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Sone D, Beheshti I, Shigemoto Y, Kimura Y, Sato N, Matsuda H. White matter brain-age in diverse forms of epilepsy and interictal psychosis. Sci Rep 2024; 14:19156. [PMID: 39160281 PMCID: PMC11333615 DOI: 10.1038/s41598-024-70313-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 08/14/2024] [Indexed: 08/21/2024] Open
Abstract
Abnormal brain aging is suggested in epilepsy. Given the brain network dysfunction in epilepsy, the white matter tracts, which primarily interconnect brain regions, could be of special importance. We focused on white matter brain aging in diverse forms of epilepsy and comorbid psychosis. We obtained brain diffusion tensor imaging (DTI) data at 3 T-MRI in 257 patients with epilepsy and 429 healthy subjects. The tract-based fractional anisotropy values of the healthy subjects were used to build a brain-age prediction model, and we calculated the brain-predicted age difference (brain-PAD: predicted age-chronological age) of all subjects. As a result, almost all epilepsy categories showed significantly increased brain-PAD (p < 0.001), including temporal lobe epilepsy (TLE) with no MRI-lesion (+ 4.2 yr), TLE with hippocampal sclerosis (+ 9.1 yr), extratemporal focal epilepsy (+ 5.1 yr), epileptic encephalopathy or progressive myoclonus epilepsy (+ 18.4 yr), except for idiopathic generalized epilepsy (IGE). Patients with psychogenic non-epileptic seizures also presented increased brain-PAD. In TLE, interictal psychosis significantly raised brain-PAD by 8.7 years. In conclusion, we observed increased brain aging in most types of epilepsy, which was generally consistent with brain morphological aging results in previous studies. Psychosis may accelerate brain aging in TLE. These findings may suggest abnormal aging mechanisms in epilepsy and comorbid psychotic symptoms.
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Affiliation(s)
- Daichi Sone
- Department of Radiology, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan.
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan.
| | - Iman Beheshti
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Yoko Shigemoto
- Department of Radiology, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Yukio Kimura
- Department of Radiology, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Noriko Sato
- Department of Radiology, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Hiroshi Matsuda
- Department of Radiology, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
- Drug Discovery and Cyclotron Research Center, Southern Tohoku Research Institute for Neuroscience, Fukushima, Japan
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2
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de Toffol B. Epilepsy and psychosis. Rev Neurol (Paris) 2024; 180:298-307. [PMID: 38336524 DOI: 10.1016/j.neurol.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 02/12/2024]
Abstract
Psychotic disorders are eight times more frequent in epilepsy than in the general population. The various clinical syndromes are classified according to their chronology of onset in relation to epileptic seizures: ictal psychoses (during epileptic discharge), post-ictal psychoses (PIP, after a seizure), interictal psychoses (IIP, with no chronological link) and those related to complete seizure control. Antiepileptic drugs can cause psychotic disorders in all these situations. Post-ictal psychoses (PIP) are affective psychoses that occur after a lucid interval lasting 12 to 120hours following a cluster of seizures. They last an average of 10days, with an abrupt beginning and end. PIP are directly linked to epileptic seizures, and disappear when the epilepsy is controlled. Interictal psychoses are schizophrenias. The management of psychotic disorders in epilepsy is neuropsychiatric, and requires close collaboration between epileptologists and psychiatrists. Antipsychotics can be prescribed in persons with epilepsy. Even today, psychotic disorders in epilepsy are poorly understood, under-diagnosed and under-treated.
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Affiliation(s)
- B de Toffol
- Université des Antilles, Neurology Department, Centre Hospitalier de Cayenne, CIC Inserm 1424, rue des Flamboyants, 97300 Cayenne, French Guiana.
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3
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Allebone J, Kanaan RA, Rayner G, Maller J, O'Brien TJ, Mullen SA, Cook M, Adams SJ, Vogrin S, Vaughan DN, Kwan P, Berkovic SF, D'Souza WJ, Jackson G, Velakoulis D, Wilson SJ. Neuropsychological function in psychosis of epilepsy. Epilepsy Res 2023; 196:107222. [PMID: 37717505 DOI: 10.1016/j.eplepsyres.2023.107222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE The neuropsychological profile of patients with psychosis of epilepsy (POE) has received limited research attention. Recent neuroimaging work in POE has identified structural network pathology in the default mode network and the cognitive control network. This study examined the neuropsychological profile of POE focusing on cognitive domains subserved by these networks. METHODS Twelve consecutive patients with a diagnosis of POE were prospectively recruited from the Comprehensive Epilepsy Programmes at The Royal Melbourne, Austin and St Vincent's Hospitals, Melbourne, Australia between January 2015 and February 2017. They were compared to 12 matched patients with epilepsy but no psychosis and 42 healthy controls on standardised neuropsychological tests of memory and executive functioning in a case-control design. RESULTS Mean scores across all cognitive tasks showed a graded pattern of impairment, with the POE group showing the poorest performance, followed by the epilepsy without psychosis and the healthy control groups. This was associated with significant group-level differences on measures of working memory (p = < 0.01); immediate (p = < 0.01) and delayed verbal recall (p = < 0.01); visual memory (p < 0.001); and verbal fluency (p = 0.02). In particular, patients with POE performed significantly worse than the healthy control group on measures of both cognitive control (p = .005) and memory (p < .001), whereas the epilepsy without psychosis group showed only memory difficulties (delayed verbal recall) compared to healthy controls (p = .001). CONCLUSION People with POE show reduced performance in neuropsychological functions supported by the default mode and cognitive control networks, when compared to both healthy participants and people with epilepsy without psychosis.
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Affiliation(s)
- James Allebone
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Richard A Kanaan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Department of Psychiatry, University of Melbourne, Austin Health, Melbourne, Australia.
| | - Genevieve Rayner
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Jerome Maller
- ANU College of Health and Medicine, Australian National University, Canberra, Victoria, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Terence J O'Brien
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Alfred Hospital, Monash University, Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Saul A Mullen
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Mark Cook
- Graeme Clark Institute, University of Melbourne, Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Sophia J Adams
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Simon Vogrin
- St Vincent's Hospital, Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - David N Vaughan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Patrick Kwan
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Alfred Hospital, Monash University, Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Samuel F Berkovic
- Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Graeme Jackson
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne, Health, Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
| | - Sarah J Wilson
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia
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Mula M. Impact of psychiatric comorbidities on the treatment of epilepsies in adults. Expert Rev Neurother 2023; 23:895-904. [PMID: 37671683 DOI: 10.1080/14737175.2023.2250558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Epilepsy is often accompanied by psychiatric comorbidities and the management of epilepsy in these patients presents unique challenges due to the interplay between the underlying neurological condition and the psychiatric symptoms and the combined use of multiple medications. AREAS COVERED This paper aims to explore the complexities associated with managing epilepsy in the presence of psychiatric comorbidities, focusing on the impact of psychiatric disorders on epilepsy treatment strategies and the challenges posed by the simultaneous administration of multiple medications. EXPERT OPINION Patients with epilepsy and psychiatric comorbidities seem to present with a more severe form of epilepsy that is resistant to drug treatments and burdened by an increased morbidity and mortality. Whether prompt treatment of psychiatric disorders can influence the long-term prognosis of the epilepsy is still unclear as well as the role of specific treatment strategies, such as neuromodulation, in this group of patients. Clinical practice recommendations and guidelines will prompt the development of new models of integrated care to be implemented.
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Affiliation(s)
- Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St George's University Hospital, London, UK of Great Britain and Northern Ireland
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
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Sone D. Neurobiological mechanisms of psychosis in epilepsy: Findings from neuroimaging studies. Front Psychiatry 2022; 13:1079295. [PMID: 36506456 PMCID: PMC9728542 DOI: 10.3389/fpsyt.2022.1079295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Abstract
Despite the high prevalence and clinical importance of comorbid psychosis in epilepsy, its neurobiological mechanisms remain understudied. This narrative mini-review aims to provide an overview of recent updates in in vivo neuroimaging studies on psychosis in epilepsy, including structural and diffusion magnetic resonance imaging (MRI) and functional and molecular imaging, and to discuss future directions in this field. While the conventional morphological analysis of structural MRI has provided relatively inconsistent results, advanced methods, including brain network analysis, hippocampal subregion volumetry, and machine learning models, have recently provided novel findings. Diffusion MRI, for example, has revealed a reduction in white matter integrity mainly in the frontal and temporal lobes, as well as a disruption of brain white matter networks. Functional neuroimaging, such as perfusion single-photon emission computed tomography (SPECT) or fluorodeoxyglucose positron emission tomography (FDG-PET), often identifies hyperactivity in various brain regions. The current limitations of these more recent studies may include small and sometimes heterogeneous samples, insufficient control groups, the effects of psychoactive drugs, and the lack of longitudinal analysis. Further investigations are required to establish novel treatments and identify clinical diagnostic or disease-monitoring biomarkers in psychosis in epilepsy.
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Affiliation(s)
- Daichi Sone
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
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6
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Allebone J, Wilson SJ, Bradlow RCJ, Maller J, O'Brien T, Mullen SA, Cook M, Adams SJ, Vogrin S, Vaughan DN, Connelly A, Kwan P, Berkovic SF, D'Souza WJ, Jackson G, Velakoulis D, Kanaan RA. Increased cortical thickness in nodes of the cognitive control and default mode networks in psychosis of epilepsy. Seizure 2022; 101:244-252. [PMID: 36116283 DOI: 10.1016/j.seizure.2022.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/07/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To explore the cortical morphological associations of the psychoses of epilepsy. METHODS Psychosis of epilepsy (POE) has two main subtypes - postictal psychosis and interictal psychosis. We used automated surface-based analysis of magnetic resonance images to compare cortical thickness, area, and volume across the whole brain between: (i) all patients with POE (n = 23) relative to epilepsy-without psychosis controls (EC; n = 23), (ii) patients with interictal psychosis (n = 10) or postictal psychosis (n = 13) relative to EC, and (iii) patients with postictal psychosis (n = 13) relative to patients with interictal psychosis (n = 10). RESULTS POE is characterised by cortical thickening relative to EC, occurring primarily in nodes of the cognitive control network; (rostral anterior cingulate, caudal anterior cingulate, middle frontal gyrus), and the default mode network (posterior cingulate, medial paracentral gyrus, and precuneus). Patients with interictal psychosis displayed cortical thickening in the left hemisphere in occipital and temporal regions relative to EC (lateral occipital cortex, lingual, fusiform, and inferior temporal gyri), which was evident to a lesser extent in postictal psychosis patients. There were no significant differences in cortical thickness, area, or volume between the postictal psychosis and EC groups, or between the postictal psychosis and interictal psychosis groups. However, prior to correction for multiple comparisons, both the interictal psychosis and postictal psychosis groups displayed cortical thickening relative to EC in highly similar regions to those identified in the POE group overall. SIGNIFICANCE The results show cortical thickening in POE overall, primarily in nodes of the cognitive control and default mode networks, compared to patients with epilepsy without psychosis. Additional thickening in temporal and occipital neocortex implicated in the dorsal and ventral visual pathways may differentiate interictal psychosis from postictal psychosis. A novel mechanism for cortical thickening in POE is proposed whereby normal synaptic pruning processes are interrupted by seizure onset.
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Affiliation(s)
- James Allebone
- Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Sarah J Wilson
- Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia
| | | | - Jerome Maller
- ANU College of Health and Medicine, Australian National University, Canberra, Victoria, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Melbourne, Australia
| | - Terry O'Brien
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Alfred Hospital, Monash University, Melbourne, Australia
| | - Saul A Mullen
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Mark Cook
- Graeme Clark Institute, University of Melbourne, Melbourne, Australia
| | - Sophia J Adams
- Department of Psychiatry, Austin Health, University of Melbourne, Melbourne, Australia
| | - Simon Vogrin
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - David N Vaughan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia
| | - Alan Connelly
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia
| | - Patrick Kwan
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Alfred Hospital, Monash University, Melbourne, Australia
| | - Samuel F Berkovic
- Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Australia
| | - Graeme Jackson
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Richard A Kanaan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Department of Psychiatry, Austin Health, University of Melbourne, Melbourne, Australia.
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7
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Sone D, Sato N, Shigemoto Y, Kimura Y, Matsuda H. Upper cerebellar glucose hypermetabolism in patients with temporal lobe epilepsy and interictal psychosis. Epilepsia Open 2022; 7:657-664. [PMID: 35977826 PMCID: PMC9712471 DOI: 10.1002/epi4.12645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/12/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Psychosis is an important comorbidity in epilepsy, but its pathophysiology is still unknown. The imaging modality 18 F-fluorodeoxyglucose-positron emission tomography (18 F-FDG PET) is widely used to measure brain glucose metabolism, and we speculated that 18 F-FDG PET may detect characteristic alteration patterns in individuals with temporal lobe epilepsy (TLE) and psychosis. METHODS We enrolled 13 patients with TLE and interictal psychosis (TLE-P) and 21 patients with TLE without psychosis (TLE-N). All underwent interictal 18 F-FDG-PET scanning. Statistical Parametric Mapping (SPM)12 software was used for the normalization process, and we performed a voxel-wise comparison of the TLE-P and TLE-N groups. RESULTS Cerebral hypometabolic areas were observed in the ipsilateral temporal pole to hippocampus in both patient groups. In the TLE-P group, the voxel-wise comparison revealed significantly increased 18 F-FDG signals in the upper cerebellum, superior cerebellar peduncle, and midbrain. There were no significant between-group metabolic differences around the focus or other cerebral areas. SIGNIFICANCE Our results demonstrated significant hypermetabolism around the upper cerebellum in patients with TLE and interictal psychosis compared to patients with TLE without psychosis. These findings may reflect the involvement of the cerebellum in the underlying neurobiology of interictal psychosis and could contribute to a better understanding of this disorder.
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Affiliation(s)
- Daichi Sone
- Department of RadiologyNational Center of Neurology and PsychiatryTokyoJapan,Department of PsychiatryJikei University School of MedicineTokyoJapan
| | - Noriko Sato
- Department of RadiologyNational Center of Neurology and PsychiatryTokyoJapan
| | - Yoko Shigemoto
- Department of RadiologyNational Center of Neurology and PsychiatryTokyoJapan,Drug Discovery and Cyclotron Research CenterSouthern Tohoku Research Institute for NeuroscienceFukushimaJapan
| | - Yukio Kimura
- Department of RadiologyNational Center of Neurology and PsychiatryTokyoJapan
| | - Hiroshi Matsuda
- Department of RadiologyNational Center of Neurology and PsychiatryTokyoJapan,Drug Discovery and Cyclotron Research CenterSouthern Tohoku Research Institute for NeuroscienceFukushimaJapan
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Mula M, Coleman H, Wilson SJ. Neuropsychiatric and Cognitive Comorbidities in Epilepsy. Continuum (Minneap Minn) 2022; 28:457-482. [PMID: 35393966 DOI: 10.1212/con.0000000000001123] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article discusses psychiatric and cognitive comorbidities of epilepsy over the lifespan and illustrates opportunities to improve the quality of care of children and adults with epilepsy. RECENT FINDINGS One in 3 people with epilepsy have a lifetime history of psychiatric disorders, and they represent an important prognostic marker of epilepsy. Contributors are diverse and display a complex relationship. Cognitive comorbidities are also common among those living with epilepsy and are increasingly recognized as a reflection of changes to underlying brain networks. Among the cognitive comorbidities, intellectual disability and dementia are common and can complicate the diagnostic process when cognitive and/or behavioral features resemble seizures. SUMMARY Comorbidities require consideration from the first point of contact with a patient because they can determine the presentation of symptoms, responsiveness to treatment, and the patient's day-to-day functioning and quality of life. In epilepsy, psychiatric and cognitive comorbidities may prove a greater source of disability for the patient and family than the seizures themselves, and in the case of essential comorbidities, they are regarded as core to the disorder in terms of etiology, diagnosis, and treatment.
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Conde-Blanco E, Reyes-Leiva D, Pintor L, Donaire A, Manzanares I, Rumia J, Roldan P, Boget T, Bargalló N, Gil-López FJ, Khawaja M, Setoain X, Centeno M, Carreño M. Psychotic symptoms in drug resistant epilepsy patients after cortical stimulation. Epilepsy Res 2021; 173:106630. [PMID: 33865048 DOI: 10.1016/j.eplepsyres.2021.106630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/21/2021] [Accepted: 03/31/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE The use of invasive EEG (iEEG) recordings before epilepsy surgery has increased as more complex focal epilepsies are evaluated. Psychotic symptoms (PS) during iEEG have been scarcely reviewed. We aim to report our series of patients with psychotic symptoms (PS) brought about by cortical stimulation (CS) and to identify triggers. METHODS Retrospective cohort of patients who underwent iEEG and CS. We report patients who developed delusional thinking and/or disorganized behaviour within 24 h after CS. Exclusion criteria were primary psychiatric disorders or absence of CS. RESULTS We evaluated 32 (SEEG 23; subdural 9) patients with a median age of 38 years, 6 with PS. Patients underwent 2586 stimulations over 1130 contacts. Age at CS was significantly higher in patients with PS. Temporal lobe epilepsy was significantly more often documented in patients with PS (χ2: 3.94; p< 0.05). We found no correlation between stimulation of the limbic system and development of psychosis. Four (66.7 %) patients were stimulated in the non-dominant limbic system and developed psychosis compared to 7 (27 %) who did not [χ2: 3.41; p= 0.06].Epilepsy duration was significantly higher in PS patients (p=0.002). Patients with history of postictal psychosis were twice more likely to experience PS(p=0.04). CONCLUSIONS PS may arise more frequently in patients with PIP history, older age and longer epilepsy duration. The neurobiology and physiology of psychosis, that may share common mechanisms with epilepsy, is yet to be identified but we hypothesize that it may be triggered by CS due to alteration of brain networks dynamics.
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Affiliation(s)
- Estefanía Conde-Blanco
- Epilepsy Program, Neurology Department, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain.
| | - David Reyes-Leiva
- Department of Neurology, Hospital Sant Pau de Barcelona, Barcelona, Spain
| | - Luís Pintor
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Program, Psychiatry Department, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Antonio Donaire
- Epilepsy Program, Neurology Department, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Isabel Manzanares
- Epilepsy Program, Neurology Department, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Jordi Rumia
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Program, Neurosurgery Department, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Pedro Roldan
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Program, Neurosurgery Department, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Teresa Boget
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Program, Neuropsychology Department, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Núria Bargalló
- Epilepsy Program, Neuroradiology Department, Magnetic Resonance Imaging Core Facility, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | | | - Mariam Khawaja
- Epilepsy Program, Neurology Department, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Xavier Setoain
- University of Barcelona (UB), Barcelona, 08007, Spain; Epilepsy Program, Nuclear Medicine Department, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Diagnostic Imaging Centre, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - María Centeno
- Epilepsy Program, Neurology Department, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Mar Carreño
- Epilepsy Program, Neurology Department, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
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10
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Vagus nerve stimulation as a potential modulator of periictal psychotic episodes: A report of four cases. Epilepsy Behav Rep 2021; 15:100434. [PMID: 33665601 PMCID: PMC7905174 DOI: 10.1016/j.ebr.2021.100434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 11/23/2022] Open
Abstract
PPE are treatable and we report a case series of patients successfully treated with VNS. Both antiseizure and antipsychotic VNS effects are not immediate. Antipsychotic effect of VNS may be observed even in patients who do not become seizure free.
Drug resistant epilepsy (DRE) has been associated with a high incidence of psychotic disorders. Patients can develop psychosis after starting a new antiseizure medication, after undergoing resective surgery, or after implantation of a vagus nerve stimulation (VNS) system. The aim of this study was to investigate the modulation effect of VNS on psychotic episodes in DRE patients with a pre-existing history of periictal psychotic episodes (PPE). We retrospectively report the outcome of four patients from a single tertiary center with PPE prior to implantation. None of the implanted patients developed de novo PPE after VNS therapy. Regarding seizure outcome, all patients demonstrated a response to VNS with two who experienced who status epilepticus and three patients wtih a change in semiology with after VNS implantation. PPE disappeared in all the study patients, two of them at 6 months post-implantation and in the others after 2 and 3 years, respectively. 18F-FDG-PET results showed hypermetabolism in both anterior insular and medial frontal lobes which disappeared in the 18F -FDG-PET 4 years post-implantation. Based on the results of this series of cases we suggest that VNS therapy may be useful to modulatet PPE in patients with DRE, though effectiveness may be time-dependent.
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Neuroimaging-based brain-age prediction in diverse forms of epilepsy: a signature of psychosis and beyond. Mol Psychiatry 2021; 26:825-834. [PMID: 31160692 PMCID: PMC7910210 DOI: 10.1038/s41380-019-0446-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/17/2019] [Accepted: 05/03/2019] [Indexed: 12/17/2022]
Abstract
Epilepsy is a diverse brain disorder, and the pathophysiology of its various forms and comorbidities is largely unknown. A recent machine learning method enables us to estimate an individual's "brain-age" from MRI; this brain-age prediction is expected as a novel individual biomarker of neuropsychiatric disorders. The aims of this study were to estimate the brain-age for various categories of epilepsy and to evaluate clinical discrimination by brain-age for (1) the effect of psychosis on temporal lobe epilepsy (TLE), (2) psychogenic nonepileptic seizures (PNESs) from MRI-negative epilepsies, and (3) progressive myoclonic epilepsy (PME) from juvenile myoclonic epilepsy (JME). In total, 1196 T1-weighted MRI scans from healthy controls (HCs) were used to build a brain-age prediction model with support vector regression. Using the model, we calculated the brain-predicted age difference (brain-PAD: predicted age-chronological age) of the HCs and 318 patients with epilepsy. We compared the brain-PAD values based on the research questions. As a result, all categories of patients except for extra-temporal lobe focal epilepsy showed a significant increase in brain-PAD. TLE with hippocampal sclerosis presented a significantly higher brain-PAD than several other categories. The mean brain-PAD in TLE with inter-ictal psychosis was 10.9 years, which was significantly higher than TLE without psychosis (5.3 years). PNES showed a comparable mean brain-PAD (10.6 years) to that of epilepsy patients. PME had a higher brain-PAD than JME (22.0 vs. 9.3 years). In conclusion, neuroimaging-based brain-age prediction can provide novel insight into or clinical usefulness for the diverse symptoms of epilepsy.
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12
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Sone D, Sato N, Shigemoto Y, Kimura Y, Maikusa N, Ota M, Foong J, Koepp M, Matsuda H. Disrupted White Matter Integrity and Structural Brain Networks in Temporal Lobe Epilepsy With and Without Interictal Psychosis. Front Neurol 2020; 11:556569. [PMID: 33071943 PMCID: PMC7542674 DOI: 10.3389/fneur.2020.556569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/20/2020] [Indexed: 01/05/2023] Open
Abstract
Background: Despite the importance of psychosis as a comorbidity of temporal lobe epilepsy (TLE), the underlying neural mechanisms are still unclear. We aimed to investigate abnormalities specific to psychosis in TLE, using diffusion MRI parameters and graph-theoretical network analysis. Material and Methods: We recruited 49 patients with TLE (20 with and 29 without interictal schizophrenia-like psychosis) and 42 age-/gender-matched healthy controls. We performed 3-tesla MRI scans including 3D T1-weighted imaging and diffusion tensor imaging in all participants. Among the three groups, fractional anisotropy (FA), mean diffusivity (MD), and global network metrics were compared by analyses of covariance. Regional connectivity strength was compared by network-based statistics. Results: Compared to controls, TLE patients showed significant temporal and extra-temporal changes in FA, and MD, which were more severe and widespread in patients with than without psychosis. We observed distinct differences between TLE patients with and without psychosis in the anterior thalamic radiation (ATR), inferior fronto-occipital fasciculus (IFOF), and inferior longitudinal fasciculus (ILF). Similarly, for network metrics, global, and local efficiency and increased path length were significantly reduced in TLE patients compared to controls, but with more severe changes in TLE with psychosis than without psychosis. Network-based statistics detected significant differences between TLE with and without psychosis mainly involving the left limbic and prefrontal areas. Conclusion: TLE patients with interictal schizophrenia-like psychosis showed more widespread and severe white matter impairment, involving the ATR, IFOF and ILF, as well as disrupted network connectivity, particularly in the left limbic and prefrontal cortex, than patients without psychosis.
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Affiliation(s)
- Daichi Sone
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, United Kingdom
| | - Noriko Sato
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoko Shigemoto
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yukio Kimura
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Norihide Maikusa
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Miho Ota
- Division of Clinical Medicine, Department of Neuropsychiatry, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Jacqueline Foong
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, United Kingdom
| | - Matthias Koepp
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, United Kingdom
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
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13
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Radmanesh M, Jalili M, Kozlowska K. Activation of Functional Brain Networks in Children With Psychogenic Non-epileptic Seizures. Front Hum Neurosci 2020; 14:339. [PMID: 33192376 PMCID: PMC7477327 DOI: 10.3389/fnhum.2020.00339] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/03/2020] [Indexed: 02/03/2023] Open
Abstract
Objectives Psychogenic non-epileptic seizures (PNES) have been hypothesized to emerge in the context of neural networks instability. To explore this hypothesis in children, we applied a graph theory approach to examine connectivity in neural networks in the resting-state EEG in 35 children with PNES, 31 children with other functional neurological symptoms (but no PNES), and 75 healthy controls. Methods The networks were extracted from Laplacian-transformed time series by a coherence connectivity estimation method. Results Children with PNES (vs. controls) showed widespread changes in network metrics: increased global efficiency (gamma and beta bands), increased local efficiency (gamma band), and increased modularity (gamma and alpha bands). Compared to controls, they also had higher levels of autonomic arousal (e.g., lower heart variability); more anxiety, depression, and stress on the Depression Anxiety and Stress Scales; and more adverse childhood experiences on the Early Life Stress Questionnaire. Increases in network metrics correlated with arousal. Children with other functional neurological symptoms (but no PNES) showed scattered and less pronounced changes in network metrics. Conclusion The results indicate that children with PNES present with increased activation of neural networks coupled with increased physiological arousal. While this shift in functional organization may confer a short-term adaptive advantage-one that facilitates neural communication and the child's capacity to respond self-protectively in the face of stressful life events-it may also have a significant biological cost. It may predispose the child's neural networks to periods of instability-presenting clinically as PNES-when the neural networks are faced with perturbations in energy flow or with additional demands.
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Affiliation(s)
| | - Mahdi Jalili
- School of Engineering, RMIT University, Melbourne, VIC, Australia
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.,The University of Sydney School of Medicine, Sydney, NSW, Australia.,Westmead Institute for Medical Research, Sydney, NSW, Australia
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14
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de Toffol B, Adachi N, Kanemoto K, El-Hage W, Hingray C. [Interictal psychosis of epilepsy]. Encephale 2020; 46:482-492. [PMID: 32594995 DOI: 10.1016/j.encep.2020.04.014] [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: 02/26/2020] [Revised: 03/23/2020] [Accepted: 04/07/2020] [Indexed: 02/06/2023]
Abstract
Interictal psychosis (IIP) refers to psychosis that occurs in clear consciousness in persons with epilepsy (PWE) with temporal onset not during or immediately following a seizure. The pooled prevalence estimate of psychosis in PWE is 5.6%. PWE and schizophrenia have very high mortality, and more than one in four persons with both disorders die between the age of 25 and 50years. IIP can manifest in brief or chronic forms. The chronic forms of IIP may closely resemble schizophrenia. However, some authors have described the typical presence of persecutory and religious delusions, sudden mood swings and the preservation of affect, as well as rarity of negative symptoms and catatonic states, but these differences remain controversial. Typically, IIP starts after many years of active temporal lobe epilepsy. Several epilepsy-related variables are considered pathogenically relevant in IIP including epilepsy type and seizure characteristics. Risk factors for developing IIP are family history of psychosis, learning disability, early age of onset of epilepsy, unilateral or bilateral hippocampal sclerosis, history of status epilepticus, history of febrile seizures, and poorly controlled temporal lobe epilepsy. In patients with epilepsy and psychosis, structural imaging studies have shown several relevant changes leading to conflicting findings. Altered neuronal plasticity and excitability have been described in epilepsy and psychotic disorders. Neuropathological data suggest that IIP are not the result of classic epileptic pathology of the temporal lobe. Forced normalization (FN) and alternating psychosis refer to patients with poorly controlled epilepsy (focal or generalized) who have had psychotic episodes associated with remission of their seizures and disappearance of epileptiform activity on their EEGs. FN mainly occurs in temporal lobe epilepsy when patients have frequent seizures that are abruptly terminated triggered by an antiepileptic drug, vagus nerve stimulation or epilepsy surgery. Treatment is based on withdrawal of the responsible drug, and by transient use of antipsychotics for acute symptomatic control on a case-by-case basis. FN is an entity whose pathophysiology remains uncertain. Antiepileptic drugs (AEDs) may sometimes induce psychotic symptoms and psychosis could be a direct effect of the AEDs. IIP has been reported more frequently following the initiation of zonisamide, topiramate, and levetiracetam when compared with other antiepileptic drugs. However, AEDs do not appear to be the only determinant of IIP. The management of IIP requires a multidisciplinary approach with early involvement of a liaison psychiatrist associated with a neurologist. IIP are underdiagnosed and mistreated. Existing recommendations are extrapolated from those established for the treatment of schizophrenia with some additional guidance from expert opinions. A two-step procedure, not necessarily consecutive, is suggested. The first step requires reevaluation of the antiepileptic treatment. The second step requires initiation of atypical neuroleptics. Antipsychotic drugs should be selected with consideration of the balance between pharmacological profiles, efficacy, and adverse effects. Regarding pharmacokinetic interactions, AEDs with inducing properties reduce the blood levels of all antipsychotics. It is important to consider implications of combining neuroleptics and AEDs with a similar spectrum of side effects. Regarding the duration of treatment, IIP episodes are more likely to be recurrent than in primary schizophrenia. In practice, atypical neuroleptics with few motor side effects such as risperidone can be used as first choice, given the low propensity for drug-drug interactions and the low seizure risk, with the added suggestion to start low and go slow. Clozapine could be prescribed in selected cases.
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Affiliation(s)
- B de Toffol
- Service de neurologie et de neurophysiologie clinique, U1253 ibrain, Inserm, université de Tours, Tours, France; CHU Bretonneau, 2 bis, boulevard Tonnellé, 37044 Tours cedex, France.
| | - N Adachi
- Adachi Mental Clinic, Kitano 7-5-12, Kiyota, Sapporo 004-0867, Japon
| | - K Kanemoto
- Aichi Medical University, Neuropsychiatric Department, Nagakute, Japon
| | - W El-Hage
- U1253, iBrain, Inserm, CHRU de Tours, université de Tours, Tours, France
| | - C Hingray
- Service de neurologie, CHRU Nancy, 54000 Nancy, France; Pôle universitaire de psychiatrie du grand Nancy, CPN, 54520 Laxou, France
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15
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Waddington JL. Psychosis in Parkinson's disease and parkinsonism in antipsychotic-naive schizophrenia spectrum psychosis: clinical, nosological and pathobiological challenges. Acta Pharmacol Sin 2020; 41:464-470. [PMID: 32139896 PMCID: PMC7470778 DOI: 10.1038/s41401-020-0373-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/27/2020] [Indexed: 01/13/2023] Open
Abstract
Following the formulation of operational criteria for the diagnosis of psychosis in Parkinson's disease, a neurodegenerative disorder, the past decade has seen increasing interest in such nonmotor psychopathology that appears to be independent of dopaminergic therapy. Similarly, there has been a resurgence of interest in motor aspects of the neurodevelopmental disorder of schizophrenia, including spontaneous parkinsonism that appears to be independent of antipsychotic treatment. This review first addresses the clinical and nosological challenges of these superficially paradoxical insights and then considers pathobiological challenges. It proposes that diverse modes of disturbance to one or more element(s) in a cortical-striatal-thalamocortical neuronal network, whether neurodegenerative or neurodevelopmental, can result in movement disorder, psychosis or both. It then proposes that time- and site-dependent dysfunction in such a neuronal network may be a generic substrate for the emergence of psychosis not only in Parkinson's disease and schizophrenia-spectrum disorders but also in other neuropsychiatric disorders in which psychosis, and sometimes movement disorders, can be encountered; these include substance abuse, cerebrovascular disease, cerebral trauma, cerebral neoplasia, epilepsy, Huntington's disease, frontotemporal dementia, Alzheimer's disease and multiple sclerosis.
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Affiliation(s)
- John L Waddington
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, 2, Ireland.
- Jiangsu Key Laboratory of Translational Research & Therapy for Neuro-Psychiatric Disorders and Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou 215123, China.
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16
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Allebone J, Kanaan R, Maller J, O'Brien T, Mullen SA, Cook M, Adams SJ, Vogrin S, Vaughan DN, Connelly A, Kwan P, Berkovic SF, D'Souza WJ, Jackson G, Velakoulis D, Wilson SJ. Bilateral volume reduction in posterior hippocampus in psychosis of epilepsy. J Neurol Neurosurg Psychiatry 2019; 90:688-694. [PMID: 30796132 DOI: 10.1136/jnnp-2018-319396] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/07/2018] [Accepted: 01/21/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Psychosis of epilepsy (POE) occurs more frequently in temporal lobe epilepsy, raising the question as to whether abnormalities of the hippocampus are aetiologically important. Despite decades of investigation, it is unclear whether hippocampal volume is reduced in POE, perhaps due to small sample sizes and methodological limitations of past research. METHODS In this study, we examined the volume of the total hippocampus, and the hippocampal head, body and tail, in a large cohort of patients with POE and patients with epilepsy without psychosis (EC). One hundred adults participated: 50 with POE and 50 EC. Total and subregional hippocampal volumes were manually traced and compared between (1) POE and EC; (2) POE with temporal lobe epilepsy, extratemporal lobe epilepsy and generalised epilepsy; and (3) patients with POE with postictal psychosis (PIP) and interictal psychosis (IP). RESULTS Compared with EC the POE group had smaller total left hippocampus volume (13.5% decrease, p<0.001), and smaller left hippocampal body (13.3% decrease, p=0.002), and left (41.5% decrease, p<0.001) and right (36.4% decrease, p<0.001) hippocampal tail volumes. Hippocampal head volumes did not differ between groups. CONCLUSION Posterior hippocampal volumes are bilaterally reduced in POE. Volume loss was observed on a posteroanterior gradient, with severe decreases in the tail and moderate volume decreases in the body, with no difference in the hippocampal head. Posterior hippocampal atrophy is evident to a similar degree in PIP and IP. Our findings converge with those reported for the paradigmatic psychotic disorder, schizophrenia, and suggest that posterior hippocampal atrophy may serve as a biomarker of the risk for psychosis, including in patients with epilepsy.
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Affiliation(s)
- James Allebone
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia .,The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Richard Kanaan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Department of Psychiatry, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jerome Maller
- ANU College of Health and Medicine, Australian National University, Canberra, Victoria, Australia.,Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Terry O'Brien
- Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Neuroscience, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Saul Alator Mullen
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Mark Cook
- Graeme Clark Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Sophia J Adams
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Simon Vogrin
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - David N Vaughan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alan Connelly
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick Kwan
- Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Neuroscience, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - S F Berkovic
- Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Graeme Jackson
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Sarah J Wilson
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
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