memory cognitive functions were assessed using comprehensive neuropsychological test batteries in 21 adult patients with newly diagnosed non-lesional TLE and individually matched controls. In addition, the analyses included ratings of self-perceived emotional status. RESULTS The patients performed more poorly than the control group regarding delayed visual memory (p = 0.013) and executive function tasks related to switching (Trail Making Test and verbal fluency shifting; p = 0.025 and p = 0.03, respectively). We found no differences in verbal learning and memory, attention/working memory/processing speed, and other executive functions. SIGNIFICANCE Our results show that patients with TLE often have specific cognitive deficits at time of diagnosis, even in the absence of structural brain abnormalities. This supports the hypothesis that memory dysfunction is linked to an underlying pathology rather than to the effect of recurrent seizures, long-term use of anti-seizure medication, or other epilepsy-related factors. As certain executive functions are affected at an early stage, the pathology may involve brain regions beyond the temporal lobe and may comprise larger brain networks. These results indicate the need for greater awareness of cognition at the time of diagnosis of TLE and before initiation of treatment, and integration of neuropsychological assessment into early routine clinical care.
Collapse
Affiliation(s)
- Agnes Balint Bjørke
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Neurology, Division of Neurology, Rheumatology and Habilitation, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Ylva Østby
- Institute of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Simon Gevert Grahl
- Institute of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Pål Gunnar Larsson
- Section of Clinical Neurophysiology, Department of Neurosurgery, Division of Clinical Neuroscience, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ketil Berg Olsen
- Section of Clinical Neurophysiology, Department of Neurosurgery, Division of Clinical Neuroscience, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Marianne C Johansen Nævra
- Section of Clinical Neurophysiology, Department of Neurosurgery, Division of Clinical Neuroscience, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Geir Andre Ringstad
- Department of Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Atle Bjørnerud
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Leif Gjerstad
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Erik Taubøll
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kjell Heuser
- Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| |
Collapse
|
8
|
Herrera-Fortin T, Bou Assi E, Gagnon MP, Nguyen DK. Seizure detection devices: A survey of needs and preferences of patients and caregivers. Epilepsy Behav 2021; 114:107607. [PMID: 33248943 DOI: 10.1016/j.yebeh.2020.107607] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
AIMS Seizure detectors could have many positive effects on the quality of life of people with epilepsy (PWE) such as alarms to reduce seizure-related injuries or reliable seizure counts leading to improved epilepsy management. As seizure detection gains increasing interest within the epilepsy research community, guidelines for patient-centered designs are needed. This study aims to detail the preferences, needs and concerns regarding potential seizure detectors, of PWE and their caregivers across Canada. METHODS Two questionnaires were designed to survey PWE and their caregivers on seizure detection acceptability and to collect general clinical characteristics. The surveys were available online for nine weeks and were promoted by Canadian organizations of PWE. Participation was voluntary and anonymous. RESULTS Responses from 221 PWE and 171 caregivers were collected. Ninety-seven percent of PWE and 99% of caregivers expressed interest in seizure detection. Most would use seizure detectors continuously, in conjunction with a seizure diary, and wanted automated alarms. Smartwatches and bracelets/rings were considered most acceptable and would be worn continuously by 58% and 61% of PWE, respectively. Additional value was attributed to multimodal seizure detection. Responders were most concerned about false negatives, comfort and cost. They expected seizure detection to improve their quality of life and quality of care, and felt confident in their ability to use a seizure detector. CONCLUSIONS While PWE and caregivers in Canada show great enthusiasm for seizure detection, their opinions are shaped by their perception of the effectiveness and reliability of this technology and its cost. A preliminary technology acceptance model and recommendations promoting the development of seizure detectors demonstrating an understanding of their future users are presented. Future investigations should focus on a larger population of patients who have previously used seizure detection devices to assess user-feedback.
Collapse
Affiliation(s)
- Tamara Herrera-Fortin
- Research Center of the University of Montreal Health Center, Montreal, Quebec H2X 0A9, Canada.
| | - Elie Bou Assi
- Research Center of the University of Montreal Health Center, Montreal, Quebec H2X 0A9, Canada
| | - Marie-Pierre Gagnon
- University Health Center of Quebec - University of Laval, Quebec City, Quebec G1V 4G2, Canada
| | - Dang K Nguyen
- Research Center of the University of Montreal Health Center, Montreal, Quebec H2X 0A9, Canada
| |
Collapse
|
9
|
A prospective pilot study of cognitive impairment and mood in adults with first seizure, new-onset epilepsy, and newly diagnosed epilepsy at time of initial seizure presentation. Epilepsy Behav 2020; 112:107359. [PMID: 32858365 DOI: 10.1016/j.yebeh.2020.107359] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION This is an observational prospective cohort study of cognition and mood in individuals presenting to a tertiary neurology clinic with first unprovoked seizure (FS), new-onset epilepsy (NOE), and newly diagnosed epilepsy (NDE). Our aim was to understand the cognitive profile of these three diagnostic groups at the time of first presentation. Follow-up was obtained to evaluate any association between cognition at presentation and subsequent clinical course. METHODS Forty-three participants (age: 18-60 years) were recruited with FS (n = 17), NOE (n = 16), and NDE (n = 10). Clinical details, neuropsychological testing, and screening for mood disorders were obtained at the time of presentation to clinic. Seizure recurrence was evaluated at clinic follow-up at least 6-12 months following the initial presentation. RESULTS In all groups, general intelligence (intelligence quotient [IQ]) was consistent with population norms, but more than half of participants (55.8%) were impaired in at least one cognitive domain. The most commonly impaired domain in all diagnostic groups was visuospatial and visuoconstruction suggesting that it may be a sensitive marker of early cognitive impairment. Those with epilepsy (NOE and NDE) at initial presentation were more likely to be impaired than those with FS, particularly on tests of attention, working memory, and processing speed. Seven participants with FS converted to NOE (FSNOE) at follow-up. They were more likely to be impaired on tests of memory than those with FS who did not convert to NOE. On mood screening, 21% of participants scored moderate or severe for depressive symptoms, and 25.6% of participants scored moderate or severe for anxiety symptoms. DISCUSSION Cognitive impairment and mood changes are common at first seizure presentation and mirror the pattern seen in chronic epilepsy. This cooccurrence of symptomatology at disease onset prior to prolonged antiepilepsy drug exposure suggests a shared underlying disease mechanism and carries important clinical implications for effective diagnosis and management of epilepsy. Furthermore, early cognitive testing may become a clinical biomarker and enable the prediction of an individual's clinical course.
Collapse
|
10
|
Hobbs SL, Law TH, Volk HA, Younis C, Casey RA, Packer RMA. Impact of canine epilepsy on judgement and attention biases. Sci Rep 2020; 10:17719. [PMID: 33082493 PMCID: PMC7576193 DOI: 10.1038/s41598-020-74777-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022] Open
Abstract
Idiopathic epilepsy (IE) is the most common chronic neurological condition in dogs, characterised by recurrent seizure activity and associated with negative behavioural and cognitive changes. We hypothesised that IE would negatively impact putative affective state, with dogs with IE exhibiting a more pessimistic judgement bias and more negative attention bias than controls. Dogs were tested in a previously-validated spatial judgement bias task, and a novel auditory attention bias task testing attention to sounds with different valence or salience (neutral, novel pre-habituated, threatening). Sixty-eight dogs (IE = 33, Control = 35) were tested, of which n = 37 acquired the spatial discrimination and responses to judgement bias probes were tested (IE = 19, Control = 18), and n = 36 were tested for responses to sounds (IE = 20, Control = 16). Study groups did not significantly differ by age, sex, breed or neuter-status (p > 0.05). Main effects of study group were not significant in judgement bias (F1,102 = 0.20, p = 0.658) or attention bias tasks (F3,102 = 1.64, p = 0.184). In contrast with our hypotheses, there was no evidence that IE altered cognitive biases in this study population; however, dogs with IE were significantly more likely to be unable to learn the spatial discrimination task (p = 0.019), which may reflect IE-related cognitive deficits. Developing methods to test affective state without excluding cognitively impaired individuals is a future challenge for animal welfare science.
Collapse
Affiliation(s)
- Sarah L Hobbs
- Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA, Hertfordshire, UK
| | - Tsz Hong Law
- Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA, Hertfordshire, UK
| | - Holger A Volk
- Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA, Hertfordshire, UK.,Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg, 30559, Hannover, Germany
| | - Chantal Younis
- Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA, Hertfordshire, UK
| | - Rachel A Casey
- Dogs Trust, 17 Wakley Street, The Angel, London, EC1V 7RQ, UK
| | - Rowena M A Packer
- Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA, Hertfordshire, UK.
| |
Collapse
|
11
|
Allone C, Bonanno L, Lo Buono V, Corallo F, Palmeri R, Micchia K, Pollicino P, Bramanti A, Marino S. Neuropsychological assessment and clinical evaluation in temporal lobe epilepsy with associated cortical dysplasia. J Clin Neurosci 2020; 72:146-150. [PMID: 31918906 DOI: 10.1016/j.jocn.2019.12.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/16/2019] [Indexed: 11/16/2022]
Abstract
Temporal Lobe Epilepsy (TLE) is a chronic neurological disorder, often associated to cognitive deficits. Focal cortical dysplasia (FCD), frequently associated to high risk of epilepsy, can lead to abnormalities in cognition. The aim of this study was to explore neuropsychological performance and to identify potential risk factors for cognitive impairment in TLE subjects with associated FCD. Our sample was composed by 46 TLE patients with FCD (37.76 ± 12.60 years; 29 females and 16 males) and 44 healthy controls (41.05 ± 9.74 years; 25 females and 19 males). All subjects performed a neuropsychological battery associated to a measurement of depression and anxiety. Results showed a poor performance of all domains of cognitive functioning and identified age of epilepsy onset as potential risk factor of cognitive impairment. These findings support the importance to focus on cognitive impairment in TLE patients with FCD to better clarify the impact of epilepsy features and FCD in therapeutic and everyday management.
Collapse
Affiliation(s)
| | - Lilla Bonanno
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | | | | | | | - Katia Micchia
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | | | - Alessia Bramanti
- Institute of Applied Science and Intelligent Systems "ISASI Eduardo Caianiello", CNR, Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy; Department of Biomedical Sciences and Morphological and Fuctional Imaging, University of Messina, Messina, Italy
| |
Collapse
|
12
|
Zapata Barco AM, Restrepo-Martínez M, Restrepo D. Depression in People with Epilepsy. What is the Connection? REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:53-61. [PMID: 32081210 DOI: 10.1016/j.rcp.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/25/2017] [Accepted: 10/22/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Depression is the most common psychiatric comorbidity in people with epilepsy. It worsens the prognosis and quality of life of these patients. Despite this, depression is poorly diagnosed and when the treatment is given, it is frequently suboptimal. OBJECTIVE To perform a narrative review of the medical literature, seeking to collect useful information regarding the relationship between epilepsy and depression. RESULTS Narrative reviews, systematic reviews, meta-analyses, clinical trials, and follow-up studies were identified in English and Spanish with no time limit, including epidemiological, clinical, associated factors, etiological explanations, diagnostic and therapeutic approaches to comorbid depression in epilepsy. CONCLUSION The relationship between epilepsy and depression is complex. The available scientific evidence suggests the possibility of a bidirectional relationship that could be explained from common aetiopathogenic mechanisms. Despite the high prevalence of depression in epileptic patients, this mental disorder continues to be poorly identified by clinicians. To improve this, we have easy-to-apply instruments that routinely screen this patient population and contribute substantially to making the problem more visible and seek to improve the quality of life for this population.
Collapse
|
13
|
Baroli G, Sanchez JR, Agostinelli E, Mariottini P, Cervelli M. Polyamines: The possible missing link between mental disorders and epilepsy (Review). Int J Mol Med 2019; 45:3-9. [PMID: 31746386 DOI: 10.3892/ijmm.2019.4401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/22/2019] [Indexed: 11/05/2022] Open
Abstract
Polyamines are small positively charged alkylamines that are essential in a number of crucial eukaryotic processes, like normal cell growth and development. In normal physiological conditions, intracellular polyamine content is tightly regulated through a fine regulated network of biosynthetic and catabolic enzymes and a transport system. The dysregulation of this network is frequently associated to different tumors, where high levels of polyamines has been detected. Polyamines also modulate ion channels and ionotropic glutamate receptors and altered levels of polyamines have been observed in different brain diseases, including mental disorders and epilepsy. The goal of this article is to review the role of polyamines in mental disorders and epilepsy within a frame of the possible link between these two brain pathologies. The high comorbidity between these two neurological illnesses is strongly suggestive that they share a common background in the central nervous system. This review proposes an additional association between the noradrenalin/serotonin and glutamatergic neuronal circuits with polyamines. Polyamines can be considered supplementary defensive shielding molecules, important to protect the brain from the development of epilepsy and mental illnesses that are caused by different types of neurons. In this contest, the modulation of polyamine metabolism may be a novel important target for the prevention and therapeutic treatment of these diseases that have a high impact on the costs of public health and considerably affect quality of life.
Collapse
Affiliation(s)
- Giulia Baroli
- Department of Science, University of Rome 'Roma Tre', I‑00146 Rome, Italy
| | | | - Enzo Agostinelli
- Department of Biochemical Sciences 'Rossi Fanelli', University of Rome 'La Sapienza', I‑00185 Rome, Italy
| | - Paolo Mariottini
- Department of Science, University of Rome 'Roma Tre', I‑00146 Rome, Italy
| | - Manuela Cervelli
- Department of Science, University of Rome 'Roma Tre', I‑00146 Rome, Italy
| |
Collapse
|
14
|
Goodman AM, Allendorfer JB, Heyse H, Szaflarski BA, Eliassen JC, Nelson EB, Storrs JM, Szaflarski JP. Neural response to stress and perceived stress differ in patients with left temporal lobe epilepsy. Hum Brain Mapp 2019; 40:3415-3430. [PMID: 31033120 DOI: 10.1002/hbm.24606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/21/2019] [Accepted: 04/14/2019] [Indexed: 01/28/2023] Open
Abstract
Patients with epilepsy are often able to predict seizure occurrence subsequent to an acute stress experience. However, neuroimaging investigations into the neural basis of this relationship or the potential influence of perceived life stress are limited. The current study assessed the relationship between perceived stress and the neurobehavioral response to stress in patients with left temporal lobe epilepsy (LTLE) and healthy controls (HCs) using heart rate, salivary cortisol level, and functional magnetic resonance imaging and compared these effects between HCs and LTLE. Matched on perceived stress levels, groups of 36 patients with LTLE and 36 HCs completed the Montreal Imaging Stress Task, with control and stress math task conditions. Among LTLEs, 27 reported that prior (acute) stress affected their seizures (LTLES+), while nine did not (LTLES-). The results revealed that increased perceived stress was associated with seizure frequency in LTLE. Further, cortisol secretion was greater in LTLE, but did not vary with perceived stress as observed in HCs. A linear mixed-effects analysis revealed that as perceived stress increased, activation in the hippocampal complex (parahippocampal gyrus and hippocampus) decreased during stressful math in the LTLES+, increased in HCs, but did not vary in the LTLES-. Task-based functional connectivity analyses revealed LTLE differences in hippocampal functional connectivity with sensory cortex specific to stressor modalities. We argue that the current study demonstrates an inhibitory hippocampal mechanism underlying differences in resilience to stress between HCs and LTLE, as well as LTLE patients who report stress as a precipitant of seizures.
Collapse
Affiliation(s)
- Adam M Goodman
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jane B Allendorfer
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Heidi Heyse
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Basia A Szaflarski
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - James C Eliassen
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio.,Department of Psychology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Erik B Nelson
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Judd M Storrs
- Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Jerzy P Szaflarski
- Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio.,Department of Psychiatry, University of Cincinnati Academic Health Center, Cincinnati, Ohio.,Department of Psychology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| |
Collapse
|
15
|
Vrinda M, Arun S, Srikumar B, Kutty BM, Shankaranarayana Rao B. Temporal lobe epilepsy-induced neurodegeneration and cognitive deficits: Implications for aging. J Chem Neuroanat 2019; 95:146-153. [DOI: 10.1016/j.jchemneu.2018.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 02/16/2018] [Accepted: 02/16/2018] [Indexed: 12/12/2022]
|
16
|
Genetic polymorphisms of the 5HT receptors are not related with depression in temporal lobe epilepsy caused by hippocampal sclerosis. Epilepsy Behav 2018; 83:181-185. [PMID: 29709878 DOI: 10.1016/j.yebeh.2018.03.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/13/2018] [Accepted: 03/26/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Temporal lobe epilepsy caused by hippocampal sclerosis (TLE-HS) is the most frequent form of drug-resistant epilepsy in adults. Mood disorders are the most frequent psychiatric comorbidities observed in these patients. Common pathophysiological mechanisms of epilepsy and psychiatric comorbidities include abnormalities in the serotonin pathway. The primary goal of this study was to determine the possible association between polymorphisms of genes encoding the serotonin receptors 5HT1A (rs6295), 5HT1B (rs6296), and 5HT2C (rs6318) and the presence of mood disorders in patients with TLE-HS. Our secondary goal was to evaluate the possible association between these variants and susceptibility to develop seizures in TLE-HS. METHODS We assessed 119 patients with TLE-HS, with and without psychiatric comorbidities; 146 patients with major depressive disorder; and 113 healthy volunteers. Individuals were genotyped for the rs6295, rs6296, and rs6318 polymorphisms. RESULTS No difference was observed between the group with TLE-HS, healthy controls, and the group with major depressive disorder without epilepsy regarding the polymorphisms that were evaluated. There was no correlation between rs6318, rs6295, rs6296, and epilepsy-related factors and history of psychiatric comorbidities. CONCLUSIONS Our work suggests that the studied polymorphisms were not related to the presence of TLE, psychiatric comorbidities in TLE, and epilepsy-related factors.
Collapse
|
17
|
Alba-Ferrara L, Kochen S, Hausmann M. Emotional Prosody Processing in Epilepsy: Some Insights on Brain Reorganization. Front Hum Neurosci 2018; 12:92. [PMID: 29593517 PMCID: PMC5859098 DOI: 10.3389/fnhum.2018.00092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/26/2018] [Indexed: 11/27/2022] Open
Abstract
Drug resistant epilepsy is one of the most complex, multifactorial and polygenic neurological syndrome. Besides its dynamicity and variability, it still provides us with a model to study brain-behavior relationship, giving cues on the anatomy and functional representation of brain function. Given that onset zone of focal epileptic seizures often affects different anatomical areas, cortical but limited to one hemisphere, this condition also let us study the functional differences of the left and right cerebral hemispheres. One lateralized function in the human brain is emotional prosody, and it can be a useful ictal sign offering hints on the location of the epileptogenic zone. Besides its importance for effective communication, prosody is not considered an eloquent domain, making resective surgery on its neural correlates feasible. We performed an Electronic databases search (Medline and PsychINFO) from inception to July 2017 for studies about prosody in epilepsy. The search terms included “epilepsy,” “seizure,” “emotional prosody,” and “vocal affect.” This review focus on emotional prosody processing in epilepsy as it can give hints regarding plastic functional changes following seizures (preoperatively), resection (post operatively), and also as an ictal sign enabling the assessment of dynamic brain networks. Moreover, it is argued that such reorganization can help to preserve the expression and reception of emotional prosody as a central skill to develop appropriate social interactions.
Collapse
Affiliation(s)
- Lucy Alba-Ferrara
- Facultad de Ciencias Biomedicas, Austral University, Buenos Aires, Argentina.,Estudios en Neurociencias y Sistemas Complejos, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Florencio Varela, Argentina
| | - Silvia Kochen
- Estudios en Neurociencias y Sistemas Complejos, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Florencio Varela, Argentina
| | - Markus Hausmann
- Science Labs, Department of Psychology, Durham University, Durham, United Kingdom
| |
Collapse
|
18
|
Abstract
Psychiatric comorbidities, including mood, anxiety, and psychotic disorders, are common in epilepsy, often occurring at rates 2-3-fold or higher than in the general population without epilepsy. This article discusses the epidemiology of psychiatric disorders in epilepsy, hypotheses regarding the pathogenesis of these comorbidities, and treatment implications. More specifically, it addresses: (1) How common are major depressive disorder, anxiety disorders, and psychotic disorders in epilepsy? (2) How does one screen for these psychiatric disorders in persons with epilepsy? (3) Why do psychiatric conditions occur in epilepsy? (4) Is the treatment of psychiatric comorbidity in epilepsy associated with seizures? The important topic of suicide and suicidal ideation in epilepsy, risk factors for their occurrence, and how to screen for these co-existent conditions is also discussed. Finally, gaps in knowledge regarding psychiatric conditions in epilepsy are briefly discussed.
Collapse
Affiliation(s)
- Colin B Josephson
- a Department of Clinical Neurosciences , Hotchkiss Brain Institute and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary , Calgary , AB , Canada
| | - Nathalie Jetté
- a Department of Clinical Neurosciences , Hotchkiss Brain Institute and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary , Calgary , AB , Canada
| |
Collapse
|
19
|
Rider FK, Danilenko OA, Grishkina MN, Kustov GV, Akzhigitov RG, Lebedeva AV, Guekht AB. [Depression and epilepsy: comorbidities, pathogenesis, principles of therapy]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:19-24. [PMID: 28005042 DOI: 10.17116/jnevro20161169219-24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Numerous trials of last years confirm the bilateral link between depression and epilepsy with mutual complication of both diseases. Depression increases the risk of the first unprovoked paroxysm, worsens the compliance of epileptic patients, leads to decrease of the response both to therapeutic and surgical treatment and to increase of side effects of antiepileptic drugs. Depression is associated with high risk of suicidal behavior and reduces the quality of life level. Depression in epileptic patients is characterized by atypical clinical course in most cases what makes its diagnostics difficult and becomes the reason of the absence of the necessary pharmacologic and psychotherapeutic treatment. All of the above creates significant economical burden for the community because the epileptic patient with comorbid depression visits the physicians 2-4 times more often.
Collapse
Affiliation(s)
- F K Rider
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - O A Danilenko
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - M N Grishkina
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - G V Kustov
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - R G Akzhigitov
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia
| | - A V Lebedeva
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia; Pirogov Russian Natural Research Medical Univercity, Moscow, Russia
| | - A B Guekht
- Soloviev Moscow Research and Clinical for Neuropsychiatry, Moscow, Russia; Pirogov Russian Natural Research Medical Univercity, Moscow, Russia
| |
Collapse
|
20
|
Yazici E, Yazici AB, Aydin N, Varoglu AO, Kirpinar I. Affective Temperaments in Epilepsy. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20120731060406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Esra Yazici
- Service of Psychiatry, Derince Training and Research Hospital, Kocaeli - Turkey
| | | | - Nazan Aydin
- Department of Psychiatry, School of Medicine, Atatürk University, Erzurum - Turkey
| | - Asuman Orhan Varoglu
- Department of Neurology, Selçuklu School of Medicine, Selçuk University, Konya - Turkey
| | - Ismet Kirpinar
- Department of Psychiatry, School of Medicine, Bezmialem University, İstanbul - Turkey
| |
Collapse
|
21
|
Major depressive episode, cognition, and epilepsy. Epilepsy Behav 2016; 64:219-223. [PMID: 27764732 DOI: 10.1016/j.yebeh.2016.09.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 08/21/2016] [Accepted: 09/16/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE In patients with epilepsy (PWE), relationships between depression, epilepsy characteristics, and cognitive aspects are complex. This study aimed to assess the occurrence of possible major depressive episode in PWE and to verify whether it is associated with the clinical aspects of the disease and cognition. METHODS Two hundred consecutive PWE with a mean age and standard deviation of 47.6 (±15.1) years were included in the study. We determined whether their Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) scores were associated with their clinical, cognitive, and QOLIE-31 aspects using a significance level of 5% (p<0.05). RESULTS Twenty-six patients (13%) had an NDDI-E score >15, suggestive of major depressive episode. Logistic regression showed that NDDI-E >15 was associated with seizure frequency (p=0.022) and worse performance in the category fluency test (p=0.003). An NDDI-E >15 was also correlated with lower quality of life (p<0.001). CONCLUSION The present findings suggest that possible major depressive episode is associated not only with epilepsy characteristics but also with cognitive aspects, such as category fluency, and quality of life.
Collapse
|
22
|
Chen SD, Wang YL, Liang SF, Shaw FZ. Rapid Amygdala Kindling Causes Motor Seizure and Comorbidity of Anxiety- and Depression-Like Behaviors in Rats. Front Behav Neurosci 2016; 10:129. [PMID: 27445726 PMCID: PMC4916743 DOI: 10.3389/fnbeh.2016.00129] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 06/08/2016] [Indexed: 11/30/2022] Open
Abstract
Amygdala kindling is a model of temporal lobe epilepsy (TLE) with convulsion. The rapid amygdala kindling has an advantage on quick development of motor seizures and for antiepileptic drugs screening. The rapid amygdala kindling causes epileptogenesis accompanied by an anxiolytic response in early isolation of rat pups or depressive behavior in immature rats. However, the effect of rapid amygdala kindling on comorbidity of anxiety- and depression-like behaviors is unexplored in adult rats with normal breeding. In the present study, 40 amygdala stimulations given within 2 days were applied in adult Wistar rats. Afterdischarge (AD) and seizure stage were recorded throughout the amygdala kindling. Anxiety-like behaviors were evaluated by the elevated plus maze (EPM) test and open field (OF) test, whereas depression-like behaviors were assessed by the forced swim (FS) and sucrose consumption (SC) tests. A tonic-clonic convulsion was provoked in the kindle group. Rapid amygdala kindling resulted in a significantly lower frequency entering an open area of either open arms of the EPM or the central zone of an OF, lower sucrose intake, and longer immobility of the FS test in the kindle group. Our results suggest that rapid amygdala kindling elicited severe motor seizures comorbid with anxiety- and depression-like behaviors.
Collapse
Affiliation(s)
- Shang-Der Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan; Center for Translational Research in Biomedical Science, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung, Taiwan
| | - Yu-Lin Wang
- Department of Computer Science and Information Engineering, National Cheng Kung University Tainan, Taiwan
| | - Sheng-Fu Liang
- Department of Computer Science and Information Engineering, National Cheng Kung UniversityTainan, Taiwan; Institute of Medical Informatics, National Cheng Kung UniversityTainan, Taiwan
| | - Fu-Zen Shaw
- Department of Psychology, National Cheng Kung University Tainan, Taiwan
| |
Collapse
|
23
|
Osman A, Seri S, Cavanna AE. Clinical characteristics of patients with epilepsy in a specialist neuropsychiatry service. Epilepsy Behav 2016; 58:44-7. [PMID: 27057744 DOI: 10.1016/j.yebeh.2016.02.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 02/21/2016] [Accepted: 02/23/2016] [Indexed: 12/29/2022]
Abstract
Neuropsychiatry services provide specialist input into the assessment and management of behavioral symptoms associated with a range of neurological conditions, including epilepsy. Despite the centrality of epilepsy to neuropsychiatry and the recent expansion of neuropsychiatry service provision, little is known about the clinical characteristics of patients with epilepsy who are routinely seen by a specialist neuropsychiatry service. This retrospective study filled this gap by retrospectively evaluating a naturalistic series of 60 consecutive patients with epilepsy referred to and assessed within a neuropsychiatry setting. Fifty-two patients (86.7%) had active epilepsy and were under the ongoing care of the referring neurologist for seizure management. The majority of patients (N=42; 70.0%) had a diagnosis of localization-related epilepsy, with temporal lobe epilepsy as the most common epilepsy type (N=37; 61.7%). Following clinical assessment, 39 patients (65.0%) fulfilled formal diagnostic criteria for at least one psychiatric disorder; nonepileptic attack disorder (N=37; 61.7%), major depression (N=23; 38.3%), and generalized anxiety disorder (N=16; 26.7%) were the most commonly diagnosed comorbidities. The clinical characteristics of patients seen in specialist neuropsychiatry settings are in line with the results from previous studies in neurology clinics in terms of both epilepsy and psychiatric comorbidity. Our findings confirm the need for the development and implementation of structured care pathways for the neuropsychiatric aspects of epilepsy, with focus on comorbid nonepileptic attacks and affective and anxiety symptoms. This is of particular importance in consideration of the impact of behavioral symptoms on patients' health-related quality of life.
Collapse
Affiliation(s)
- Adam Osman
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Stefano Seri
- School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, UK; Children's Epilepsy Surgery Programme, The Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Andrea E Cavanna
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK; School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, UK; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and UCL, London, UK.
| |
Collapse
|
24
|
Tong X, An D, Lan L, Zhou X, Zhang Q, Xiao F, Park SP, Kanemoto K, Kanner AM, Zhou D. Validation of the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy (C-NDDI-E) in West China. Epilepsy Behav 2015; 47:6-10. [PMID: 26004785 DOI: 10.1016/j.yebeh.2015.03.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We aimed to validate the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) for Chinese people with epilepsy (PWE). METHODS The NDDI-E was translated into a Chinese version. A consecutive cohort of PWE from West China Hospital was recruited to test the reliability and validity of the Chinese version of the NDDI-E (C-NDDI-E). Each patient underwent the Mini International Neuropsychiatric Interview (MINI) and C-NDDI-E. RESULTS A total of 202 PWE completed the psychiatric evaluation. The C-NDDI-E was easily comprehended and quickly completed by all participants. Fifty-four patients (26.7%) had current major depressive disorder (MDD) according to the MINI criteria. The Cronbach's α coefficient for the C-NDDI-E was 0.825. Receiver operating characteristic analyses showed an area under the curve of 0.936 (95% CI=0.904-0.968). At a cutoff score of >12, the C-NDDI-E had a sensitivity of 0.926, a specificity of 0.804, a positive predictive value of 0.633, and a negative predictive value of 0.967. CONCLUSION The C-NDDI-E is a valuable instrument for screening MDD in Chinese PWE.
Collapse
Affiliation(s)
- Xin Tong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
| | - Dongmei An
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
| | - Lili Lan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
| | - Xiaobo Zhou
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
| | - Qin Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
| | - Fenglai Xiao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
| | - Sung-Pa Park
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Kousuke Kanemoto
- Department of Neuropsychiatry, School of Medicine, Aichi Medical University, Nagakute, Japan.
| | - Andres M Kanner
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
| |
Collapse
|
25
|
Mula M. The Clinical Spectrum of Bipolar Symptoms in Epilepsy: A Critical Reappraisal. Postgrad Med 2015; 122:17-23. [DOI: 10.3810/pgm.2010.07.2171] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
26
|
Yang Y, Gao X, Xu Y. The dilemma of treatments for epileptic patients with depression. Int J Neurosci 2014; 125:566-77. [PMID: 25271800 DOI: 10.3109/00207454.2014.959122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Depression is a state of low mood and aversion to activity. It may occur due to existence of other mental or physical diseases or from the medications for those illnesses. It is one of the leading sources of disability. Among these physical diseases, epilepsy is widely recognized as one of the main causes of depression. Patients with epilepsy are at high risk of developing depressive symptoms, and the suicide rates in patients with epilepsy have been reported to be much higher than in the general population. However, due to fears of lowering seizure threshold and adverse drug interactions between antidepressants and antiepileptic drugs, physician are reluctant to place patients with epilepsy on antidepressant medication. As a result, the question has been raised that what the best managements should be used to treat epileptic patients with depression. In this review, the currently used medications for antidepressants and antiepileptic drugs were summarized by their working targets in order to establish appropriate pharmacological management of depression and epilepsy. Despite the complex relationship between epilepsy and depression, coadministration of antidepressants and AEDs can still be done safely and effectively under the conditions of good clinical management. The ideal antidepressants for people with epilepsy should be efficacious but with few adverse effects, which will not antagonize GABAergic mechanisms or interfere with plasma anticonvulsant concentrations.
Collapse
Affiliation(s)
- Yang Yang
- 1Department of Clinical Psychology, Subei People Hospital of Jiangsu Province, Yangzhou, 225001, China
| | | | | |
Collapse
|
27
|
Fitzgerald PB. Treatment of Depression in a Patient With Epilepsy. Brain Stimul 2014; 7:619-20. [DOI: 10.1016/j.brs.2014.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/03/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022] Open
|
28
|
Bragatti JA, Torres CM, Cherubini PA, Leistner-Segal S, Bianchin MM. Is interictal EEG activity a biomarker for mood disorders in temporal lobe epilepsy? Clin Neurophysiol 2014; 125:1952-8. [PMID: 24631009 DOI: 10.1016/j.clinph.2014.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/20/2014] [Accepted: 02/15/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Psychiatric comorbidities are frequent in temporal lobe epilepsy (TLE), and symptoms of these comorbidities may be related to epilepsy activity. Here we evaluated interictal EEG activity in TLE patients with or without psychiatric comorbidities. METHODS A cohort study of 78 patients with TLE, with evaluation of wake/sleep interictal scalp EEG. All subjects were submitted to a psychiatric structured clinical interview (SCID) for the diagnosis of lifetime psychiatric comorbidities. Three major diagnostic categories were studied: mood disorders, anxiety disorders, and psychosis. We then evaluated differences in interictal EEG activity between patients with and without these psychiatric comorbidities. RESULTS Infrequent EEG interictal spikes, defined as less than one event per minute, were significantly associated with mood disorders in TLE (p=0.02). CONCLUSIONS Low intensity seizure disorder has been associated with a decrease in interictal EEG discharges and with an increase in psychiatric symptoms in TLE, a phenomenon known as forced normalization. In our study, we observed a low interictal spike frequency on EEG in TLE patients with mood disorders. SIGNIFICANCE A low spike index might be a neurophysiological marker for depression in temporal lobe epilepsy.
Collapse
Affiliation(s)
- José Augusto Bragatti
- Post-Graduation Course in Medicine, Medical Sciences, Universidade Federal do Rio Grande do Sul, Brazil; Basic Research and Advanced Investigations in Neurology, Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Brazil.
| | - Carolina Machado Torres
- Post-Graduation Course in Medicine, Medical Sciences, Universidade Federal do Rio Grande do Sul, Brazil; Basic Research and Advanced Investigations in Neurology, Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Brazil
| | - Pedro Abrahim Cherubini
- Basic Research and Advanced Investigations in Neurology, Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Brazil
| | - Sandra Leistner-Segal
- Basic Research and Advanced Investigations in Neurology, Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Brazil; Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Brazil
| | - Marino Muxfeldt Bianchin
- Post-Graduation Course in Medicine, Medical Sciences, Universidade Federal do Rio Grande do Sul, Brazil; Basic Research and Advanced Investigations in Neurology, Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Brazil
| |
Collapse
|
29
|
Elliott JO. Possible methods for the prevention of bone loss in persons with epilepsy. Expert Rev Neurother 2014; 9:797-812. [DOI: 10.1586/ern.09.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
30
|
Charyton C, Elliott JO, Moore JL, Klatte ET. Is it time to consider cognitive behavioral therapy for persons with epilepsy? Clues from pathophysiology, treatment and functional neuroimaging. Expert Rev Neurother 2014; 10:1911-27. [DOI: 10.1586/ern.10.138] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
31
|
Köster M, Grohmann R, Engel RR, Nitsche MA, Rüther E, Degner D. Seizures during antidepressant treatment in psychiatric inpatients--results from the transnational pharmacovigilance project "Arzneimittelsicherheit in der Psychiatrie" (AMSP) 1993-2008. Psychopharmacology (Berl) 2013; 230:191-201. [PMID: 24068157 DOI: 10.1007/s00213-013-3281-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 09/02/2013] [Indexed: 12/12/2022]
Abstract
RATIONALE There is little clinical data available about seizure rates in psychiatric inpatients, and there are no studies with reference data to the frequencies of antidepressant (AD) use for this important clinical population. OBJECTIVE This study investigates seizure rates during AD treatment in psychiatric inpatient settings, drawn from the transnational pharmacovigilance programme Arzneimittelsicherheit in der Psychiatrie (AMSP) in relation to the known frequencies of ADs used in the participating clinics. Comparisons are made to former publications and their limitations. RESULTS Seventy-seven cases were identified with grand mal seizures (GMS) during AD treatment between 1993 and 2008, with a total number of 142,090 inpatients under surveillance treated with ADs in the participating hospitals. The calculated overall rate of reported seizures of patients during AD treatment in this collective is 0.05 % for ADs imputed alone or in combination with other psychotropic drug groups and 0.02 % when only ADs were given and held responsible for GMS. The patients receiving tri- or tetracyclic ADs (TCAs) had a 2-fold risk to develop a seizure as compared to the overall average rate in this sample. In 11 cases, there was only one AD imputed--the majority of these cases (9/11) were TCA. Monotherapy with selective serotonin reuptake inhibitors (SSRI) or dual serotonin and noradrenaline reuptake inhibitors (SNRI) were never imputed alone in this sample. CONCLUSIONS The results of the study favour the assumption that SSRIs, noradrenergic and specific serotonergic antidepressants (NaSSA) and dual SNRI might be more appropriate than TCAs for the treatment of psychiatric patients with an enhanced seizure risk.
Collapse
Affiliation(s)
- M Köster
- , Rothstrasse 54, 8057, Zürich, Switzerland,
| | | | | | | | | | | |
Collapse
|
32
|
Winawer MR, Connors R. Evidence for a shared genetic susceptibility to migraine and epilepsy. Epilepsia 2013; 54:288-95. [PMID: 23294289 DOI: 10.1111/epi.12072] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE Although epilepsy and migraine are known to co-occur within individuals, the contribution of a shared genetic susceptibility to this comorbidity remains unclear. We investigated the hypothesis of shared genetic effects on migraine and epilepsy in the Epilepsy Phenome/Genome Project (EPGP) cohort. METHODS We studied prevalence of a history of migraine in 730 EPGP participants aged ≥ 12 years with nonacquired focal epilepsy (NAFE) or generalized epilepsy (GE) from 501 families containing two or more individuals with epilepsy of unknown cause. Information on migraine without aura (MO) and migraine with aura (MA) was collected using an instrument validated for individuals ≥ 12 years. Because many individuals have both MO and MA, we considered two nonoverlapping groups of individuals with migraine: those who met criteria for MA in any of their headaches (MA), and those who did not ("MO-only"). EPGP participants were interviewed about the history of seizure disorders in additional nonenrolled family members. We evaluated associations of migraine prevalence in enrolled subjects with a family history of seizure disorders in additional nonenrolled relatives, using generalized estimating equations to control for the nonindependence of observations within families. KEY FINDINGS Prevalence of a history of MA (but not MO-only) was significantly increased in enrolled participants with two or more additional affected first-degree relatives. SIGNIFICANCE These findings support the hypothesis of a shared genetic susceptibility to epilepsy and MA.
Collapse
Affiliation(s)
- Melodie R Winawer
- GH Sergievsky Center, Columbia University, New York, New York 10032, USA.
| | | | | |
Collapse
|
33
|
Brand JG, Mindt MR, Schaffer SG, Alper KR, Devinsky O, Barr WB. Emotion processing bias and age of seizure onset among epilepsy patients with depressive symptoms. Epilepsy Behav 2012; 25:552-7. [PMID: 23153721 DOI: 10.1016/j.yebeh.2012.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 09/15/2012] [Accepted: 09/17/2012] [Indexed: 11/18/2022]
Abstract
The current study examined whether mood-congruent biases in emotion processing extend to epilepsy patients with depressive symptoms and the potentially moderating effects of age of seizure onset on these biases. In addition, we examined associations between depression (Beck Depression Inventory - 2nd Edition; BDI-II) and quality of life (Quality of Life in Epilepsy - 10-item questionnaire; QOLIE-10). Data from 101 epilepsy patients were analyzed, including 61 females and 40 males. Measures included the Comprehensive Affect Testing System - Abbreviated (CATS-A), from which indices of mood-congruent bias were derived. A significant interaction between BDI-II raw scores and age of seizure onset was found for mood-congruent bias scores in the facial affect modality (β=-0.24, p<.03). Beck Depression Inventory - 2nd Edition raw scores were significantly and positively correlated with quality of life (QOLIE-10; r=.69, p<.01). Results of the current study show that epilepsy patients with an early age of seizure onset may be most at risk for mood-congruent biases when experiencing depressive symptoms and that such symptoms have real-world implications for quality of life for persons living with epilepsy.
Collapse
Affiliation(s)
- Jesse G Brand
- University of Virginia Health System, Charlottesville, VA, USA.
| | | | | | | | | | | |
Collapse
|
34
|
Metternich B, Wagner K, Buschmann F, Anger R, Schulze-Bonhage A. Validation of a German version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Epilepsy Behav 2012; 25:485-8. [PMID: 23153711 DOI: 10.1016/j.yebeh.2012.10.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/16/2012] [Accepted: 10/11/2012] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Goal of the present study was the validation of a German version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). METHODS 197 adult epilepsy patients completed the NDDI-E (185 completed both the NDDI-E and BDI). 95 patients received psychiatric consults. RESULTS 33 patients received a diagnosis of major depression according to ICD-10 criteria. Internal consistency of the NDDI-E was .83. Receiver operating characteristics (ROC) showed an area under the curve of 0.92. Applying a cutoff score of ≥14 resulted in both sensitivity and specificity of 0.85. In the subsample with psychiatric consult, at the same optimal cutoff, sensitivity was 0.92, and specificity was 0.86. Further analyses showed a high concurrent validity with the BDI. DISCUSSION The German version of the NDDI-E constitutes a brief and reliable depression screening instrument for epilepsy patients.
Collapse
|
35
|
Metternich B, Wagner K, Buschmann F, Anger R, Schulze-Bonhage A. Depressionsscreening bei Epilepsiepatienten. ZEITSCHRIFT FUR EPILEPTOLOGIE 2012. [DOI: 10.1007/s10309-012-0269-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
36
|
Cognitive dysfunction in people with convulsive seizures in rural China. Epilepsy Behav 2012; 24:435-8. [PMID: 22683286 DOI: 10.1016/j.yebeh.2012.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 05/03/2012] [Accepted: 05/04/2012] [Indexed: 11/21/2022]
Abstract
One hundred and forty-four people with convulsive seizures (CS) and 144 healthy controls were evaluated for cognitive function, using a battery of neuropsychological tests. People with CS performed significantly worse than the controls on the Mini-Mental State Examination, Hamilton Depression Rating Scale, auditory verbal learning test, digit span test, verbal fluency test, and digit cancellation test. The percentage of patients who had abnormal scores on the Hamilton Depression Rating Scale was higher than that of controls (54.9% vs. 7.6%, p<0.001). Cognitive functional impairment was detected in 65.3% of the patients and 29.2% of the controls (p<0.001). People with CS presented with depressive mood and a wide range of cognitive deficits, particularly deficits in episodic declarative memory, attentional capacity, semantic memory, and mental speed. Years in education were positively associated with the cognitive performance of people with CS (OR=0.655, 95% CI: 0.486-0.882, p=0.005).
Collapse
|
37
|
Inostroza M, Cid E, Menendez de la Prida L, Sandi C. Different emotional disturbances in two experimental models of temporal lobe epilepsy in rats. PLoS One 2012; 7:e38959. [PMID: 22720001 PMCID: PMC3376131 DOI: 10.1371/journal.pone.0038959] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 05/16/2012] [Indexed: 11/24/2022] Open
Abstract
Affective symptoms such as anxiety and depression are frequently observed in patients with epilepsy. The mechanisms of comorbidity of epilepsy and affective disorders, however, remain unclear. Diverse models are traditionally used in epilepsy research, including the status epilepticus (SE) model in rats, which are aimed at generating chronic epileptic animals; however, the implications of different SE models and rat strains in emotional behaviors has not been reported. To address this issue, we examined the emotional sequelae of two SE models of temporal lobe epilepsy (TLE)--the lithium-pilocarpine (LIP) model and the kainic acid (KA) model--in two different rat strains (Wistar and Sprague-Dawley), which differ significantly in the pattern and extent of TLE-associated brain lesions. We found differences between LIP- and KA-treated animals in tests for depression-like and anxiety-like behaviors, as well as differences in plasma corticosterone levels. Whereas only LIP-treated rats displayed increased motivation to consume saccharin, both SE models led to reduced motivation for social contact, with LIP-treated animals being particularly affected. Evaluation of behavior in the open field test indicated very low levels of anxiety in LIP-treated rats and a mild decrease in KA-treated rats compared to controls. After exposure to a battery of behavioral tests, plasma corticosterone levels were increased only in LIP-treated animals. This hyperactivity in the hypothalamus-pituitary-adrenocortical (HPA) axis was highly correlated with performance in the open field test and the social interaction test, suggesting that comorbidity of epilepsy and emotional behaviors might also be related to other factors such as HPA axis function. Our results indicate that altered emotional behaviors are not inherent to the epileptic condition in experimental TLE; instead, they likely reflect alterations in anxiety levels related to model-dependent dysregulation of the HPA axis.
Collapse
Affiliation(s)
- Marion Inostroza
- Instituto Cajal, Spanish National Research Council (CSIC), Madrid, Spain
- Departamento de Psicología, Universidad de Chile, Santiago, Chile
| | - Elena Cid
- Instituto Cajal, Spanish National Research Council (CSIC), Madrid, Spain
| | | | - Carmen Sandi
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Federal de Lausanne (EPFL), Lausanne, Switzerland
| |
Collapse
|
38
|
|
39
|
Schwartzkroin PA. Cellular bases of focal and generalized epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2012; 107:13-33. [PMID: 22938962 DOI: 10.1016/b978-0-444-52898-8.00002-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
40
|
Kalra G. Teaching diagnostic approach to a patient through cinema. Epilepsy Behav 2011; 22:571-3. [PMID: 21871839 DOI: 10.1016/j.yebeh.2011.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 06/16/2011] [Accepted: 07/17/2011] [Indexed: 11/27/2022]
Abstract
Films are produced with the aim of entertaining people, but recently there has been increasing use of films to educate medical trainees about various disorders, symptoms of these disorders, patient-therapist interactions, and various other medical and psychiatric issues. Discussions in academic circles have moved from criticism of negative portrayals of mental illness in earlier films to their use in teaching sessions. Films can be used either in full length or clip format to conduct training modules. Use of the film Stigmata to train residents about diagnostic dilemmas and taking a diagnostic approach to patients is discussed.
Collapse
Affiliation(s)
- Gurvinder Kalra
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Sion General Hospital, Mumbai, India.
| |
Collapse
|
41
|
Chang YT, Chen PC, Tsai IJ, Sung FC, Chin ZN, Kuo HT, Tsai CH, Chou IC. Bidirectional relation between schizophrenia and epilepsy: a population-based retrospective cohort study. Epilepsia 2011; 52:2036-42. [PMID: 21929680 DOI: 10.1111/j.1528-1167.2011.03268.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE Schizophrenia and epilepsy may share a mutual susceptibility. This study examined the bidirectional relation between the two disorders. METHODS We used claims data obtained from the Taiwan National Health Insurance database to conduct retrospective cohort analyses. Analysis 1 compared 5,195 patients with incident schizophrenia diagnosed in 1999-2008 with 20,776 controls without the disease randomly selected during the same period, frequency matched with sex and age. Analysis 2 comprised a similar method to compare 11,527 patients with newly diagnosed epilepsy with 46,032 randomly selected sex- and age-matched controls. At the end of 2008, analysis 1 measured the incidence and risk of developing epilepsy and analysis 2 measured the incidence and risk of developing schizophrenia. KEY FINDINGS In analysis 1, the incidence of epilepsy was higher in the schizophrenia cohort than in the nonschizophrenia cohort (6.99 vs. 1.19 per 1,000 person-years) with an adjusted hazard ratio (aHR) of 5.88 [95% confidence interval (CI) 4.71-7.36] for schizophrenia patients. In analysis 2, the incidence of schizophrenia was higher in the epilepsy cohort than in the nonepilepsy comparison cohort (3.53 vs. 0.46 per 1,000 person-years) with an aHR of 7.65 (95% CI 6.04-9.69) for epilepsy patients. The effect of schizophrenia on subsequent epilepsy was greater for women, but the association between epilepsy and elevated incidence of schizophrenia was more pronounced in men. SIGNIFICANCE We found a strong bidirectional relation between schizophrenia and epilepsy. These two conditions may share common causes. Further studies on the mechanism are required.
Collapse
Affiliation(s)
- Yu-Tzu Chang
- Division of Pediatric Neurology, Department of Pediatrics, China Medical University and Hospital, Taichung, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Koshy S. Role of pharmacists in the management of patients with epilepsy. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011; 20:65-8. [PMID: 22236182 DOI: 10.1111/j.2042-7174.2011.00156.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The aim of this article is to highlight the roles that pharmacists currently have in the management of patients with epilepsy and the opportunities and challenges associated with these roles. KEY FINDINGS There are many opportunities for pharmacists in the management of patients with epilepsy owing to the accessibility and extensive knowledge of drug therapy. The role of pharmacists extends beyond dispensing medications. The pharmacists have a significant role in the education of patients about the disease and therapy, encouraging adherence and explaining side effects and providing information on potential drug-drug interactions, resulting in improved clinical outcomes and decreased costs. Physicians prefer pharmacists as information sources for medication profile and drug interaction screening for patients with epilepsy. However, there are certain challenges which the pharmacists should overcome if effective medication therapy management services are to be provided on a routine basis. Educational interventions are required to improve the knowledge and skills of pharmacists. The gap between patients' and pharmacists' views of the pharmacist's role has to be narrowed to ensure enhanced role of the pharmacists in this patient group. CONCLUSIONS There are a lot of opportunities and challenges for pharmacists to provide medication therapy management services for patients with epilepsy. Evidence in the literature provides justification for such services. However more research is required to provide foundation for routine provision of such services in all healthcare facilities.
Collapse
Affiliation(s)
- Samuel Koshy
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait.
| |
Collapse
|
43
|
Mula M, Schmitz B. Depression in epilepsy: mechanisms and therapeutic approach. Ther Adv Neurol Disord 2011; 2:337-44. [PMID: 21180624 DOI: 10.1177/1756285609337340] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In patients with epilepsy, mood disorders represent a frequent psychiatric comorbidity but they often remain unrecognized and untreated. However, comorbid depression may have a major impact on the quality of life of patients with epilepsy, sometimes even more than the seizures. Among the potential neurobiological and psychosocial determinants, epilepsy-related variables (age at onset of seizures, temporal lobe epilepsy and frequency of seizures) and the antiepileptic drug treatment have been associated with depression. Nonetheless, data on treatment strategies are still limited with a lack of controlled trials on the use of antidepressant drugs. Moreover, the issue of psychotropic drug treatment of depression in epilepsy is interlinked with that of worsening seizures. This paper is aimed at discussing all these subjects in the light of current literature on the neurobiology of depression in epilepsy.
Collapse
Affiliation(s)
- Marco Mula
- Department of Neurology, Amedeo Avogadro University, Novara, Italy
| | | |
Collapse
|
44
|
Shihab N, Bowen J, Volk HA. Behavioral changes in dogs associated with the development of idiopathic epilepsy. Epilepsy Behav 2011; 21:160-7. [PMID: 21531631 DOI: 10.1016/j.yebeh.2011.03.018] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 03/04/2011] [Accepted: 03/14/2011] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of the study was to demonstrate behavioral changes with the development of epilepsy in dogs, a species proposed as a naturally occurring animal model for human epilepsy. METHODS Owners of dogs diagnosed with idiopathic epilepsy (n=80) completed a modified, previously-validated behavioral and seizure questionnaire. Principal axis factor analysis identified behavioral factors, the scores for which were compared before and after the development of epilepsy. RESULTS Drug-naïve dogs showed an increase in the behavior factors Fear/Anxiety, Defensive Aggression, and Abnormal Perception. In dogs receiving antiepileptic medication, there were still increases in Fear/Anxiety and Abnormal Perception, but no longer in Defensive Aggression. Additional increases were observed in Abnormal Reactivity, Attachment Disorder, Demented Behavior, and Apathetic Behavior. Pharmacoresistant dogs had larger increases in Controlling Aggression, Abnormal Perception, and Demented Behavior than drug responders. CONCLUSION Our data suggest that dogs, like humans and rodents, exhibit neurobehavioral comorbidities with the development of epilepsy.
Collapse
Affiliation(s)
- Nadia Shihab
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hertfordshire, UK.
| | | | | |
Collapse
|
45
|
Elliott JO, Charyton C, Sprangers P, Lu B, Moore JL. The impact of marriage and social support on persons with active epilepsy. Epilepsy Behav 2011; 20:533-8. [PMID: 21333606 DOI: 10.1016/j.yebeh.2011.01.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 01/07/2011] [Accepted: 01/12/2011] [Indexed: 11/29/2022]
Abstract
Persons with epilepsy (PWE) are more likely to report never being married than those without epilepsy. Social support, especially from marriage, may buffer the negative impact of stressful events and chronic health conditions. In 2005, sixteen U.S. states asked about epilepsy and social support in the Behavioral Risk Factor Surveillance System. A set of survey weight-adjusted logistic regression analyses were conducted to examine the impact of marriage and social support on self-rated health status and life satisfaction in persons with active epilepsy. PWE who were married with poor social support were less likely to report excellent/very good self-rated health status (OR=0.34) and better life satisfaction (OR=0.20), compared with those who were married with good support (reference group) after controlling for demographics and comorbid conditions. Once poor mental health status was controlled for, these differences were no longer significant. In contrast, persons with active epilepsy who were not married with poor support were significantly less likely to report better life satisfaction (OR=0.22) after controlling for demographics, comorbid conditions, and poor mental health status. Epilepsy practitioners need to address poor mental health through appropriate treatment and/or referral. Practitioners should also encourage PWE to improve their social support contacts.
Collapse
Affiliation(s)
- John O Elliott
- Department of Medical Education, OhioHealth Riverside Methodist Hospital, Columbus, OH 43214, USA.
| | | | | | | | | |
Collapse
|
46
|
de Oliveira GNM, Kummer A, Salgado JV, Portela EJ, Sousa-Pereira SR, David AS, Kanner AM, Teixeira AL. Brazilian version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Epilepsy Behav 2010; 19:328-31. [PMID: 20729151 DOI: 10.1016/j.yebeh.2010.07.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 07/14/2010] [Accepted: 07/17/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this research was to evaluate the Brazilian-Portuguese version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and to assess its psychometric properties. METHODS This study involved 98 outpatients who underwent psychopathological evaluation with the Mini International Neuropsychiatric Interview-Plus Version, Hamilton Depression Scale (HAM-D), and a Portuguese version of the NDDI-E. RESULTS The NDDI-E was easily understood and quickly administered to most of the patients. At a cutoff score >15, NDDI-E had a sensitivity of 81.5%, a specificity of 83.1%, and a negative predictive value of 92.2% for diagnosis of major depression. Internal consistency reliability of the NDDI-E was 0.79, and there was also a positive correlation between the NDDI-E and the HAM-D (P<0.001). CONCLUSION The Brazilian-Portuguese version of NDDI-E can be used as a practical screening tool to improve recognition of depression in Brazilian people with epilepsy.
Collapse
|
47
|
de Oliveira GNM, Kummer A, Salgado JV, Portela EJ, Sousa-Pereira SR, David AS, Teixeira AL. Psychiatric disorders in temporal lobe epilepsy: an overview from a tertiary service in Brazil. Seizure 2010; 19:479-84. [PMID: 20708951 DOI: 10.1016/j.seizure.2010.07.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 06/30/2010] [Accepted: 07/09/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate the frequency and intensity of psychiatric disorders in a group of temporal lobe epilepsy (TLE) patients from a tertiary-care center. METHODS Clinical and sociodemographic data of 73 patients were collected and a neuropsychiatric evaluation was performed with the following instruments: Mini-Mental State Examination (MMSE), structured clinical interview (MINI-PLUS), Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D), Brief Psychiatric Rating Scale (BPRS). RESULTS Patients with TLE showed a high frequency of lifetime psychiatric disorders (70%), the most frequent being mood disorders (49.3%). At assessment, 27.4% of the patients were depressed and 9.6% met criteria for bipolar disorder. Nevertheless, depression had not been properly diagnosed nor treated. Anxiety disorders were also frequent (42.5%), mainly generalized anxiety disorder (GAD) (21.9%). Obsessive compulsive disorder (OCD) was present in 11.0% and psychotic disorders in 5.5% of the sample. Patients with left mesial temporal sclerosis (LMTS) exhibited more psychopathologic features, mainly anxiety disorders (p=0.006), and scored higher on HAM-A and HAM-D (p<0.05 in both). CONCLUSION TLE is related to a high frequency of psychiatric disorders, such as anxiety and depression, which are usually underdiagnosed and undertreated. Damage to the left mesial temporal lobe, seen in LMTS, seems to be an important pathogenic lesion linked to a broad range of psychopathological features in TLE, mainly anxiety disorders. The present study prompts discussion on the recognition of the common psychiatric disorders in TLE, especially on the Brazilian setting.
Collapse
|
48
|
When a doctor becomes a patient with a mystery illness: a case report. Case Rep Med 2010; 2010:565980. [PMID: 20671956 PMCID: PMC2910477 DOI: 10.1155/2010/565980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 06/16/2010] [Accepted: 06/17/2010] [Indexed: 11/17/2022] Open
Abstract
Symptoms presenting as mental disorders may represent epileptic discharges, especially from the temporal lobe. Both mental and somatic symptoms are common in temporal lobe epilepsy, which may confuse doctors, leading to extensive medical examinations and tests, false diagnoses, and ineffective treatment. Also, the episodic nature and variety of symptoms between as well as in individual cases hinder correct diagnosis. Since epileptic discharges may be visible on EEG only during an epileptic fit—and may need highly specialized equipment to detect—many cases are undiagnosed or treated under false diagnoses. The author believes that undetected temporal lobe epilepsy falsely labelled as psychiatric disorders are common. Specific and effective treatment exists for temporal lobe epilepsy, making correct diagnosis important. This history—based on the author's personal experience—also illustrates aspects of the physician-patients' problems and resources, as well as the gap between somatic and psychiatric medicine concerning this rather common neuropsychiatric disorder.
Collapse
|
49
|
Taylor J, Kolamunnage-Dona R, Marson AG, Smith PEM, Aldenkamp AP, Baker GA. Patients with epilepsy: Cognitively compromised before the start of antiepileptic drug treatment? Epilepsia 2010; 51:48-56. [DOI: 10.1111/j.1528-1167.2009.02195.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
50
|
Metternich B, Wagner K, Brandt A, Kraemer R, Buschmann F, Zentner J, Schulze-Bonhage A. Preoperative depressive symptoms predict postoperative seizure outcome in temporal and frontal lobe epilepsy. Epilepsy Behav 2009; 16:622-8. [PMID: 19879810 DOI: 10.1016/j.yebeh.2009.09.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 09/17/2009] [Accepted: 09/21/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Recent research has pointed to the possibility of a bidirectional relationship between seizure frequency in epilepsy and depressive symptoms. The study described here investigated the relationship between preoperative depressive symptomatology and postoperative seizure outcome in a sample of patients with temporal (TLE) and frontal (FLE) lobe epilepsy. METHODS A retrospective analysis was conducted on the data from 115 eligible patients with TLE (N=97) and FLE (N=18) and resections limited to one cortical lobe who were evaluated preoperatively and 1year after epilepsy surgery with respect to depressive symptoms (Beck Depression Inventory, BDI) and seizure outcome. The latter was assessed in terms of actual total seizure frequency as well as a dichotomous variable (seizure free vs. not seizure free) for the 1-year outcome. Repeated-measures analyses of variance and regression analyses were applied. RESULTS Seizure-free patients had significantly lower BDI scores preoperatively as well as postoperatively than patients who were not seizure free. In the regression analyses, the preoperative BDI score was a significant predictor of postoperative seizure frequency as well as seizure freedom. When only patients with TLE were analyzed, the results for the association between preoperative BDI and postoperative seizure frequency and seizure freedom remained consistent. CONCLUSION The present results provide evidence for a statistical bidirectionality of the relationship between depressive symptoms and postoperative seizure status in a mixed sample of patients with TLE and FLE. Possible reasons for this bidirectional association include an underlying common pathology in both depression and epilepsy, for example, structural changes or functional alterations in neurotransmitter systems.
Collapse
Affiliation(s)
- Birgitta Metternich
- Section for Epileptology, Department of Neurosurgery, University Hospital Freiburg im Breisgau, 79106 Freiburg, Germany.
| | | | | | | | | | | | | |
Collapse
|