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Meador KJ, Dimova S, Bourikas D, Elmoufti S, Floricel F, Laloyaux C, Moseley B, Nondonfaz X, Klein P. Time-course of drug-related psychiatric and behavioral treatment-emergent adverse events during brivaracetam treatment in adults with focal-onset seizures. Epilepsy Behav 2024; 156:109844. [PMID: 38788664 DOI: 10.1016/j.yebeh.2024.109844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE We previously analyzed data from three phase lll trials of adjunctive brivaracetam (BRV) in adults showing that the incidence and prevalence of drug-related central nervous system treatment-emergent adverse events (TEAEs) quickly peaked and decreased over several weeks following BRV treatment initiation. However, that analysis did not assess psychiatric and behavioral side effects which can occur with antiseizure medication (ASM) treatment. Here, we investigate the time-course of psychiatric and behavioral TEAEs by week of BRV treatment and how these TEAEs were managed. METHODS Data were pooled from three trials (N01252 [NCT00490035]; N01253 [NCT00464269]; N01358 [NCT01261325]) in adult patients (≥16 years of age) with focal-onset seizures receiving BRV adjunctive therapy. This post hoc analysis reports data on the incidence and prevalence of drug-related psychiatric or behavioral TEAEs over time in patients who received BRV doses of 50-200 mg/day (without titration) or placebo (PBO) during the 12-week treatment period. A logistic regression model was used to determine if psychiatric or behavioral comorbid conditions were predictors for drug-related psychiatric or behavioral TEAEs, or BRV discontinuation due to psychiatric or behavioral TEAEs. RESULTS A total of 803 patients received BRV 50-200 mg/day, and 459 patients received PBO. Drug-related psychiatric or behavioral TEAEs were reported by 11.0 % of patients during adjunctive BRV treatment (PBO: 4.8 %) with onset early after BRV initiation (median time to onset of first drug-related psychiatric or behavioral TEAE: 15 days). Incidence peaked at week 1 and decreased over the first 4 weeks following BRV initiation. Prevalence peaked at week 4 and then remained stable between weeks 5-12. In an analysis excluding patients on concomitant levetiracetam (BRV: n = 744; PBO: n = 422), the incidence of drug-related psychiatric or behavioral TEAEs was similar to the incidence in the overall population. The most common drug-related psychiatric or behavioral TEAEs were irritability, insomnia, depression, and anxiety. Only 2 % of patients discontinued BRV due to psychiatric or behavioral TEAEs (PBO: 1.3 %), while most patients on BRV who reported drug-related psychiatric or behavioral TEAEs did not require a change in dose (84.1 %; PBO: 63.6 %). A history of psychiatric or behavioral comorbid conditions (not ongoing at BRV initiation) was not associated with an increased likelihood of drug-related psychiatric or behavioral TEAEs, or BRV discontinuation due to psychiatric or behavioral TEAEs. Ongoing psychiatric or behavioral comorbid conditions at BRV initiation increased the likelihood of drug-related psychiatric or behavioral TEAEs, but not the likelihood of BRV discontinuation due to psychiatric or behavioral TEAEs. CONCLUSIONS Drug-related psychiatric and behavioral TEAEs occurred early during BRV treatment, and most patients did not require a change in BRV dose. These data can help guide clinician monitoring and patient expectations after starting BRV.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA.
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Szaflarski JP, Besson H, D'Souza W, Faught E, Klein P, Reuber M, Rosenow F, Salas-Puig J, Soto Insuga V, Steinhoff BJ, Strzelczyk A, Bourikas D, Daniels T, Floricel F, Friesen D, Laloyaux C, Villanueva V. Effectiveness and tolerability of brivaracetam in patients with epilepsy stratified by comorbidities and etiology in the real world: 12-month subgroup data from the international EXPERIENCE pooled analysis. J Neurol 2024; 271:3169-3185. [PMID: 38436680 PMCID: PMC11136785 DOI: 10.1007/s00415-024-12253-z] [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: 12/11/2023] [Revised: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To assess the effectiveness and tolerability of brivaracetam (BRV) in adults with epilepsy by specific comorbidities and epilepsy etiologies. METHODS EXPERIENCE/EPD332 was a pooled analysis of individual patient records from several non-interventional studies of patients with epilepsy initiating BRV in clinical practice. Outcomes included ≥ 50% reduction from baseline in seizure frequency, seizure freedom (no seizures within prior 3 months), continuous seizure freedom (no seizures since baseline), BRV discontinuation, and treatment-emergent adverse events (TEAEs) at 3, 6, and 12 months. Analyses were performed for all adult patients (≥ 16 years of age) and stratified by comorbidity and by etiology at baseline (patients with cognitive/learning disability [CLD], psychiatric comorbidity, post-stroke epilepsy, brain tumor-related epilepsy [BTRE], and traumatic brain injury-related epilepsy [TBIE]). RESULTS At 12 months, ≥ 50% seizure reduction was achieved in 35.6% (n = 264), 38.7% (n = 310), 41.7% (n = 24), 34.1% (n = 41), and 50.0% (n = 28) of patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE, respectively; and continuous seizure freedom was achieved in 5.7% (n = 318), 13.7% (n = 424), 29.4% (n = 34), 11.4% (n = 44), and 13.8% (n = 29), respectively. During the study follow-up, in patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE, 37.1% (n = 403), 30.7% (n = 605), 33.3% (n = 51), 39.7% (n = 68), and 27.1% (n = 49) of patients discontinued BRV, respectively; and TEAEs since prior visit at 12 months were reported in 11.3% (n = 283), 10.0% (n = 410), 16.7% (n = 36), 12.5% (n = 48), and 3.0% (n = 33), respectively. CONCLUSIONS BRV as prescribed in the real world is effective and well tolerated among patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE.
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Affiliation(s)
- Jerzy P Szaflarski
- University of Alabama at Birmingham (UAB) Heersink School of Medicine Department of Neurology and UAB Epilepsy Center, Birmingham, AL, USA.
| | | | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
| | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | | | - Victor Soto Insuga
- Pediatric Neurology, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | - Bernhard J Steinhoff
- Kork Epilepsy Center, Kehl-Kork and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | | | | | | | | | | | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, EpiCARE member, Valencia, Spain
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Klein P, Bourikas D. Narrative Review of Brivaracetam: Preclinical Profile and Clinical Benefits in the Treatment of Patients with Epilepsy. Adv Ther 2024:10.1007/s12325-024-02876-z. [PMID: 38811492 DOI: 10.1007/s12325-024-02876-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/16/2024] [Indexed: 05/31/2024]
Abstract
One third of patients with epilepsy will continue to have uncontrolled seizures despite treatment with antiseizure medications (ASMs). There is therefore a need to develop novel ASMs. Brivaracetam (BRV) is an ASM that was developed in a major drug discovery program aimed at identifying selective, high-affinity synaptic vesicle protein 2A (SV2A) ligands, the target molecule of levetiracetam. BRV binds to SV2A with 15- to 30-fold higher affinity and greater selectivity than levetiracetam. BRV has broad-spectrum antiseizure activity in animal models of epilepsy, a favorable pharmacokinetic profile, few clinically relevant drug-drug interactions, and rapid brain penetration. BRV is available in oral and intravenous formulations and can be initiated at target dose without titration. Efficacy and safety of adjunctive BRV (50-200 mg/day) treatment of focal-onset seizures was demonstrated in three pivotal phase III trials (NCT00490035/NCT00464269/NCT01261325), including in patients who had previously failed levetiracetam. Efficacy and safety of adjunctive BRV were also demonstrated in adult Asian patients with focal-onset seizures (NCT03083665). In several open-label trials (NCT00150800/NCT00175916/NCT01339559), long-term safety and tolerability of adjunctive BRV was established, with efficacy maintained for up to 14 years, with high retention rates. Evidence from daily clinical practice highlights BRV effectiveness and tolerability in specific epilepsy patient populations with high unmet needs: the elderly (≥ 65 years of age), children (< 16 years of age), patients with cognitive impairment, patients with psychiatric comorbid conditions, and patients with acquired epilepsy of specific etiologies (post-stroke epilepsy/brain tumor related epilepsy/traumatic brain injury-related epilepsy). Here, we review the preclinical profile and clinical benefits of BRV from pivotal trials and recently published evidence from daily clinical practice.
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Affiliation(s)
- Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, 6410 Rockledge Dr, Bethesda, MD, 20817, USA.
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Hajji EB, Traore B, Hassoune S, Khoubila A, Bellakhdar S, Rafai MA, Lakhdar A. Prevalence and associated factors of psychiatric comorbidities in epilepsy in the Casablanca-Settat region of Morocco: A cross-sectional study. Epilepsia Open 2024. [PMID: 38738817 DOI: 10.1002/epi4.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/29/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024] Open
Abstract
OBJECTIVE To determine the estimated prevalence of anxiety, depression, and anxiety-depression syndrome (ADS) and to identify the associated factors in Moroccan people with epilepsy (PWE). METHOD A cross-sectional study was conducted among adult PWE (June 2021-December 2022) in the Casablanca-Settat region. PWE were interviewed by completing a questionnaire collecting sociodemographic and clinical data. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Out of 21 points, a score ≥8 is in favor of considerable anxiety/depression symptoms and a sum of the two scores ≥15 indicates the presence of ADS. Data were analyzed using Statistical Package for Social Sciences (SPSS) 21.0. p-values ≤0.05 were considered statistically significant and logistic regression was performed to determine the associated factors. RESULTS Among 294 PWE, the median age was 39 years (interquartile range [IQR]: 25.75-54.00). The median anxiety, depression, and ADS scores were 8 (IQR: 5.00-10.00), 7 (IQR: 4.00-10.00), and 15 (IQR: 10.00-20.00), respectively. Anxiety, depression, and ADS were revealed in 51.4%, 44.9%, and 51.0% of PWE, respectively. Depression was the only predictor for anxiety (aOR = 24.20; 95%CI: 12.45-47.01). Antiseizure polytherapy (aOR = 3.35; 95%CI: 1.72-6.54) and anxiety (aOR = 24.04; 95%CI: 12.12-47.67) were the factors associated with depression. The risk of ADS was increased by female gender (aOR = 2.83; 95%CI: 1.68-4.78), antiseizure polytherapy (aOR = 2.75; 95%CI: 1.62-4.65), structural epilepsy (aOR = 1.73; 95%CI: 1.01-2.94), and the presence of concomitant conditions with epilepsy (aOR = 1.96; 95%CI: 1.16-3.31). SIGNIFICANCE Our study reports high psychiatric comorbidity prevalence in epilepsy, which supports the bidirectional link hypothesis. Associated factors found are important in the prognosis and prevention. PLAIN LANGUAGE SUMMARY The neural mechanisms underlying epilepsy tend to expose PWE to psychiatric disorders. Our study aims to quantify the rate of psychiatric comorbidities and their predictive factors in Moroccan PWE. The estimated prevalences of significant symptoms of anxiety, depression, and ADS were 51.4%, 44.9%, and 51.0%, respectively. Depression was the predictor of anxiety. Antiseizure polymedication and anxiety were the associated factors with depression. The risk of SAD was increased by female gender, antiseizure polymedication, structural epilepsy, and concomitant diseases with epilepsy. Our results are important for considering the psychiatric aspect of PWE and improving their care and quality of life.
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Affiliation(s)
- El Bachir Hajji
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Boubacar Traore
- Laboratory of Epidemiology, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Direction de la Pharmacie et du Médicament (DPM), Bamako, Mali
| | - Samira Hassoune
- Laboratory of Epidemiology, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Laboratory of Cellular and Molecular Pathology, Team "Epidemiology and Histology of Chronic and Cancerous Diseases", Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Adil Khoubila
- Clinical Neurosciences and Mental Health Research Laboratory, University Hassan II, Casablanca, Morocco
- University Psychiatric Centre, University Hospital Ibn Rochd, Casablanca, Morocco
| | - Salma Bellakhdar
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Department of Neurology, IBN ROCHD University Hospital, Casablanca, Morocco
| | - Mohammed Abdoh Rafai
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Department of Neurology, IBN ROCHD University Hospital, Casablanca, Morocco
| | - Abdelhakim Lakhdar
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Department of Neurosurgery, IBN ROCHD University Hospital, Casablanca, Morocco
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Vilyte G, Butler J, Ives-Deliperi V, Pretorius C. In response: Diagnosing functional seizures with a single video-EEG may miss epileptic seizures. Seizure 2024; 118:123-124. [PMID: 38691946 DOI: 10.1016/j.seizure.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024] Open
Affiliation(s)
- Gabriele Vilyte
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - James Butler
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Victoria Ives-Deliperi
- Division of Neurosurgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Chrisma Pretorius
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa.
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Maritan BS, Favaretto G, Tarifa B, de Faria FM, Antônio LF, Ricci MF, de Araújo Filho GM. Clinical and sociodemographic characteristics of patients with epilepsy attended at a regional reference psychiatric emergency unit. Epilepsy Res 2024; 203:107369. [PMID: 38701645 DOI: 10.1016/j.eplepsyres.2024.107369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/25/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Epilepsy is one of the most prevalent chronic neurological diseases, presenting a high frequency of psychiatric disorders (PD). This study sought to evaluate the clinical and sociodemographic profile of patients with epilepsy (PWE) attended at a regional reference psychiatric emergency unit. METHODS A retrospective, cross-sectional, and descriptive observational study was conducted utilizing a patient record database of individuals with epilepsy who were attended in a regional reference psychiatric emergency unit between January 2018 and August 2022. RESULTS Out of the 31,800 psychiatric emergency visits, 260 (0.8 %) were of patients with epilepsy (ICD-10: G40). The majority were males (63.5 %) with a mean age of 42.11±15.39 years, single marital status (154; 59.25 %) and elementary education (75; 28.9 %). Most of them (203; 78.1 %) presented at least one psychiatric comorbidity at the emergency visit, but 109 (41.9 %) were not receiving any psychiatric follow-up. A total of 106 patients (40.8 %) had experienced at least one past psychiatric hospitalization. CONCLUSIONS The occurrence of PD is highly prevalent in PWE, and probably with a high frequency of psychiatric emergencies occurring among them. Further studies are needed to assess such patient profile, particularly involving data from psychiatric emergency units.
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Affiliation(s)
- Bruno Soleman Maritan
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto, SP 15090-000, Brazil.
| | - Giovanna Favaretto
- Hospital Psiquiátrico Dr. Adolfo Bezerra de Menezes, R. Major João Batista França, 298 - Vila Esplanada, São José do Rio Preto, SP 15010-100, Brazil
| | - Bruna Tarifa
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto, SP 15090-000, Brazil
| | - Fernanda Menezes de Faria
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto, SP 15090-000, Brazil
| | - Leonardo Ferreira Antônio
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto, SP 15090-000, Brazil
| | - Mayra Folgosi Ricci
- Hospital Psiquiátrico Dr. Adolfo Bezerra de Menezes, R. Major João Batista França, 298 - Vila Esplanada, São José do Rio Preto, SP 15010-100, Brazil
| | - Gerardo Maria de Araújo Filho
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto, SP 15090-000, Brazil
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Olkhova EA, Smith LA, Dennis BH, Ng YS, LeBeau FEN, Gorman GS. Delineating mechanisms underlying parvalbumin neuron impairment in different neurological and neurodegenerative disorders: the emerging role of mitochondrial dysfunction. Biochem Soc Trans 2024; 52:553-565. [PMID: 38563502 PMCID: PMC11088917 DOI: 10.1042/bst20230191] [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: 11/21/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
Given the current paucity of effective treatments in many neurological disorders, delineating pathophysiological mechanisms among the major psychiatric and neurodegenerative diseases may fuel the development of novel, potent treatments that target shared pathways. Recent evidence suggests that various pathological processes, including bioenergetic failure in mitochondria, can perturb the function of fast-spiking, parvalbumin-positive neurons (PV+). These inhibitory neurons critically influence local circuit regulation, the generation of neuronal network oscillations and complex brain functioning. Here, we survey PV+ cell vulnerability in the major neuropsychiatric, and neurodegenerative diseases and review associated cellular and molecular pathophysiological alterations purported to underlie disease aetiology.
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Affiliation(s)
- Elizaveta A. Olkhova
- Wellcome Centre for Mitochondrial Research, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K
| | - Laura A. Smith
- Wellcome Centre for Mitochondrial Research, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K
| | - Bethany H. Dennis
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K
| | - Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K
- NIHR Newcastle Biomedical Research Centre, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, U.K
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE2 4HH, U.K
| | - Fiona E. N. LeBeau
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K
| | - Gráinne S. Gorman
- Wellcome Centre for Mitochondrial Research, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K
- NIHR Newcastle Biomedical Research Centre, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, U.K
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE2 4HH, U.K
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Faiman I, Hodsoll J, Jasani I, Young AH, Shotbolt P. Sociodemographic and clinical risk factors for suicidal ideation and suicide attempt in functional/dissociative seizures and epilepsy: a large cohort study. BMJ MENTAL HEALTH 2024; 27:e300957. [PMID: 38642918 PMCID: PMC11033658 DOI: 10.1136/bmjment-2023-300957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/22/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND People with functional/dissociative seizures (FDS) are at elevated suicidality risk. OBJECTIVE To identify risk factors for suicidality in FDS or epilepsy. METHODS Retrospective cohort study from the UK's largest tertiary mental healthcare provider, with linked national admission data from the Hospital Episode Statistics. Participants were 2383 people with a primary or secondary diagnosis of FDS or epilepsy attending between 01 January 2007 and 18 June 2021. Outcomes were a first report of suicidal ideation and a first hospital admission for suicide attempt (International Classification of Diseases, version 10: X60-X84). Demographic and clinical risk factors were assessed using multivariable bias-reduced binomial-response generalised linear models. FINDINGS In both groups, ethnic minorities had significantly reduced odds of hospitalisation following suicide attempt (OR: 0.45-0.49). Disorder-specific risk factors were gender, age and comorbidity profile. In FDS, both genders had similar suicidality risk; younger age was a risk factor for both outcomes (OR: 0.16-1.91). A diagnosis of depression or personality disorders was associated with higher odds of suicidal ideation (OR: 1.91-3.01). In epilepsy, females had higher odds of suicide attempt-related hospitalisation (OR: 1.64). Age had a quadratic association with both outcomes (OR: 0.88-1.06). A substance abuse disorder was associated with higher suicidal ideation (OR: 2.67). Developmental disorders lowered the risk (OR: 0.16-0.24). CONCLUSIONS This is the first study systematically reporting risk factors for suicidality in people with FDS. Results for the large epilepsy cohort complement previous studies and will be useful in future meta-analyses. CLINICAL IMPLICATIONS Risk factors identified will help identify higher-risk groups in clinical settings.
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Affiliation(s)
- Irene Faiman
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Hodsoll
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iman Jasani
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paul Shotbolt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Jud J, Stefanits H, Gelpi E, Quinot V, Aull-Watschinger S, Czech T, Dorfer C, Rössler K, Baumgartner C, Kasprian G, Watschinger C, Moser D, Brugger J, Pataraia E. Which parameters influence cognitive, psychiatric and long-term seizure outcome in mesial temporal lobe epilepsy after selective amygdalohippocampectomy? J Neurol 2024:10.1007/s00415-024-12343-y. [PMID: 38619597 DOI: 10.1007/s00415-024-12343-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND We aimed to analyze potentially prognostic factors which could have influence on postoperative seizure, neuropsychological and psychiatric outcome in a cohort of patients with mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS) after selective amygdalohippocampectomy (SAHE) via transsylvian approach. METHODS Clinical variables of 171 patients with drug-resistant MTLE with HS (88 females) who underwent SAHE between 1994 and 2019 were evaluated using univariable and multivariable logistic regression models, to investigate which of the explanatory parameters can best predict the outcome. RESULTS At the last available follow-up visit 12.3 ± 6.3 years after surgery 114 patients (67.9%) were seizure-free. Left hemispheric MTLE was associated with worse postoperative seizure outcome at first year after surgery (OR = 0.54, p = 0.01), female sex-with seizure recurrence at years 2 (OR = 0.52, p = 0.01) and 5 (OR = 0.53, p = 0.025) and higher number of preoperative antiseizure medication trials-with seizure recurrence at year 2 (OR = 0.77, p = 0.0064), whereas patients without history of traumatic brain injury had better postoperative seizure outcome at first year (OR = 2.08, p = 0.0091). All predictors lost their predictive value in long-term course. HS types had no prognostic influence on outcome. Patients operated on right side performed better in verbal memory compared to left (VLMT 1-5 p < 0.001, VLMT 7 p = 0.001). Depression occurred less frequently in seizure-free patients compared to non-seizure-free patients (BDI-II Z = - 2.341, p = 0.019). CONCLUSIONS SAHE gives an improved chance of achieving good postoperative seizure, psychiatric and neuropsychological outcome in patients with in MTLE due to HS. Predictors of short-term outcome don't predict long-term outcome.
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Affiliation(s)
- Judith Jud
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Harald Stefanits
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Ellen Gelpi
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Valérie Quinot
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Susanne Aull-Watschinger
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Thomas Czech
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karl Rössler
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Baumgartner
- Department of Neurology, General Hospital Hietzing With Neurological Center Rosenhügel, Vienna, Austria
- Karl Landsteiner Institute of Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Gregor Kasprian
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neuroradiology, Medical University of Vienna, Vienna, Austria
| | - Clara Watschinger
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Doris Moser
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Vienna General Hospital, Vienna, Austria
| | - Jonas Brugger
- Institute of Medical Statistics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Ekaterina Pataraia
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria.
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10
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Gandy M, Coleman H, Cutler H, Jones MP, Karin E, Kwan P, Nikpour A, Parratt K, Rayner G, Titov N, Todd L, Seil E, Winton‐Brown T, Wu W, Dear BF. Comparative effectiveness of digital mental healthcare models for adults with epilepsy: A study protocol of a randomized controlled trial. Epilepsia Open 2024; 9:808-818. [PMID: 38345357 PMCID: PMC10984311 DOI: 10.1002/epi4.12913] [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: 11/22/2023] [Accepted: 01/25/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Mental health complaints are prevalent among people with epilepsy, yet there are major barriers that prevent access to psychological care, including high out-of-pocket costs and a lack of accessible specialized services. The purpose of the current study is to examine the comparative efficacy, acceptability, cost-effectiveness, and long-term outcomes of a digital psychological intervention when delivered under two models of care (i.e., guided vs. unguided) in supporting the mental health and functioning of adults with epilepsy. METHOD Approximately 375 participants across Australia will be enrolled. Eligible participants will have a confirmed diagnosis of epilepsy, experience difficulties with their emotional health, be at least 18 years of age, and live in Australia. Participants will be randomized (2:2:1) to receive the Wellbeing Neuro Course, a 10-week internet-delivered program, with (i.e., guided) or without guidance by a mental health clinician (i.e., unguided), or be allocated to a treatment-as-usual waiting-list control group. Participants will complete online questionnaires at pre-, post-treatment, and 3- and 12-month follow-up and consent to have their data linked to their medical records to capture healthcare system resource use and costs. ANALYSIS Primary outcome measures will be symptoms of depression and anxiety. A cost-utility analysis will be undertaken using the Australian healthcare system perspective and according to current economic evaluation guidelines. Resource use and costs to the healthcare system during the study period will be captured via data linkage to relevant administrative datasets in Australia. SIGNIFICANCE The results of this trial will provide important data concerning the relative outcomes of these different models of care and will inform the integration of digital psychological interventions translation into healthcare services. ETHICS AND DISSEMINATION The Human Research Ethics Committee of Macquarie University approved the proposed study (Reference No: 520231325151475). The results will be disseminated through peer-reviewed publication(s). ANZCTR TRIAL REGISTRATION NUMBER ACTRN12623001327673. PLAIN LANGUAGE SUMMARY This study seeks to find out if a 10-week online psychological treatment can improve the mental health and well-being of Australian adults with epilepsy. Around 375 participants will be randomly assigned to different groups: one will receive treatment with guidance from mental health clinician (guided group), one without guidance (unguided group), and one starting later (waiting control group). All participants will fill out the same outcome measures online. The main goal of this research is to compare these groups and assess how well the treatment works in improving mental health outcomes.
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Affiliation(s)
- Milena Gandy
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Honor Coleman
- Melbourne School of Psychological SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Henry Cutler
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
- Macquarie University Centre for the Health EconomySydneyNew South WalesAustralia
- Macquarie University Business SchoolSydneyNew South WalesAustralia
| | - Michael P. Jones
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Eyal Karin
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Armin Nikpour
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Kaitlyn Parratt
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- The Epilepsy Society of AustraliaSouth AustraliaAustralia
| | - Genevieve Rayner
- Melbourne School of Psychological SciencesThe University of MelbourneMelbourneVictoriaAustralia
- Comprehensive Epilepsy ProgramAlfred HospitalMelbourneVictoriaAustralia
| | - Nickolai Titov
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
- MindSpotMQ Health, Macquarie UniversityNew South WalesAustralia
| | - Lisa Todd
- Epilepsy Action AustraliaSydneyNew South WalesAustralia
| | - Elizabeth Seil
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
- Macquarie University Centre for the Health EconomySydneyNew South WalesAustralia
- Macquarie University Business SchoolSydneyNew South WalesAustralia
| | - Toby Winton‐Brown
- Comprehensive Epilepsy ProgramAlfred HospitalMelbourneVictoriaAustralia
| | - Wendy Wu
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Blake F. Dear
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
- MindSpotMQ Health, Macquarie UniversityNew South WalesAustralia
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11
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Drapier D. Schizophrenia and epileptic comorbidity. Rev Neurol (Paris) 2024; 180:308-313. [PMID: 38503587 DOI: 10.1016/j.neurol.2024.03.002] [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: 09/30/2023] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
Epileptic seizures have been widely considered as a complication of external or iatrogenic factors in schizophrenia. However, epidemiologic, neurodevelopmental and genetic data have changed regards on this topic considering the complexity of the bidirectional link between epilepsy and schizophrenia. We will examine these data constituting the pathophysiological aspects of this particular association and detail the particular impact of antipsychotics on the occurence of epileptic seizure in schizophrenia as well as the management strategies.
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Affiliation(s)
- D Drapier
- University of Rennes, rue du Thabor, 35000 Rennes, France; Centre hospitalier Guillaume-Regnier, 108, avenue Général-Leclerc, 35703 Rennes, France.
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12
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Lattanzi S, Chiesa V, Di Gennaro G, Ferlazzo E, Labate A, La Neve A, Meletti S, Di Bonaventura C. Brivaracetam use in clinical practice: a Delphi consensus on its role as first add-on therapy in focal epilepsy and beyond. Neurol Sci 2024:10.1007/s10072-024-07485-w. [PMID: 38558319 DOI: 10.1007/s10072-024-07485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Antiseizure medications remain the cornerstone of treatment for epilepsy, although a proportion of individuals with the condition will continue to experience seizures despite appropriate therapy. Treatment choices for epilepsy are based on variables related to both the individual patient and the available medications. Brivaracetam is a third-generation agent antiseizure medication. METHODS We carried out a Delphi consensus exercise to define the role of brivaracetam in clinical practice and to provide guidance about its use as first add-on ASM and in selected clinical scenarios. A total of 15 consensus statements were drafted by an expert panel following review of the literature and all were approved in the first round of voting by panelists. The consensus indicated different clinical scenarios for which brivaracetam can be a good candidate for treatment, including first add-on use. RESULTS Overall, brivaracetam was considered to have many advantageous characteristics that render it a suitable option for patients with focal epilepsy, including a fast onset of action, favorable pharmacokinetic profile with few drug-drug interactions, broad-spectrum activity, and being well tolerated across a range of doses. Brivaracetam is also associated with sustained clinical response and good tolerability in the long term. CONCLUSIONS These characteristics also make it suitable as an early add-on for the elderly and for patients with post-stroke epilepsy or status epilepticus as highlighted by the present Delphi consensus.
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Affiliation(s)
- Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy.
| | - Valentina Chiesa
- Epilepsy Center, Child Neurology Unit, ASST Santi Paolo Carlo, Milan, Italy
| | | | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Angelo Labate
- Neurophysiopathology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Angela La Neve
- DiBraiN, University Hospital of Bari "A. Moro", Bari, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
- Neurology and neurophysiology unit - AOU Modena, Modena, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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13
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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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Wu Y, Zhang Z, Dong X, Liang P, Li L, Zhai X, Zou B. Epilepsy and childhood psychiatric disorders: a two-sample bidirectional Mendelian randomization study. Neurol Sci 2024:10.1007/s10072-024-07447-2. [PMID: 38488928 DOI: 10.1007/s10072-024-07447-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Observational studies have indicated that psychiatric disorders are the most common comorbidities in pediatric epilepsy. However, the existence and direction of a causal relationship between the two remains controversial. This study aims to investigate the association between common childhood psychiatric disorders and epilepsy using a two-sample, bidirectional Mendelian randomization (MR) approach. METHODS Genetic instruments were obtained from the most recent and largest genome-wide association studies (GWAS), including datasets for epilepsy (N_case = 29,994, N_control = 52,538), attention deficit hyperactivity disorder (ADHD) (N_case = 38,691, N_control = 186,843), autism spectrum disorder (ASD) (N_case = 18,381, N_control = 27,969), and Tourette syndrome (TS) (N_case = 4,819, N_control = 9488). MR analyses were conducted using the inverse variance weighted (IVW) method, weighted median method, and MR-Egger regression. RESULTS No reliable evidence was found to suggest a causal effect of ADHD, ASD, or TS on epilepsy, nor was there any reliable evidence indicating that epilepsy increases the risk of these three psychiatric disorders. These findings remained consistent across various sensitivity analyses. CONCLUSION Although observational studies have highlighted a high comorbidity rate between pediatric epilepsy and psychiatric disorders like ADHD and ASD, the MR analysis did not confirm a causal relationship between them. This suggests that previous studies might have been influenced by confounding biases or other biases, potentially overestimating the true relationship. A deeper understanding of the mechanisms underlying these comorbidities is crucial for refining the treatment of pediatric epilepsy.
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Affiliation(s)
- YuXin Wu
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - ZaiYu Zhang
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Xinyu Dong
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Ping Liang
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Lusheng Li
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Xuan Zhai
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Bin Zou
- Department of Neurosurgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2Nd Road, Yuzhong District, Chongqing, 400010, China.
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China.
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Kanner AM, Shankar R, Margraf NG, Schmitz B, Ben-Menachem E, Sander JW. Mood disorders in adults with epilepsy: a review of unrecognized facts and common misconceptions. Ann Gen Psychiatry 2024; 23:11. [PMID: 38433207 PMCID: PMC10910742 DOI: 10.1186/s12991-024-00493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/03/2024] [Indexed: 03/05/2024] Open
Abstract
Epilepsy is one of the most common neurologic conditions. Its clinical manifestations are not restricted to seizures but often include cognitive disturbances and psychiatric disorders. Prospective population-based studies have shown that people with epilepsy have an increased risk of developing mood disorders, and people with a primary mood disorder have an increased risk of developing epilepsy. The existence of common pathogenic mechanisms in epilepsy and mood disorders may explain the bidirectional relation between these two conditions. Recognition of a personal and family psychiatric history at the time of evaluation of people for a seizure disorder is critical in the selection of antiseizure medications: those with mood-stabilizing properties (e.g., lamotrigine, oxcarbazepine) should be favoured as a first option in those with a positive history while those with negative psychotropic properties (e.g., levetiracetam, topiramate) avoided. While mood disorders may be clinically identical in people with epilepsy, they often present with atypical manifestations that do not meet ICD or DSM diagnostic criteria. Failure to treat mood disorders in epilepsy may have a negative impact, increasing suicide risk and iatrogenic effects of antiseizure medications and worsening quality of life. Treating mood disorders in epilepsy is identical to those with primary mood disorders. Yet, there is a common misconception that antidepressants have proconvulsant properties. Most antidepressants are safe when prescribed at therapeutic doses. The incidence of seizures is lower in people randomized to antidepressants than placebo in multicenter randomized placebo-controlled trials of people treated for a primary mood disorder. Thus, there is no excuse not to prescribe antidepressant medications to people with epilepsy.
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Affiliation(s)
- Andres M Kanner
- Epilepsy Division and Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW, 14th Street, Room 1324, Miami, FL, 33136, USA.
| | - Rohit Shankar
- University of Plymouth Peninsula School of Medicine, Truro, UK
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - Nils G Margraf
- Department of Neurology, Christian-Albrechts University of Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bettina Schmitz
- Department of Neurology, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Elinor Ben-Menachem
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, 2103SW, The Netherlands
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
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16
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Conner K, Gandy M, Munger-Clary HM. What is the role of screening instruments in the management of psychiatric comorbidities in epilepsy? Tools and practical tips for the most common comorbidities: Depression and anxiety. Epilepsy Behav Rep 2024; 25:100654. [PMID: 38389991 PMCID: PMC10881315 DOI: 10.1016/j.ebr.2024.100654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/13/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
Depression and anxiety are the most common psychiatric comorbidities in epilepsy and are known to increase healthcare utilization, the risk of refractory epilepsy, and anti-seizure medication intolerability. Despite this, depression and anxiety continue to be underrecognized and undertreated in people with epilepsy (PWE). Several barriers to the identification of depression and anxiety in PWE exist, including reliance on unstructured interviews rather than standardized, validated instruments. Moreover, there is a dearth of behavioral health providers to manage these comorbidities once identified. The use of validated screening instruments in epilepsy clinics can assist with both the identification of psychiatric symptoms and monitoring of treatment response by the epilepsy clinician for PWE with comorbid depression and/or anxiety. While screening instruments can identify psychiatric symptoms occurring within a specified time, they are not definitively diagnostic. Screeners can be time efficient tools to identify patients requiring further evaluation for diagnostic confirmation. This article reviews recent literature on the utility of depression and anxiety screening instruments in epilepsy care, including commonly used screening instruments, and provides solutions for potential barriers to clinical implementation. Validated depression and anxiety screening instruments can increase identification of depression and anxiety and guide epilepsy clinician management of these comorbidities which has the potential to positively impact patient care.
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Affiliation(s)
- Kelly Conner
- Department of Physician Assistant Studies, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Milena Gandy
- The School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Heidi M Munger-Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Mula M, Borghs S, Ferro B, Zaccara G, Dainese F, Ferlazzo E, Romigi A, Gambardella A, Perucca E. Effect of drug treatment changes and seizure outcomes on depression and suicidality in adults with drug-resistant focal epilepsy. Epilepsia 2024; 65:473-482. [PMID: 38073337 DOI: 10.1111/epi.17856] [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: 06/23/2023] [Revised: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVE To investigate changes in depressive and suicidality status and their relationship with seizure outcomes after the addition or substitution of another antiseizure medication (ASM) in adults with drug-resistant focal epilepsy. METHODS Seven hundred seventy consecutively enrolled patients were assessed and followed prospectively for seizure outcome and depressive status over a 6-month period after starting treatment with a newly introduced ASM. The Neurological Disorders Depression Inventory for Epilepsy (NDDIE) was used to screen for depression and suicidality. Correlations of NDDIE results with clinical and treatment-related variables were assessed by using a stepwise logistic regression model. RESULTS At baseline, 50% of patients had a positive screening test result for depression and 13% had a positive screening test result for suicidal ideation. A psychiatric comorbidity at baseline was associated with a 2.3 times increased risk of an initially negative NDDIE screening result becoming positive at re-assessment after 6 months. In addition, the number of ASMs taken at baseline correlated with an increased risk of a change in depression screening test results from negative to positive during follow-up, whereas no association was identified with sociodemographic and epilepsy-related variables, including seizure outcomes. Approximately 6% of patients who were initially negative at screening for suicidal ideation became positive at the 6-month re-assessment. The risk of switch from a negative to a positive screening test result for suicidal ideation was increased more than two-fold in individuals who screened positive for depression at baseline, and was unrelated to the type of ASM introduced, sociodemographic variables, or seizure outcomes. SIGNIFICANCE Almost 1 in 5 adults with drug-resistant focal epilepsy who screen negative for depression become positive when re-assessed 6 months after a treatment change. At re-assessment 6 months later, 6.1% who screen initially negative for passive suicidal ideation become positive. These changes in screening status are independent of type of ASM introduced or seizure outcomes but correlate with psychiatric status at baseline.
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Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education, St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Filippo Dainese
- Department of Neuroscience, Unit of Neurology and Neurophysiology, University Hospital of Padova, Padova, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Andrea Romigi
- Sleep Medicine Center, IRCCS Neuromed Istituto Neurologico Mediterraneo, Pozzilli, Italy
- Psychology Faculty, International Telematic University Uninettuno, Rome, Italy
| | | | - Emilio Perucca
- Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
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18
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Kalinin VV, Zemlyanaya AA, Subbotin KY. [The relationship between immunological and psychopathological characteristics in patients with focal epilepsy depending on the profile of interhemispheric asymmetry]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:37-44. [PMID: 38465809 DOI: 10.17116/jnevro202412402137] [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] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To identify the possible influence of cellular immunity parameters and neurobiological variables (frequency of seizures of various semiotics and their severity) on comorbid psychopathological symptoms depending on the profile of interhemispheric asymmetry in patients with focal forms of epilepsy. MATERIAL AND METHODS The study included 92 patients with epilepsy (38 men, 54 women, mean age 38.7+8.45 years). Focal temporal lobe epilepsy was diagnosed in 36 patients, focal frontal lobe epilepsy in 16 patients, and temporal-frontal lobe epilepsy in 40 patients. For each type of seizure, severity was assessed according to the National Seizure Severity Scale (NHS3). The mental status of patients was assessed using the SCL-90 self-report questionnaire. The Annette scale was used to assess the profile of interhemispheric asymmetry. The number of different clusters of lymphocytes was studied, including the number of T-lymphocytes (CD3+), T-helpers (CD3+CD4+), T-cytotoxic (CD3+CD8+), T-NK (natural killers CD3+CD16+CD56+), B-lymphocytes (CD3-CD19+), as well as immunoregulatory index (CD4/CD8 ratio). In order to identify any possible relationships between neurobiological and immune variables, on the one hand, and the SCL-90 constructs, on the other hand, a separate correlation analysis of Spearman ranks within the left-handed group and the right-handed group was carried out. RESULTS We revealed the differences between groups of patients with epilepsy with right and left profiles of hemispheric asymmetry regarding the relationship between the frequency of seizures, their severity and accompanying psychopathological variables, on the one hand, and between immunity indices and psychopathological constructs, on the other hand. It has been established that neurobiological and immune variables in left-handers can determine the psychopathological structure of the comorbid mental disorder. CONCLUSION Prediction of concomitant psychopathological syndromes in patients with epilepsy on the basis of clinical data and data on immunity is quite possible, but only in left-handed patients.
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Affiliation(s)
- V V Kalinin
- Moscow Research Institute of Psychiatry - Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - A A Zemlyanaya
- Moscow Research Institute of Psychiatry - Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - K Y Subbotin
- Moscow Research Institute of Psychiatry - Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
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Bergamaschi EDNC, Machado G, Rodrigues GM, Lin K. Self-reported attention and hyperactivity symptoms among adults with epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-7. [PMID: 38286432 PMCID: PMC10824590 DOI: 10.1055/s-0044-1779298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 10/24/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Patients with epilepsy (PWE) frequently have comorbid psychiatric disorders, the most common of which are depression and anxiety. Attention deficit disorder with hyperactivity (ADHD) is also more frequent among PWE, though that condition has been scarcely studied among the adult PWE population. OBJECTIVE This study aimed to compare the presence of ADHD symptoms between adult PWE and the general population. METHODS This was an observational case-control study. Ninety-five adult PWE from a tertiary center in southern Brazil were compared with 100 healthy controls. All subjects were submitted to three structured scales: 1) the World Health Organization Adult ADHD Self-Report Scale version 1.1 (ASRS); 2) the Hospital Anxiety and Depression Scale (HADS); and 3) the Adverse Events Profile (AEP). Dichotomic variables were analyzed through chi-square test and Fisher's exact test, as appropriate, and non-parametric variables were analyzed through the Mann-Whitney U test. RESULTS Medians and interquartile ranges (IR) were: 1) ASRS: 26.00 (IR: 18 to 38) among PWE versus 17.00 (IR: 11 to 24) among controls, p < 0.001; 2) HADS: 14.00 (IR: 8 to 21) among PWE versus 11.00 (IR: 8 to 16) among controls, p = 0.007; 3) AEP: 3800 (IR: 31 to 49) among PWE versus 33.00 (IR: 23 to 43) among controls, p = 0.001. CONCLUSION PWE showed a higher burden of symptoms of ADHD, depression, and anxiety when compared with controls, which replicates in the Brazilian population the findings of current literature that point toward a higher prevalence of such disorders among PWE.
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Affiliation(s)
| | - Gabriela Machado
- Universidade Federal de Santa Catarina, Florianópolis SC, Brazil.
| | | | - Katia Lin
- Universidade Federal de Santa Catarina, Florianópolis SC, Brazil.
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Guo W, Li YX, Zhang Y, Lv XR, Wang SX, Zhang SY, Wang ES, Chen XJ, Li Y. Risk analysis of depression among adult patients with epilepsy of different sex: a retrospective single-center study from China. Front Psychiatry 2023; 14:1283983. [PMID: 38111615 PMCID: PMC10725914 DOI: 10.3389/fpsyt.2023.1283983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023] Open
Abstract
Objective To determine sex differences in the prevalence of depression and assess the risk factors for depression among adult patients with epilepsy from the Dali area of China. Methods We retrospectively analyzed the clinical data of adult patients with epilepsy who visited the First Affiliated Hospital of Dali University from January 2017 to January 2022. Patient Health Questionnaire-9 was used to assess depressive symptoms in patients with epilepsy. The risk factors of depression were analyzed by binary logistic regression among different sex in patients with epilepsy. Results There were significant sex differences in depression in patients with epilepsy (p < 0.001), and females were 4.27 times more likely to suffer from depression than males (95% confidence interval: 3.70-4.92). The risk factors for depression among female patients with epilepsy included occupation (p < 0.001), years with epilepsy (p < 0.001), seizure frequency (p < 0.001), seizure type (p < 0.001), etiology (p < 0.001), number of antiseizure medications used (p < 0.001), antiseizure medications (p < 0.001), and electroencephalogram findings (p < 0.001). The risk factors for depression among male patients with epilepsy included age (p < 0.001), ethnicity (p < 0.001), occupation (p < 0.001), years with epilepsy (p < 0.001), seizure frequency (p < 0.001), seizure type (p < 0.001), etiology (p < 0.001), number of antiseizure medications used (p < 0.001), antiseizure medications (p < 0.001), and electroencephalogram findings (p < 0.001). Conclusion Adult female patients with epilepsy had a higher risk of depression than adult male patients with epilepsy. There were sex differences in the risk factors associated with depression among patients with epilepsy.
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Affiliation(s)
- Wang Guo
- Clinical Medical School, Dali University, Dali, China
| | - Yu-xuan Li
- Clinical Medical School, Dali University, Dali, China
| | - Yi Zhang
- Clinical Medical School, Dali University, Dali, China
| | - Xue-rui Lv
- Clinical Medical School, Dali University, Dali, China
| | | | - Shuang-yuan Zhang
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, China
| | - En-si Wang
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, China
| | - Xin-jie Chen
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, China
| | - Yun Li
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, China
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Liao P, Trollor J, Reppermund S, Cvejic RC, Srasuebkul P, Vajdic CM. Factors associated with acute care service use after epilepsy hospitalisation in people with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1317-1335. [PMID: 36330725 PMCID: PMC10952954 DOI: 10.1111/jir.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/30/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This study aimed to identify factors associated with unplanned acute hospital readmission and emergency department (ED) presentation after hospitalisation for epilepsy in people with intellectual disability (ID). METHODS This study is a retrospective cohort study using linked administrative datasets. We identified 3293 people with ID aged 5-64 years with a hospitalisation for epilepsy between 2005 and 2014 in New South Wales, Australia. We examined unplanned readmission and ED presentation within 30 or 365 days and associations with demographic, socio-economic and health status variables. Modified Poisson regression with robust estimation was used to model outcomes within 30 days. Negative binomial regression was used to account for the overdispersion of the data and to model 365-day outcome rates. RESULTS Around half of the cohort had an unplanned readmission and ED presentation within 365 days of the index hospitalisation. In fully adjusted models, being female, being a young adult and having a longer or acute care index admission, mental and physical comorbidities and a history of incarceration were associated with an elevated risk of readmission or ED presentation. The strongest association was observed between history of self-harm and 365-day readmission (incidence rate ratio 2.15, 95% confidence interval 1.41-3.29). CONCLUSIONS Socio-demographic, justice and health factors are associated with unplanned readmission and ED presentation risk after hospitalisation for epilepsy in people with ID. Interventions targeting improving continuity of care should be tailored for individuals and their support workers. The findings also emphasise the importance of person-centred multidisciplinary care across different health sectors.
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Affiliation(s)
- P. Liao
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - J. Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - S. Reppermund
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - R. C. Cvejic
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - P. Srasuebkul
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - C. M. Vajdic
- Centre for Big Data Research in Health, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
- Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
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Lopez MR, VanCott AC, Amuan ME, Panahi S, Henion A, Pugh MJ. Prescribing Trends of Antiseizure Drugs in Women Veterans With Epilepsy. Mil Med 2023; 188:e3628-e3634. [PMID: 37283266 PMCID: PMC11022647 DOI: 10.1093/milmed/usad194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/21/2023] [Accepted: 05/12/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE Antiseizure medications (ASMs) are frequently used for other indications, such as migraine, pain syndromes, and psychiatric disorders. Possible teratogenic effects are therefore of wide concern and the risks imposed by the medications must be weighed against the risk with the disorder treated. It is our objective to update family practitioners on the implications of starting ASM for women with epilepsy during childbearing age. We hypothesized that clinicians would prescribe ASM based on avoiding teratogenesis and treating associated comorbidities simultaneously. METHODS The study cohort was derived from women veterans with epilepsy (WVWE) prescribed ASM who received Veterans Health Administration care for at least 3 years in Veterans Health Administration between fiscal years (FY)01 and FY19. Regimens were classified as monotherapy or polytherapy. Multivariant logistic regression examined the association between demographics, military characteristics, physical/psychiatric comorbidities, neurological care, and use of each ASM. RESULTS Among 2,283 WVWE, in ages between 17 and 45, the majority (61%) received monotherapy in FY19. Commonly prescribed ASM included 29% gabapentin, 27% topiramate, 20% lamotrigine, 16% levetiracetam, and 8% valproate (VPA). Comorbid diagnosis of headache predicted use of topiramate and VPA, bipolar disease predicted use of LMT and VPA, pain predicted gabapentin, and schizophrenia was associated with VPAs use. Women receiving levetiracetam and lamotrigine were significantly more likely to receive neurology care previously. CONCLUSION The presence of medical comorbidities influences the selection of ASM. VPAs use in WVWE during childbearing age continues, despite the high teratogenic risk, especially in women with bipolar disorder and headaches. Multidisciplinary care integrating family practice doctors, mental health, and neurology can prevent the enduring problem of teratogenesis in women taking ASM.
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Affiliation(s)
- Maria Raquel Lopez
- VA Epilepsy Centers of Excellence, Miami Veterans Health Care System, Miami, FL 33125, USA
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33125, USA
| | - Anne C VanCott
- VA Pittsburgh Healthcare System, University of Pittsburgh, University Drive C, Pittsburgh, PA 15240, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15240, USA
| | - Megan E Amuan
- Department of Medicine, Texas A&M Health Science Center, Bryan, TX 78229, USA
- Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, Bedford, MA 01730, USA
| | - Samin Panahi
- Division of Epidemiology, Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - Amy Henion
- Division of Epidemiology, Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - Mary Jo Pugh
- Division of Epidemiology, Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
- Internal Medicine, Division of Epidemiology, Research Career Scientist VA, Salt Lake City, UT 84132, USA
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23
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Tokatly Latzer I, Richmond TK, Zhang B, Pearl PL. Eating disorders occur at high rates in adolescents with epilepsy and are associated with psychiatric comorbidities and suicidality. Epilepsia 2023; 64:2982-2992. [PMID: 37611929 DOI: 10.1111/epi.17759] [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: 04/25/2023] [Revised: 07/09/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES To assess the occurrence rate, characteristics, and impact of eating disorders (EDs) in adolescents with epilepsy. METHODS In this observational study, adolescents with epilepsy seen in a single center between 2013 and 2022 who had comorbid EDs were compared to two control groups of adolescents with only epilepsy and only EDs. Patients with intellectual disability or autism spectrum disorder were excluded. Data retrieved included demographic and anthropometric details and clinical variables relating to seizure types, EDs, and psychiatric disorders and behaviors. RESULTS A total of 376 subjects were included in the study: 84 adolescents with both epilepsy and eating disorders, 135 with only epilepsy, and 157 with only EDs. The rate of EDs in adolescents with epilepsy was 7.0% (95% confidence interval [CI] 5.6%-8.5%) overall, 11.3% (95% CI 8.8%-14.3%) in females, and 3.1% (95% CI 1.9%-4.8%) in males. The median (interquartile range [IQR]) time difference between the onset of epilepsy to an ED was 1.6 (.5-3.6) years. Among adolescents with epilepsy, those with an ED were more likely to be female (p = .001) and have a lower body mass index z-score (zBMI) percentile (p < .001). Epilepsy type, seizure frequency, or seizure duration were not specific for having or not having EDs. Among adolescents with EDs, those with epilepsy had a younger onset of their EDs (p < .001), included relatively more males (p = .007), and consisted of more cases of anorexia-nervosa-restrictive type (p < .001), and fewer cases of bulimia nervosa (p = .04) and binge eating disorder (p = .003). Adolescents with epilepsy and a comorbid ED were more likely to have psychiatric comorbidities such as depression, anxiety, and suicidality than adolescents with only epilepsy or EDs. SIGNIFICANCE EDs should be suspected and screened for in intellectually intact female and male adolescents with epilepsy, irrespective of their epilepsy type. If disturbed eating behaviors or EDs are identified, further evaluation should be directed at detecting other psychopathologies, including suicidality.
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Affiliation(s)
- Itay Tokatly Latzer
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tracy K Richmond
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Phillip L Pearl
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Ben-Menachem E, Schmitz B, Kälviäinen R, Thomas RH, Klein P. The burden of chronic drug-refractory focal onset epilepsy: Can it be prevented? Epilepsy Behav 2023; 148:109435. [PMID: 37748414 DOI: 10.1016/j.yebeh.2023.109435] [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: 07/10/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/27/2023]
Abstract
Despite the many therapeutic options for epilepsy available today, a third of patients still have poorly controlled epilepsy. Over the years, their transition through lines of treatment exposes them to increased risk of disease progression, mortality, morbidity, mental distress, and not least significantly impaired quality of life (QoL). The present review explores the multiple factors contributing to the impairment of health-related QoL in PWE-including both seizure-related and non seizure-related. The analysis aims to identify potential areas of intervention and strategies for a more holistic approach to epilepsy care and inform policy-makers and healthcare providers in their approach to this condition.
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Affiliation(s)
| | - Bettina Schmitz
- Neurology/Center for Epilepsy, Stroke Unit and Neurological Rehabilitation, Vivantes Humboldt Hospital, Berlin, Germany.
| | | | - Rhys H Thomas
- Department of Neurology, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle-Upon-Tyne NE1 4LP, United Kingdom; Translational and Clinical Research Institute, Henry Wellcome Building, Framlington Place, Newcastle-Upon-Tyne NE2 4HH, United Kingdom.
| | - Pavel Klein
- Department of Neurology, George Washington University, Boston, United States.
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Winsor AA, Ebelthite C, Onih J, Nicholson TR, Pal DK, Richardson M. Study protocol for a case series: implementation and evaluation of an integrated mental and physical healthcare programme to screen for mental health symptoms in people with epilepsy. BMJ Open 2023; 13:e075043. [PMID: 37788926 PMCID: PMC10551954 DOI: 10.1136/bmjopen-2023-075043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION The prevalence of mental health symptoms in people with epilepsy (PWE) is elevated compared with that of the general population. These symptoms can negatively impact epilepsy management and patient outcomes but can be treated once recognised. It is, therefore, important to screen for these symptoms to identify needs and put in place appropriate support. Unfortunately, mental health symptoms are rarely addressed in epilepsy services due to time constraints, lack of resources and communication between psychological and medical professionals. These barriers can result in diagnostic overshadowing, where symptoms may be attributed to the disease and reduce the level of support PWE receive. Implementing an online screening tool embedded in the electronic health record (EHR) platform with supported referral pathways may remove some of these barriers. METHODS AND ANALYSIS We will follow the Integrating Mental and Physical Healthcare: Research Training and Services framework, which is a routine clinical data collection tool used by clinical teams to electronically screen psychological symptoms among patients with long-term physical health conditions. Patient outcomes including mental health, physical health and psychosocial outcomes will be collected and uploaded to the EHR platform in real-time. An appropriate referral pathway will be recommended depending on severity of the outcome scores. We will initially pilot the tool for individuals aged 13 years and above through epilepsy clinics at King's College Hospital. Following this, the acceptability and feasibility of the tool will be assessed at baseline, 6 and 12 months. ETHICS AND DISSEMINATION Ethics approval was obtained from the National Health Service Research Ethics Committee of South Central-Oxford C, reference: 21/EM/0205. This study is expected to inform the use of integrated electronic mental health screening for youth in epilepsy clinics and improve access to psychological support. The findings will be disseminated through academic peer-reviewed journals, poster presentations and scientific meetings.
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Affiliation(s)
- Alice Afua Winsor
- School of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, King's College london, London, UK
| | | | - Jemima Onih
- King's Health Partners, Mind & Body Programme, London, UK
| | - Timothy R Nicholson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Deb K Pal
- School of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, King's College london, London, UK
| | - Mark Richardson
- School of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, King's College london, London, UK
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Delgado-García G, Engbers JDT, Wiebe S, Mouches P, Amador K, Forkert ND, White J, Sajobi T, Klein KM, Josephson CB. Machine learning using multimodal clinical, electroencephalographic, and magnetic resonance imaging data can predict incident depression in adults with epilepsy: A pilot study. Epilepsia 2023; 64:2781-2791. [PMID: 37455354 DOI: 10.1111/epi.17710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE This study was undertaken to develop a multimodal machine learning (ML) approach for predicting incident depression in adults with epilepsy. METHODS We randomly selected 200 patients from the Calgary Comprehensive Epilepsy Program registry and linked their registry-based clinical data to their first-available clinical electroencephalogram (EEG) and magnetic resonance imaging (MRI) study. We excluded patients with a clinical or Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)-based diagnosis of major depression at baseline. The NDDI-E was used to detect incident depression over a median of 2.4 years of follow-up (interquartile range [IQR] = 1.5-3.3 years). A ReliefF algorithm was applied to clinical as well as quantitative EEG and MRI parameters for feature selection. Six ML algorithms were trained and tested using stratified threefold cross-validation. Multiple metrics were used to assess model performances. RESULTS Of 200 patients, 150 had EEG and MRI data of sufficient quality for ML, of whom 59 were excluded due to prevalent depression. Therefore, 91 patients (41 women) were included, with a median age of 29 (IQR = 22-44) years. A total of 42 features were selected by ReliefF, none of which was a quantitative MRI or EEG variable. All models had a sensitivity > 80%, and five of six had an F1 score ≥ .72. A multilayer perceptron model had the highest F1 score (median = .74, IQR = .71-.78) and sensitivity (84.3%). Median area under the receiver operating characteristic curve and normalized Matthews correlation coefficient were .70 (IQR = .64-.78) and .57 (IQR = .50-.65), respectively. SIGNIFICANCE Multimodal ML using baseline features can predict incident depression in this population. Our pilot models demonstrated high accuracy for depression prediction. However, overall performance and calibration can be improved. This model has promise for identifying those at risk for incident depression during follow-up, although efforts to refine it in larger populations along with external validation are required.
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Affiliation(s)
- Guillermo Delgado-García
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pauline Mouches
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kimberly Amador
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nils D Forkert
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James White
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Karl Martin Klein
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada
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Li C, Amin U, Rivera-Cruz A, Frontera AT, Benbadis SR. The Yield of Ambulatory Video-EEG: Predictors of Successful Event Capture. Neurol Clin Pract 2023; 13:e200194. [PMID: 37736066 PMCID: PMC10511269 DOI: 10.1212/cpj.0000000000200194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/11/2023] [Indexed: 09/23/2023]
Abstract
Background and Objectives The purpose of this study was to assess the likelihood of capturing a patient's typical event in question on ambulatory video-EEG monitoring (AVEM) based on certain baseline patient or event characteristics. Methods We retrospectively reviewed 300 studies that resulted between June 2021 and August 2022 ordered by adult epileptologists. Patients were included in event analysis if the study was ordered for the purpose of capturing an event (and excluded for all other purposes). Results A total of 149 studies were included in event analysis. Sixty-eight patients (46%) had their typical events captured on AVEM. Diagnosis was an epileptic seizure in 17 patients (25%), psychogenic nonepileptic seizure in 7 (10%), and other nonepileptic events in 44 (65%). Regarding event frequency, for patients who on average had daily events, 84% had events captured, which corresponds to a significantly increased odds ratio (OR 17.90, 95% CI 7.55-42.44, p < 0.001). For those who had events <1 per week to ≥1 per month, only 9% had events captured (OR 0.06, 95% CI 0.02-0.19, p < 0.001). No patients who had events less frequently than once per month had a diagnostic AVEM. Regarding the number of antiseizure medications (ASMs), the odds ratio was increased for those not on ASMs (OR 2.65, 95% CI 1.17 -6.03, p = 0.02) and decreased for those on 1 ASM (OR 0.28, 95% CI 0.13 -0.60, p = 0.001). There was no statistical significance based on event type (motor vs nonmotor), prior seizure diagnosis, history of psychiatric comorbidity, or presence of a focal brain lesion. Discussion Certain baseline characteristics can increase or decrease the pretest probability of capturing a typical event on AVEM, particularly the frequency of events and number of ASMs. This can be useful information for clinicians before ordering a study so that resources can be properly allocated.
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Affiliation(s)
- Caralynn Li
- Department of Neurology, University of South Florida Morsani College of Medicine
| | - Ushtar Amin
- Department of Neurology, University of South Florida Morsani College of Medicine
| | - Angelica Rivera-Cruz
- Department of Neurology, University of South Florida Morsani College of Medicine
| | - Alfred T Frontera
- Department of Neurology, University of South Florida Morsani College of Medicine
| | - Selim R Benbadis
- Department of Neurology, University of South Florida Morsani College of Medicine
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Morris G, Avoli M, Bernard C, Connor K, de Curtis M, Dulla CG, Jefferys JGR, Psarropoulou C, Staley KJ, Cunningham MO. Can in vitro studies aid in the development and use of antiseizure therapies? A report of the ILAE/AES Joint Translational Task Force. Epilepsia 2023; 64:2571-2585. [PMID: 37642296 DOI: 10.1111/epi.17744] [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: 06/06/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
In vitro preparations (defined here as cultured cells, brain slices, and isolated whole brains) offer a variety of approaches to modeling various aspects of seizures and epilepsy. Such models are particularly amenable to the application of anti-seizure compounds, and consequently are a valuable tool to screen the mechanisms of epileptiform activity, mode of action of known anti-seizure medications (ASMs), and the potential efficacy of putative new anti-seizure compounds. Despite these applications, all disease models are a simplification of reality and are therefore subject to limitations. In this review, we summarize the main types of in vitro models that can be used in epilepsy research, describing key methodologies as well as notable advantages and disadvantages of each. We argue that a well-designed battery of in vitro models can form an effective and potentially high-throughput screening platform to predict the clinical usefulness of ASMs, and that in vitro models are particularly useful for interrogating mechanisms of ASMs. To conclude, we offer several key recommendations that maximize the potential value of in vitro models in ASM screening. This includes the use of multiple in vitro tests that can complement each other, carefully combined with in vivo studies, the use of tissues from chronically epileptic (rather than naïve wild-type) animals, and the integration of human cell/tissue-derived preparations.
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Affiliation(s)
- Gareth Morris
- Division of Neuroscience, Faculty of Biology, Medicine and Health, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - Massimo Avoli
- Montreal Neurological Institute-Hospital and Departments of Neurology & Neurosurgery, McGill University, Montréal, Quebec, Canada
- Department of Physiology, McGill University, Montréal, Quebec, Canada
| | - Christophe Bernard
- Inserm, INS, Institut de Neurosciences des Systèmes, Aix Marseille Univ, Marseille, France
| | - Kate Connor
- Discipline of Physiology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Marco de Curtis
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chris G Dulla
- Department of Neuroscience, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - John G R Jefferys
- Department of Physiology, 2nd Medical School, Motol, Charles University, Prague, Czech Republic
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Caterina Psarropoulou
- Laboratory of Animal and Human Physiology, Department of Biological Applications and Technology, Faculty of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Kevin J Staley
- Neurology Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark O Cunningham
- Discipline of Physiology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
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Mazarati AM. Parsing neuronal circuits involved in comorbidities of epilepsy: A commentary on "Focal impaired awareness seizures in a rodent model: A functional anatomy". Epilepsia Open 2023; 8:726-727. [PMID: 37394945 PMCID: PMC10472351 DOI: 10.1002/epi4.12783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
- Andrey M. Mazarati
- Department of Pediatrics, David Geffen School of MedicineUniversity of California Los Angeles (DGSOM UCLA)Los AngelesCaliforniaUSA
- Children's Discovery and Innovation InstituteDGSOM UCLALos AngelesCaliforniaUSA
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Nadeem MD, Memon S, Qureshi K, Farooq U, Memon UA, Aparna F, Kachhadia MP, Shahzeen F, Ali S, Varrassi G, Kumar L, Kumar S, Kumar S, Khatri M. Seizing the Connection: Exploring the Interplay Between Epilepsy and Glycemic Control in Diabetes Management. Cureus 2023; 15:e45606. [PMID: 37868449 PMCID: PMC10588297 DOI: 10.7759/cureus.45606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Epilepsy, a neurological disorder characterized by recurrent seizures, and diabetes, a metabolic disorder characterized by impaired regulation of glucose levels, are two distinct conditions that may appear unrelated at first glance. Nevertheless, recent scholarly investigations have revealed these entities' intricate and ever-evolving interplay. This review initially delves into the intricate interplay between epilepsy and its potential ramifications on glycemic control. Seizures, particularly those accompanied by convulsive manifestations, have the potential to induce acute perturbations in blood glucose levels via diverse mechanisms, encompassing the liberation of stress hormones, the emergence of insulin resistance, and the dysregulation of the autonomic nervous system. Comprehending these intricate mechanisms is paramount in customizing productive strategies for managing diabetes in individuals with epilepsy. On the contrary, it is worth noting that diabetes can substantially impact the trajectory and control of epilepsy. The correlation between hyperglycemia and an elevated susceptibility to seizures, as well as the potential for exacerbating the intensity of epilepsy, has been established. This narrative review offers a concise exposition of the intricate interplay between epilepsy and glycemic control within diabetes management. The objective of exploring reciprocal influences, underlying mechanisms, and common risk factors is to augment the clinical comprehension of this intricate interconnection. In essence, this acquired knowledge possesses the potential to serve as a guiding compass for healthcare professionals, enabling them to craft bespoke therapeutic approaches that enhance the holistic welfare of individuals grappling with the coexistence of epilepsy and diabetes.
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Affiliation(s)
| | - Siraj Memon
- Medicine, Liaquat University of Medical & Health Sciences, Jamshoro, PAK
| | - Kashifa Qureshi
- Medicine, Liaquat University of Medical & Health Sciences, Jamshoro, PAK
| | - Umer Farooq
- Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Unaib Ahmed Memon
- Neurology and Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Fnu Aparna
- Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | | | - Fnu Shahzeen
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Sameer Ali
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | | | - Lakshya Kumar
- General Medicine, Pandit Deendayal Upadhyay Medical College, Rajkot, IND
| | - Sumeet Kumar
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
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Sarkisova KY, Gabova AV, Fedosova EA, Shatskova AB, Narkevich VB, Kudrin VS. Antidepressant and Anxiolytic Effects of L-Methionine in the WAG/Rij Rat Model of Depression Comorbid with Absence Epilepsy. Int J Mol Sci 2023; 24:12425. [PMID: 37569798 PMCID: PMC10419169 DOI: 10.3390/ijms241512425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Depression is a severe and widespread psychiatric disease that often accompanies epilepsy. Antidepressant treatment of depression comorbid with epilepsy is a major concern due to the risk of seizure aggravation. SAMe, a universal methyl donor for DNA methylation and the synthesis of brain monoamines, is known to have high antidepressant activity. This study aimed to find out whether L-methionine (L-MET), a precursor of SAMe, can have antidepressant and/or anxiolytic effects in the WAG/Rij rat model of depression comorbid with absence epilepsy. The results indicate that L-MET reduces the level of anxiety and depression in WAG/Rij rats and suppresses associated epileptic seizures, in contrast to conventional antidepressant imipramine, which aggravates absence seizures. The antidepressant effect of L-MET was comparable with that of the conventional antidepressants imipramine and fluoxetine. However, the antidepressant profile of L-MET was more similar to imipramine than to fluoxetine. Taken together, our findings suggest that L-MET could serve as a promising new antidepressant drug with anxiolytic properties for the treatment of depression comorbid with absence epilepsy. Increases in the level of monoamines and their metabolites-DA, DOPAC, HVA, NA, and MHPG-in several brain structures, is suggested to be a neurochemical mechanism of the beneficial phenotypic effect of L-MET.
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Affiliation(s)
- Karine Yu. Sarkisova
- Institute of Higher Nervous Activity and Neurophysiology of Russian Academy of Sciences, Butlerova Str. 5A, Moscow 117485, Russia; (A.V.G.); (E.A.F.); (A.B.S.)
| | - Alexandra V. Gabova
- Institute of Higher Nervous Activity and Neurophysiology of Russian Academy of Sciences, Butlerova Str. 5A, Moscow 117485, Russia; (A.V.G.); (E.A.F.); (A.B.S.)
| | - Ekaterina A. Fedosova
- Institute of Higher Nervous Activity and Neurophysiology of Russian Academy of Sciences, Butlerova Str. 5A, Moscow 117485, Russia; (A.V.G.); (E.A.F.); (A.B.S.)
| | - Alla B. Shatskova
- Institute of Higher Nervous Activity and Neurophysiology of Russian Academy of Sciences, Butlerova Str. 5A, Moscow 117485, Russia; (A.V.G.); (E.A.F.); (A.B.S.)
| | - Victor B. Narkevich
- Federal State Budgetary Institution “Scientific Research Institute of Pharmacology named after V.V. Zakusov”, Baltiyskaya Str. 8, Moscow 125315, Russia; (V.B.N.); (V.S.K.)
| | - Vladimir S. Kudrin
- Federal State Budgetary Institution “Scientific Research Institute of Pharmacology named after V.V. Zakusov”, Baltiyskaya Str. 8, Moscow 125315, Russia; (V.B.N.); (V.S.K.)
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Rauh R, Domschke K, Hirsch M, Schulze-Bonhage A. Listening to anxiety in persons with epilepsy. Development of an integrative assessment model based on qualitative interviews. Epilepsy Behav 2023; 145:109319. [PMID: 37406558 DOI: 10.1016/j.yebeh.2023.109319] [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: 04/22/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE The differentiation and assessment of anxiety in persons with epilepsy is the subject of current research. There is no consensus on which forms of anxiety are epilepsy-specific, what pathological significance they have, and how they should be conceptually systematized. The aim of this study was to detect formal landmarks that organize and further distinguish the clinical multitude of epilepsy-related anxiety, thereby establishing a basis on which an integrative assessment of epilepsy-specific fears can be developed. METHOD Twenty-six patients with epilepsy-related fears were recruited for qualitative interviews at the Epilepsy Center of Freiburg in Germany. Prevalent types of anxiety included both periictal and interictal anxiety. Patients reported how living with epilepsy is associated with anxiety and to what extent. After an open interview, semi-structured questions were asked concerning epilepsy-specific anxiety, referring to established concepts and items. The contents of the interviews relating to anxiety were transcribed. RESULTS The reported fears associated with epilepsy reflect the individual "pathography" of each patient. The potentially anxiety-inducing events within this pathography include the first seizure(s), especially in cases involving the amygdalae; the process of diagnostic procedures; therapy, including side effects of antiseizure medication, surgery as a therapeutic option, or a difficult physician-patient relationship; and the further course of the disease, including the fear of disease progression with brain damage, cognitive deterioration, or professional and social disintegration. The integrative assessment model derived from the pathography of the interviewed patients thus reflects the dynamics and quality of epilepsy-specific fears, especially in relation to the healthcare system, without instantly pathologizing them. It highlights that anxiety, to a variable degree, is perceived as an adequate and comprehensible emotion and might be a problem long before the diagnosis is made in the case of ictal fear. Furthermore, anxiety symptoms may (re-)emerge, consolidate, modulate, diminish, or even aggravate during the course of the disease. The integrative assessment model maps crucial events inherent to the healthcare system that may become relevant as objects of prevention, intervention, and therapy. CONCLUSION The integrative assessment model can serve as a heuristic framework from which an integrative self-report questionnaire of epilepsy-specific anxiety might be designed. On the one hand, this would help to better understand the interrelation between epilepsy and anxiety in terms of their temporal occurrence and interdependence scientifically. On the other hand, it would allow for the enhancement of individual preventive and therapeutic measures for affected patients.
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Affiliation(s)
- Raphael Rauh
- Medical Center - University of Freiburg, Department of Neurosurgery, Freiburg Epilepsy Center, Breisacher Str. 64, 79106 Freiburg, Germany; Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Hauptstraße 5, 79104 Freiburg, Germany.
| | - Katharina Domschke
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Hauptstraße 5, 79104 Freiburg, Germany
| | - Martin Hirsch
- Medical Center - University of Freiburg, Department of Neurosurgery, Freiburg Epilepsy Center, Breisacher Str. 64, 79106 Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Medical Center - University of Freiburg, Department of Neurosurgery, Freiburg Epilepsy Center, Breisacher Str. 64, 79106 Freiburg, Germany
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Gidal BE, Rehman R, Tran T, Karasov A. Patterns of psychotropic drug use in veterans with epilepsy: Do drug interactions matter? Epilepsy Behav 2023; 145:109335. [PMID: 37429123 DOI: 10.1016/j.yebeh.2023.109335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 07/12/2023]
Abstract
RATIONALE Patients with epilepsy are likely to suffer from psychiatric comorbidities, including depression and anxiety. They often require treatment with multiple psychotropic drugs (PDs). While it is clear that CYP-inducing ASMs (EIASMs) can increase the oral clearance of multiple medications (thus lowering systemic exposure), it is less clear that all PK interactions are clinically meaningful (e.g. lower efficacy). As a first step in addressing this issue, this study sought to quantify the potential impact of ASM choice, whether EIASM or non-inducer (NIASM), on surrogate markers of suggestive of clinical use, including resultant antidepressant (AD) or antipsychotic (AP) dose, frequency of combination use of AD & AP, and number of multiple drug switches of PDs. Our hypothesis is that because of PK interactions, EIAED treatment would be associated with higher psychotropic drug doses, more frequent Rx adjustments and poly psychotropic comedication, all in order to optimize therapeutic response. METHODS Using VA pharmacy and national encounter databases, veterans with epilepsy were identified based on having a seizure diagnosis and being prescribed concomitantly an ASM and a psychotropic drug for at least 365 days between 10/1/2010 and 9/30/2014. Patients for whom psychotropic drugs were prescribed any time between beginning and end prescriptions dates of ASMs were considered. Among those, patients receiving both an EIASM + NEIASM concomitantly were categorized with the EIASM group. Patients were evaluated for AD only, AP only and both (AD & AP). To compute average drug doses per day, averages for each patient were computed and averaged again. Multiple drug switches were defined to be for patients who had been prescribed more than three psychotropic drugs during the observation period. Pearson's Chi-Square test was used to compare relative proportions of AD, AP and AD + AP in both groups. RESULTS In all, 16,188 patients were identified (57.0% on EIASM, 43.0% on NIASM) with a mean age of 58.7 years (91.2% male). A larger proportion of patients on EIASM received mono treatment with any psychotropic drug, as compared to NIASM (42.0% vs 36.1%). Among all, 59.6% received AD only, 6.5% received AP only, and 33.8% received both concurrently. Of EIASM, 62.5% were on AD, 5.9% on AP, and 31.7% on both AP & AD. For NIASM, 55.9% received AD, 7.4% AP, and 36.7% on AD & AP.Chi-square showed that the distribution of PD was statistically different between EIASM and NIASM groups. Z tests showed that each difference (AD, AP and both) in proportions was statistically significant (p values (4 tests, one Chi-square, 3 Z tests <0.001) between EIASM vs NIASM. Interestingly, mean doses of AD or AP did not appear to differ between ASM groups. CONCLUSIONS Concurrent psychotropic drug use is quite common in the VA population with epilepsy, and a large number of patients still receive enzyme-inducing ASMs that may complicate other medical therapies. Interestingly, in seeming contradiction to our hypothesis, mean daily doses of either AD or AP did not appear to differ between inducers vs non-inducers. Similarly, use of polytherapy, and/or multiple trials of various psychotropic drugs did not appear increased in the CYP-induced group. In fact, combination therapy of AD + AP was higher in NIASM than EIASM. These data suggest that perhaps these types of PK interactions may not in fact result in meaningful clinical differences. Since the present analyses did not include clinical psychiatric measures, future analyses examining direct clinical outcomes are clearly warranted.
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Affiliation(s)
- Barry E Gidal
- University of Wisconsin Madison School of Pharmacy, Madison, WI, USA.
| | - Rizwana Rehman
- Durham VA Medical Center, Southeast Epilepsy Center of Excellence, Durham, NC, USA.
| | - Tung Tran
- Durham VA Medical Center, Southeast Epilepsy Center of Excellence, Durham, NC, USA.
| | - Ariela Karasov
- Wm.S Middleton Memorial VA, Department of Psychiatry, Madison, WI, USA.
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Samsonsen C, Mestvedthagen G, Uglem M, Brodtkorb E. Disentangling the cascade of seizure precipitants: A prospective observational study. Epilepsy Behav 2023; 145:109339. [PMID: 37413785 DOI: 10.1016/j.yebeh.2023.109339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The management of epilepsy includes appropriate antiseizure medication (ASM) treatment and careful avoidance of seizure precipitating factors. Seizure precipitants may be multiple occurring with low intensity adding to each other, thus leaving essential elements unrecognized. The aim of this study was to reveal the patients' subjective perceptions of the most important factors and to compare them with standardized measurements. METHODS The study included 152 acute hospital admissions for seizures. The patients were asked to score the impact of various seizure precipitants as perceived by themselves on a visual analogue scale (VAS). The following items related to seizure occurrence were quantified: sleep deprivation by sleep diaries, ASM adherence by therapeutic drug monitoring, the Alcohol Use Identification Test, and the Hospital Anxiety and Depression Scale. Statistical analyses, including multiple regression, were performed to discover relationships between various parameters. RESULTS The interaction of the various factors was high. The association between lack of sleep and hazardous drinking and anxiety was highly significant. Perceived stress correlated well with anxiety and depression. Relatively low VAS scores for missed medication in patients with identified non-adherence suggest that insufficient patient awareness is common. Low VAS-scores for alcohol in patients with harmful drinking also suggest low acknowledgment of alcohol-related seizures. High alcohol scores were associated with sleep deprivation, anxiety and depression. CONCLUSION The circumstances leading to an epileptic seizure are complex. Stress, sleep loss, alcohol intake, and missed medication are among the most commonly reported seizure precipitants. They are often combined, and various facets of the same underlying cause may be at play. Their sequence and relative impact are often difficult to establish. Improved understanding of the cascade of events preceding a seizure can improve comprehensive personalized management of uncontrolled epilepsy.
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Affiliation(s)
- Christian Samsonsen
- Department of Neurology and Clinical Neurophysiology, St.Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Guro Mestvedthagen
- Faculty of Medicine and Health Sciences Norwegian University of Science and Technology, Trondheim, Norway.
| | - Martin Uglem
- Department of Neurology and Clinical Neurophysiology, St.Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Eylert Brodtkorb
- Department of Neurology and Clinical Neurophysiology, St.Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
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Oke O, Johnson BO, Chida S, Kekere V, Azim S. Psychosis as a Manifestation of Focal Impaired Awareness Seizure in a Geriatric Patient. Cureus 2023; 15:e41838. [PMID: 37575753 PMCID: PMC10423062 DOI: 10.7759/cureus.41838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Focal impaired awareness seizures (FIAS), previously known as complex partial seizures, refer to focal seizures that start in one hemisphere of the brain and are associated with an impairment in consciousness. FIAS of temporal lobe origin most often present with psychopathology, such as behavioral and affective symptoms. It has a bimodal age distribution peaking at the extremes of life. Geriatric presentations can often be subtle and go unnoticed asides from a few symptoms, such as confusion and memory lapses. Here, we present a unique case of a geriatric patient with FIAS presenting as transient psychosis.
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Affiliation(s)
- Oluwaseun Oke
- Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, USA
| | - Bamidele O Johnson
- Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, USA
| | - Shahzad Chida
- Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, USA
| | - Victor Kekere
- Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, USA
| | - Shiraz Azim
- Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, USA
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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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Revdal E, Kolstad BP, Winsvold BS, Selmer KK, Morken G, Brodtkorb E. Psychiatric comorbidity in relation to clinical characteristics of epilepsy: A retrospective observational study. Seizure 2023; 110:136-143. [PMID: 37379699 DOI: 10.1016/j.seizure.2023.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Abstract
PURPOSE Prevalence of psychiatric disorders in people with epilepsy is high. However, diagnostic validity and information about the nature of the seizure disorders are often poor in population-based studies. In a well validated and classified patient sample, we investigated psychiatric comorbidity according to clinical characteristics. METHOD Participants in The Trøndelag Health Study (HUNT) with ≥ 2 diagnostic epilepsy codes during 1987-2019 were identified. Medical records were reviewed, and epilepsy was validated and classified according to ILAE. Psychiatric comorbidity was defined by ICD-codes. RESULTS In 448 individuals with epilepsy, 35% had at least one psychiatric disorder (anxiety and related disorders 23%, mood disorders 15%, substance abuse and personality disorders 7%, and psychosis 3%). Comorbidity was significantly higher in women than in men (p = 0.007). The prevalence of psychiatric disorders was 37% in both focal and generalized epilepsy. In focal epilepsy, it was significantly lower when etiology was structural (p = 0.011), whereas it was higher when the cause was unknown (p = 0.024). Comorbidity prevalence was 35% both in patients achieving seizure freedom and in those with active epilepsy but 38% among 73 patients with epilepsy resolved. CONCLUSION Just over one third of people with epilepsy had psychiatric comorbidities. The prevalence was equal in focal and generalized epilepsy but was significantly higher in focal epilepsy of unknown cause compared to lesional epilepsy. Comorbidity was independent of seizure control at last follow-up but was slightly more common in those with resolved epilepsy, often having non-acquired genetic etiologies possibly linked to neuropsychiatric susceptibility.
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Affiliation(s)
- Eline Revdal
- Department of Neurology and Clinical Neurophysiology, St. Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim N-7491, Norway.
| | - Bjørn Patrick Kolstad
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bendik Slagsvold Winsvold
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway; Department of Neurology, Oslo University Hospital, Oslo, Norway; Department of Public Health and Nursing, NTNU, K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kaja Kristine Selmer
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway; Division of Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Gunnar Morken
- Department of Psychiatry, St Olav University Hospital, Trondheim, Norway; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eylert Brodtkorb
- Department of Neurology and Clinical Neurophysiology, St. Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim N-7491, Norway
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Javaid S, Alqahtani F, Ashraf W, Anjum SMM, Rasool MF, Ahmad T, Alasmari F, Alasmari AF, Alqarni SA, Imran I. Tiagabine suppresses pentylenetetrazole-induced seizures in mice and improves behavioral and cognitive parameters by modulating BDNF/TrkB expression and neuroinflammatory markers. Biomed Pharmacother 2023; 160:114406. [PMID: 36791567 DOI: 10.1016/j.biopha.2023.114406] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Tiagabine (Tia), a new-generation antiseizure drug that mimics the GABAergic signaling by inhibiting GABA transporter type-1, is the least studied molecule in chronic epilepsy models with comorbid neurobehavioral and neuroinflammatory parameters. Therefore, the current study investigated the effects of Tia in a real-time manner on electroencephalographic (EEG) activity, behavioral manifestations and mRNA expression in pentylenetetrazole (PTZ)-kindled mice. Male BALB/c mice were treated with tiagabine (0.5, 1 and 2 mg/kg) for 21 days with simultaneous PTZ (40 mg/kg) injection every other day for a total of 11 injections and monitored for seizure progression with synchronized validation through EEG recordings from cortical electrodes. The post-kindling protection from anxiety and memory deficit was verified by a battery of behavioral experiments. Isolated brains were evaluated for oxidative alterations and real-time changes in mRNA expression for BDNF/TrkB, GAT-1 and GAT-3 as well as neuroinflammatory markers. Experimental results revealed that Tia at the dose of 2 mg/kg maximally inhibited the development of full bloom seizure and reduced epileptic spike discharges from the cortex. Furthermore, Tia dose-dependently exerted the anxiolytic effects and protected from PTZ-evoked cognitive impairment. Tia reduced lipid peroxidation and increased superoxide dismutase and glutathione levels in the brain via augmentation of GABAergic modulation. PTZ-induced upregulated BDNF/TrkB signaling and pro-inflammatory cytokines were mitigated by Tia with upregulation of GAT-1 and GAT-3 transporters in whole brains. In conclusion, the observed effects of Tia might have resulted from reduced oxidative stress, BDNF/TrkB modulation and mitigated neuroinflammatory markers expression leading to reduced epileptogenesis and improved epilepsy-related neuropsychiatric effects.
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Affiliation(s)
- Sana Javaid
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; Department of Pharmacy, The Women University, Multan 60000, Pakistan
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Waseem Ashraf
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Syed Muhammad Muneeb Anjum
- The Institute of Pharmaceutical Sciences, University of Veterinary & Animal Sciences, Lahore 75270, Pakistan
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Tanveer Ahmad
- Institut pour l'Avancée des Biosciences, Centre de Recherche UGA / INSERM U1209 / CNRS 5309, Université Grenoble Alpes, France
| | - Fawaz Alasmari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Abdullah F Alasmari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Saleh Abdullah Alqarni
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan.
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Perez DL, Hoch DB, Cohen JN. Case 10-2023: A 27-Year-Old Man with Convulsions. N Engl J Med 2023; 388:1210-1218. [PMID: 36988597 DOI: 10.1056/nejmcpc2211365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- David L Perez
- From the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Massachusetts General Hospital, and the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Harvard Medical School - both in Boston
| | - Daniel B Hoch
- From the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Massachusetts General Hospital, and the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Harvard Medical School - both in Boston
| | - Jonah N Cohen
- From the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Massachusetts General Hospital, and the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Harvard Medical School - both in Boston
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Zinchuk M, Kustov G, Pashnin E, Rider F, Sviatskaya E, Popova S, Voinova N, Yakovlev A, Guekht A. Self-injurious thoughts and behaviors in Russian patients with epilepsy: A prospective observational study. Seizure 2023; 107:28-34. [PMID: 36940646 DOI: 10.1016/j.seizure.2023.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE A two-stage study aimed to estimate the prevalence of different types of self-injurious behaviors (suicidal ideation (SI), suicide attempts (SA), and nonsuicidal self-injury (NSSI)) in Russian patients with epilepsy (PWE), to identify factors associated with such behaviors, and to assess their impact on 3-year mortality. METHODS We enrolled 459 consecutive adult PWE from two level 2 outpatient epilepsy centers in Moscow. The study consisted of two phases - first, we assessed all demographic and clinical characteristics and patients' history of SI, SA, and NSSI. In the second phase, three years after the initial screening, we analyzed patients' medical records to assess how self-injurious thoughts and behaviors were related to actual mortality. RESULTS In our sample, the total lifetime and 12-month prevalence of SI was 20% and 5.7%, of SA was 8.3% and 0.7%, and of NSSI was 15.3% and 2.8%, respectively. We found no differences between deceased and alive PWE regarding lifetime and 12-month prevalence of SI, SA, and NSSI. Higher seizure frequency, lifetime NSSI and lifetime diagnosis of mental disorder were associated with SI, whereas traumatic brain injury (TBI), substance abuse, and NSSI were associated with SA in PWE. SIGNIFICANCE Our study adds to the existing data on the prevalence of different types of suicidal behaviors in PWE and advances research on NSSI in this population. However, more research is needed on the long-term consequences of different types of self-injurious behaviors.
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Affiliation(s)
- Mikhail Zinchuk
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation.
| | - Georgii Kustov
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Evgenii Pashnin
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Flora Rider
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | | | - Sofya Popova
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Nadezhda Voinova
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Alexander Yakovlev
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation; Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Alla Guekht
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation; Pirogov Russian National Research Medical University, Moscow, Russian Federation
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Li G, Wang M, Zheng M, Liu X, Yu T, Ren J, Wang Q. Causal effect of psychiatric disorders on epilepsy: A two-sample Mendelian randomization study. Brain Behav 2023; 13:e2939. [PMID: 36860142 PMCID: PMC10097067 DOI: 10.1002/brb3.2939] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND This study aims to explore the relationship between psychiatric disorders and the risk of epilepsy using Mendelian randomization (MR) analysis. METHODS We collected summary statistics of seven psychiatric traits from recent largest genome-wide association study (GWAS), including major depressive disorder (MDD), anxiety disorder, autism spectrum disorder (ASD), bipolar disorder (BIP), attention deficit hyperactivity disorder (ADHD), schizophrenia (SCZ), and insomnia. Then, MR analysis estimates were performed based on International League Against Epilepsy (ILAE) consortium data (ncase = 15,212 and ncontrol = 29,677), the results of which were subsequently validated in FinnGen consortium (ncase = 6260 and ncontrol = 176,107). Finally, a meta-analysis was conducted based on the ILAE and FinnGen data. RESULTS We found significant causal effects of MDD and ADHD on epilepsy in the meta-analysis of the ILAE and FinnGen, with corresponding odds ratios (OR) of 1.20 (95% CI 1.08-1.34, p = .001) and 1.08 (95% CI 1.01-1.16, p = .020) by the inverse-variance weighted (IVW) method respectively. MDD increases the risk of focal epilepsy while ADHD has a risk effect on generalized epilepsy. No reliable evidence regarding causal effects of other psychiatric traits on epilepsy was identified. CONCLUSIONS This study suggests that major depressive disorder and attention deficit hyperactivity disorder may causally increase the risk of epilepsy.
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Affiliation(s)
- Gongfei Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Minghui Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Meiqi Zheng
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tingting Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiechuan Ren
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
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Voronkova KV, Alieva AM, Nikitin IG, Musina GM, Surskaya EV, Zaitseva OS, Mashkevich NG, Gomonova LV, Petrukhin AS. [The role of the phenosanic acid in the combined treatment of patients with epilepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:151-157. [PMID: 36843473 DOI: 10.17116/jnevro2023123021151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Epilepsy is one of the most studied chronic neurological disorders in the world. Despite significant progress in epilepsy research, some patients continue to experience recurrent seizures. It has been proven that oxidative stress plays an important role in epilepsy. Targeting oxidative stress may provide a novel therapeutic intervention to attenuate epileptogenesis as well as cognitive and psychiatric impairment in patients with epilepsy. One of the promising directions in the search for new strategies for the treatment of epilepsy is the combined use of antiepileptic drugs with antioxidants that affect the pathogenetic links of this disease. The new Russian antiepileptic drug fenosanoic acid (Dibufelon) has an anticonvulsant effect due to the inhibition of lipid peroxidation of brain cells and the reconstruction of cell membranes. This mechanism of action also paves the way for an increase in the effectiveness of co-administered drugs with phenosanoic acid. The effect of the drug on the cognitive and mental functions of patients, the regression of asthenia phenomena is also observed. The clinical efficacy and safety of the combination of this drug with other antiepileptic drugs in epilepsy has been demonstrated in experimental and clinical studies.
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Affiliation(s)
- K V Voronkova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Petrovsky Russian Scientific Center for Surgery, Moscow, Russia
| | - A M Alieva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - I G Nikitin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - G M Musina
- Medical Center NORIS, Sterlitamak, Russia
| | - E V Surskaya
- Petrovsky Russian Scientific Center for Surgery, Moscow, Russia
| | - O S Zaitseva
- Petrovsky Russian Scientific Center for Surgery, Moscow, Russia
| | - N G Mashkevich
- Petrovsky Russian Scientific Center for Surgery, Moscow, Russia
| | - L V Gomonova
- Petrovsky Russian Scientific Center for Surgery, Moscow, Russia
| | - A S Petrukhin
- Pirogov Russian National Research Medical University, Moscow, Russia
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Mavragani A, Tchao D, Lewis-Fung S, Pardini S, Harris LR, Appel L. Virtual Reality Therapy for People With Epilepsy and Related Anxiety: Protocol for a 3-Phase Pilot Clinical Trial. JMIR Res Protoc 2023; 12:e41523. [PMID: 36692939 PMCID: PMC9906303 DOI: 10.2196/41523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Anxiety is one of the most common psychiatric comorbidities in people with epilepsy and often involves fears specifically related to the condition, such as anxiety related to the fear of having another seizure. These epilepsy- or seizure-related fears have been reported as being more disabling than the seizures themselves and significantly impact quality of life. Although research has suggested that exposure therapy (ET) is helpful in decreasing anxiety in people with epilepsy, no research to our knowledge has been conducted on ET in people with epilepsy using virtual reality (VR). The use of novel technologies such as an immersive VR head-mounted display for ET in this population offers several benefits. Indeed, using VR can increase accessibility for people with epilepsy with transportation barriers (eg, those who live outside urban centers or who have a suspended driver's license owing to their condition), among other advantages. In the present research protocol, we describe the design of an innovative VR-ET program administered in the home that focuses on decreasing anxiety in people with epilepsy, specifically anxiety related to their epilepsy or seizures. OBJECTIVE Our primary objective is to examine the feasibility of the study protocol and proposed treatment as well as identify suggestions for improvement when designing subsequent larger clinical trials. Our secondary objective is to evaluate whether VR-ET is effective in decreasing anxiety in a pilot study. We hypothesize that levels of anxiety in people with epilepsy will decrease from using VR-ET. METHODS This mixed methods study comprises 3 phases. Phase 1 involves engaging with those with lived experience through a web-based questionnaire to validate assumptions about anxiety in people with epilepsy. Phase 2 involves filming videos using a 360° camera for the VR-ET intervention (likely consisting of 3 sets of scenes, each with 3 intensity levels) based on the epilepsy- and seizure-related fears most commonly reported in the phase 1 questionnaire. Finally, phase 3 involves evaluating the at-home VR-ET intervention and study methods using a series of validated scales, as well as semistructured interviews. RESULTS This pilot study was funded in November 2021. Data collection for phase 1 was completed as of August 7, 2022, and had a final sample of 18 participants. CONCLUSIONS Our findings will add to the limited body of knowledge on anxiety in people with epilepsy and the use of VR in this population. We anticipate that the insights gained from this study will lay the foundation for a novel and accessible VR intervention for this underrecognized and undertreated comorbidity in people with epilepsy. TRIAL REGISTRATION ClinicalTrials.gov NCT05296057; https://clinicaltrials.gov/ct2/show/NCT05296057. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41523.
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Affiliation(s)
| | | | | | - Susanna Pardini
- OpenLab, University Health Network, Toronto, ON, Canada.,Department of General Psychology, University of Padova, Padova, Italy.,Digital Health Lab, Centre for Health and Wellbeing, Bruno Kessler Foundation, Trento, Italy
| | | | - Lora Appel
- OpenLab, University Health Network, Toronto, ON, Canada.,School of Health Policy & Management, York University, Toronto, ON, Canada.,Michael Garron Hospital, Toronto, ON, Canada
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Villanueva V, Artal J, Cabeza-Alvarez CI, Campos D, Castillo A, Flórez G, Franco-Martin M, García-Portilla MP, Giráldez BG, Gotor F, Gutiérrez-Rojas L, Albanell AM, Paniagua G, Pintor L, Poza JJ, Rubio-Granero T, Toledo M, Tortosa-Conesa D, Rodríguez-Uranga J, Bobes J. Proposed Recommendations for the Management of Depression in Adults with Epilepsy: An Expert Consensus. Neurol Ther 2023; 12:479-503. [PMID: 36692706 PMCID: PMC10043101 DOI: 10.1007/s40120-023-00437-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Experts agree that there is a need for protocols to guide health professionals on how to best manage psychiatric comorbidities in patients with epilepsy (PWE). We aimed to develop practical recommendations for key issues in the management of depression in PWE. METHODS This was a qualitative study conducted in four steps: (1) development of a questionnaire on the management of depression in PWE to be answered; (2) literature review and, if evidence from guidelines/consensus or systematic reviews was available, drafting initial recommendations; (3) a nominal group methodology for reviewing initial recommendations and formulating new recommendations on those issues without available evidence; and (4) drafting and approving the final recommendations. A scientific committee (one neurologist and one psychiatrist) was responsible for the development of the project and its scientific integrity. The scientific committee selected a panel of experts (nine neurologists and nine psychiatrists with experience in this field) to be involved in the nominal group meetings and to formulate final recommendations. RESULTS Fifteen recommendations were formulated. Four on the screening and diagnosis: screening and diagnosis of depression, evaluation of the risk of suicide, and diagnosis of depression secondary to epilepsy; nine on the management of depression: referral to a psychiatrist, selection of the antiseizure medication, change of antiseizure medication, antidepressant treatment initiation, selection of antidepressant, use of antidepressants during pregnancy, use of psychotherapy, antidepressant treatment duration, and discontinuation of antidepressant treatment; two on the follow-up: duration of the follow-up under usual conditions, and follow-up of patients at risk of suicide. CONCLUSION We provide recommendations based on expert opinion consensus to help healthcare professionals assess depression in PWE. The detection and treatment of major depressive disorders are key factors in improving epilepsy outcomes and avoiding suicide risk.
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Affiliation(s)
- Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Jesús Artal
- Psychiatry Department, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Spain.
| | | | - Dulce Campos
- Neurology Department, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Ascensión Castillo
- Neurology Department, Consorcio Hospital General Universitario Valencia, Valencia, Spain
| | - Gerardo Flórez
- Psychiatry Department, Addiction Treatment Unit, Orense, Spain
| | - Manuel Franco-Martin
- Psychiatry Department, Zamora Hospital (Complejo Asistencial de Zamora), Zamora, Spain
| | - María Paz García-Portilla
- Psychiatry Department, University of Oviedo, ISPA, CIBERSAM, INEUROPA, and Mental Health Services of Principality of Asturias, Oviedo, Spain
| | - Beatriz G Giráldez
- Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Francisco Gotor
- Psychiatry Department, School of Medicine, University Hospital Virgen del Rocio, Seville, Spain
| | | | | | - Gonzalo Paniagua
- Psychiatry Department, University of Oviedo, Oviedo, Spain.,Mental Health Services of Principado de Asturias, SESPA, Oviedo, Spain
| | - Luis Pintor
- Psychiatry Department, Hospital Clínico of Barcelona, Barcelona, Spain
| | - Juan José Poza
- Neurology Department, Hospital Universitario Donostia, Donostia, Spain
| | - Teresa Rubio-Granero
- Psychiatry Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Manuel Toledo
- Epilepsy Unit, Vall D'Hebron University Hospital, Barcelona, Spain
| | - Diego Tortosa-Conesa
- Neurology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Julio Bobes
- Medicine-Psychiatry, Universidad de Oviedo, Oviedo, Spain
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Tchao D, Lewis-Fung S, Gray H, Pardini S, Harris LR, Appel L. Describing epilepsy-related anxiety to inform the design of a virtual reality exposure therapy: Results from Phase 1 of the AnxEpiVR clinical trial. Epilepsy Behav Rep 2023; 21:100588. [PMID: 36794093 PMCID: PMC9922786 DOI: 10.1016/j.ebr.2023.100588] [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: 10/16/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
People with epilepsy (PwE) are at a greater risk of comorbid anxiety, which is often related to the fear of having another seizure for safety or social reasons. While virtual reality (VR) exposure therapy (ET) has been successfully used to treat several anxiety disorders, no studies to date have investigated its use in this population. This paper discusses Phase 1 of the three-phase AnxEpiVR pilot study. In Phase 1, we aimed to explore and validate scenarios that provoke epilepsy/seizure-specific (ES) interictal anxiety and provide recommendations that lay the foundation for designing VR-ET scenarios to treat this condition in PwE. An anonymous online questionnaire (including open- and closed-ended questions) that targeted PwE and those affected by it (e.g., through a family member, friend, or as a healthcare professional) was promoted by a major epilepsy foundation in Toronto, Canada. Responses from n = 18 participants were analyzed using grounded theory and the constant comparison method. Participants described anxiety-provoking scenes, which were categorized under the following themes: location, social setting, situational, activity, physiological, and previous seizure. While scenes tied to previous seizures were typically highly personalized and idiosyncratic, public settings and social situations were commonly reported fears. Factors consistently found to increase ES-interictal anxiety included the potential for danger (physical injury or inability to get help), social factors (increased number of unfamiliar people, social pressures), and specific triggers (stress, sensory, physiological, and medication-related). We make recommendations for incorporating different combinations of anxiety-related factors to achieve a customizable selection of graded exposure scenarios suitable for VR-ET. Subsequent phases of this study will include creating a set of VR-ET hierarchies (Phase 2) and rigorously evaluating their feasibility and effectiveness (Phase 3).
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Affiliation(s)
| | | | - Hannah Gray
- Faculty of Health, Department of Psychology, York University, Toronto, ON, Canada,Faculty of Science, Department of Biology, York University, Toronto, ON, Canada
| | - Susanna Pardini
- OpenLab, University Health Network, Toronto, ON, Canada,Department of General Psychology, University of Padova, Padova, Italy,Digital Health Lab, Centre for Health and Wellbeing, Bruno Kessler Foundation, Trento, Italy
| | - Laurence R. Harris
- Faculty of Health, Department of Psychology, York University, Toronto, ON, Canada
| | - Lora Appel
- OpenLab, University Health Network, Toronto, ON, Canada,Faculty of Health, School of Health Policy and Management, York University, Toronto, ON, Canada,Michael Garron Hospital, Toronto, ON, Canada,Corresponding author at: 242 Roselawn Ave, Toronto, Ontario, M4R 1E9, Canada.
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McGee RE, Patel A, Drzymalla EM, Anderson M, Johnson EK, Thompson NJ, Escoffery C. Project UPLIFT: Adoption and implementation experiences of an epilepsy self-management program. Epilepsy Behav 2023; 138:109001. [PMID: 36495799 DOI: 10.1016/j.yebeh.2022.109001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/06/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022]
Abstract
RATIONALE Project UPLIFT is an evidence-based epilepsy self-management program shown to prevent and treat depression through an 8-session, group telehealth intervention. Since 2012, the program has been disseminated by training community-based providers to deliver UPLIFT to people with epilepsy (PWE). Limited research has described the adoption, implementation, and practice-based maintenance of self-management programs like UPLIFT. We sought to gain a better understanding of this process from trained program adopters. METHODS A cross-sectional evaluation of adoption and implementation experiences was conducted. An online survey with closed- and open-ended questions was distributed to 120 UPLIFT program adopters to collect information about reasons for being trained and experiences implementing the program. Survey items were developed based on the RE-AIM model to assess program reach, effectiveness, adoption, implementation, and maintenance. For closed-ended responses, frequencies and cross-tabs were calculated. Open-ended responses were reviewed and grouped by theme. RESULTS 41 respondents completed the survey (34% response rate). Respondents were from a variety of organizations including clinical (39%, n = 16), educational/research (17%, n = 7), and Epilepsy Foundation affiliates/chapters (12%, n = 5), among others. The most frequently endorsed reason for training in UPLIFT was an interest in supporting PWE (73%, n = 30). Most respondents rated delivering UPLIFT as very important (49%, n = 20) or important (32%, n = 13) to the organization. Sixty-one percent (n = 25) of respondents reported implementing (implementors) UPLIFT. Of those who had not yet implemented UPLIFT, 50% (n = 8) planned on implementing it at some point. Among program implementors, the most frequently reported implementation facilitators included participant interest (68%, n = 17), training (68%, n = 17), and organizational support (64%, n = 16). Program implementors indicated having program champions (80%, n = 20). The most frequently reported implementation challenge reported was recruitment (72%, n = 18). In open-ended responses, funding was a key theme that would facilitate continued implementation, but 48% (n = 12) responded that did not have access to resources and/or funding to help continue offering UPLIFT. Developing partnerships was recommended to improve the reach and maintenance of the program. Despite challenges, implementors agreed (44%, n = 11) or strongly agreed (36%, n = 9) that UPLIFT was effective in addressing mental health problems among program participants, and 76% (n = 19) plan on continuing to offer UPLIFT. CONCLUSION Implementation surveys increase understanding of program adoption and impact for dissemination trainees. Implementation benefits from program champions, strong partnerships, and sustained funding. Continued refinement of implementation support, such as developing a sustained referral system, maintaining relationships with trainees, supporting evaluation activities, and exploring opportunities for program updates to further enhance adoption, implementation, and maintenance.
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Affiliation(s)
- Robin E McGee
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States.
| | - Archna Patel
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Emily M Drzymalla
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Molly Anderson
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Erica K Johnson
- Department of Rehabilitation Medicine/Epilepsy Center, University of Washington, 325 9th Avenue, Seattle, WA 98104, United States.
| | - Nancy J Thompson
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
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Henshall DC, Arzimanoglou A, Dedeurwaerdere S, Guerrini R, Jozwiak S, Kokaia M, Lerche H, Pitkänen A, Ryvlin P, Simonato M, Sisodiya SM. Shaping the future of European epilepsy research: Final meeting report from EPICLUSTER. Epilepsy Res 2023; 189:107068. [PMID: 36549242 DOI: 10.1016/j.eplepsyres.2022.107068] [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: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Collaboration is essential to the conduct of basic, applied and clinical research and its translation into the technologies and treatments urgently needed to improve the lives of people living with brain diseases and the health professionals who care for them. EPICLUSTER was formed in 2019 by the European Brain Research Area (EBRA) to support the coordination of epilepsy research in Europe. A key objective was to provide a platform to discuss shared research priorities by bringing together scientists and clinicians with multiple stakeholders including patient organisations and industry and the networks and infrastructures that provide healthcare and support research. Additional objectives were to facilitate access and sharing of data and biosamples, working together to ensure epilepsy is a priority for research funding, and embedding a culture of public and patient involvement (PPI) among epilepsy researchers. In this meeting report, we summarise the shared research priorities discussed by the leadership of EPICLUSTER at the recent final meeting. We also briefly review the discussion on patient and industry priorities, guidance on starting PPI for epilepsy researchers, and the sustainability of funding and infrastructures needed to ensure a comprehensive stakeholder-embedded community for epilepsy research.
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Affiliation(s)
- David C Henshall
- Department of Physiology & Medical Physics and FutureNeuro SFI Centre, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin D02 YN77, Ireland.
| | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospital of Lyon-HCL, Coordinator of the ERN EpiCARE, Lyon, France and Epilepsy Research Unit, Children's Hospital Sant Joan de Déu, Member of the ERN EpiCARE, Universitat de Barcelona, Barcelona, Spain
| | | | - Renzo Guerrini
- Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139 Firenze, Italy
| | - Sergiusz Jozwiak
- The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Merab Kokaia
- Epilepsy Center, Department of Clinical Sciences, Lund University Hospital, Sölvegatan 17, BMC A11, 221 84 Lund, Sweden
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University, Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Asla Pitkänen
- Epilepsy Research Laboratory, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Neulaniementie 2, FIN-70 211, Kuopio, Finland
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Champ de l'Air Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Michele Simonato
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 17-19, 44121 Ferrara, Italy; Division of Neuroscience, San Raffaele Hospital, Via Olgettina 58, 20132 Milan, Italy
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, 12 Queen Square, London, WC1N 1PJ, United Kingdom
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Sebera F, Dedeken P, Garrez I, Umwiringirwa J, Leers T, Ndacyayisenga JP, Mutungirehe S, Ndayisenga A, Niyonzima O, Umuhoza G, Teuwen DE, Boon PAMJ. Association of depression and epilepsy in Rwanda: A prospective longitudinal study. Epilepsy Behav 2023; 138:108993. [PMID: 36455447 DOI: 10.1016/j.yebeh.2022.108993] [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: 07/07/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Depression is the most common psychiatric comorbidity for persons living with epilepsy. In Rwanda, the prevalence of epilepsy and depression are high, with 4,9% and 13.0% respectively. This prospective interventional study aimed to determine the prevalence and incidence of depression and the outcome of persons living with epilepsy (PwE) with depression attending the outpatient neurology department of a tertiary center. METHODS Persons living with epilepsy enrolled between February and June 2018 in a screening cohort with a 12-month follow-up. At every 3-month study visit, PwE were screened for depression using the Patient Health Questionnaire (PHQ-9) questionnaire. Any positively screened subject was administered the Hamilton Depression Rating Scale (HDRS) to confirm the diagnosis and severity of depression. Subjects with moderate to severe depression (MSD), were started on treatment and were followed for another year. We describe the prevalence and incidence of depression, baseline characteristics, epilepsy and depression outcomes, and changes in PGI-C. RESULTS Of 572 PwE enrolled, 46 were diagnosed with MSD in a twelve-month period, resulting in an incidence of MSD of 32.7/1000 patient-years. The prevalence of any depression and MSD was 14.2% and 4.7%, respectively. Longer epilepsy duration and seizure status at baseline were associated with MSD. Significant improvements in PGI-C and seizure frequency were observed after treatment optimization. CONCLUSION The use of PHQ-9 and HDRS proved successful in identifying depression in PwE. Combined treatment of epilepsy and depression resulted in improved outcomes, warranting the implementation of depression screening every six months in daily neurology practice.
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Affiliation(s)
- Fidele Sebera
- Neurology Department, CARAES Neuropsychiatric Hospital, Kigali, Rwanda; Neurology Department, Centre Hospitalier Universitaire - Kigali (CHU-K), Kigali, Rwanda; Department of Neurology, University Hospital, Ghent University, Ghent, Belgium
| | - Peter Dedeken
- Department of Neurology, University Hospital, Ghent University, Ghent, Belgium; 4Brain, Ghent University, Ghent, Belgium; Department of Neurology, Heilig Hart Ziekenhuis, Lier, Belgium
| | - Ieme Garrez
- Department of Neurology, University Hospital, Ghent University, Ghent, Belgium; 4Brain, Ghent University, Ghent, Belgium
| | | | - Tim Leers
- WIWO Hospital, Nyarugenge District, Kigali, Rwanda; Dataroots, Leuven, Belgium
| | | | | | - Arlene Ndayisenga
- Neurology Department, CARAES Neuropsychiatric Hospital, Kigali, Rwanda; Neurology Department, King Faisal Hospital, Kigali, Rwanda
| | - Odette Niyonzima
- Neurology Department, CARAES Neuropsychiatric Hospital, Kigali, Rwanda; WIWO Hospital, Nyarugenge District, Kigali, Rwanda
| | - Georgette Umuhoza
- Neurology Department, CARAES Neuropsychiatric Hospital, Kigali, Rwanda
| | - Dirk E Teuwen
- Department of Neurology, University Hospital, Ghent University, Ghent, Belgium; 4Brain, Ghent University, Ghent, Belgium.
| | - Paul A M J Boon
- Department of Neurology, University Hospital, Ghent University, Ghent, Belgium; 4Brain, Ghent University, Ghent, Belgium
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Ierusalimsky NV, Karimova ED, Samotaeva IS, Luzin RV, Zinchuk MS, Rider FK, Guekht AB. [Structural brain changes in patients with temporal lobe epilepsy and comorbid depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:83-89. [PMID: 37796072 DOI: 10.17116/jnevro202312309183] [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] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To assess the morphological features of the brain structures in patients with temporal lobe epilepsy and comorbid depression. MATERIAL AND METHODS From 1 January 2017 to 31 December 2020, we studied 80 patients with temporal lobe epilepsy (aged 18-60 years, 38 of whom had comorbid depression) and 48 healthy subjects of comparable age. Magnetic resonance imaging (MRI) of the brain was performed using the epilepsy protocol in a scanner with a magnetic field strength of 1.5 T. Focal temporal lobe epilepsy was diagnosed by neurologists (epileptologists) specialising in epilepsy according to the International League Against Epilepsy (ILAE) classification of epilepsy. Psychiatrists assessed the presence and severity of depressive disorders by clinical interview and by participants' scores on the Beck Depression Inventory (BDI-II). MRI data were processed using FreeSurfer 6.0 software to determine volumes of subcortical structures and thicknesses of cortical structures. At the group level, analysis of covariance with Holm-Bonferroni correction was used as the statistical method. RESULTS Morphometric analysis revealed a significant decrease in the volume of the thalamus bilaterally and the brain stem and an increase in the volume of the choroid plexus in the left hemisphere, as well as a significant decrease in the thickness of the entorhinal cortex, temporal pole and isthmus of the cingulate gyrus in the left hemisphere and middle temporal gyrus and inferior temporal gyrus in the right hemisphere in patients with epilepsy compared to healthy controls. No association was found between the presence of depression and significant structural changes on MRI. CONCLUSION The data obtained suggest an effect of temporal lobe epilepsy, but not comorbid depression, on the morphology of brain structures.
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Affiliation(s)
- N V Ierusalimsky
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - E D Karimova
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - I S Samotaeva
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - R V Luzin
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - M S Zinchuk
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - F K Rider
- Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - A B Guekht
- Scientific and Practical Psychoneurological Center, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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Pisani F, Pisani LR, Barbieri MA, de Leon J, Spina E. Optimization of Therapy in Patients with Epilepsy and Psychiatric Comorbidities: Key Points. Curr Neuropharmacol 2023; 21:1755-1766. [PMID: 35619263 PMCID: PMC10514544 DOI: 10.2174/1570159x20666220526144314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/24/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022] Open
Abstract
Psychiatric disorder comorbidity in patients with epilepsy (PWE) is very frequent with a mean percentage prevalence of up to 50% and even higher. Such a high frequency suggests that epilepsy and psychiatric disorders might share common pathological pathways. Various aspects contribute in making the matter very complex from a therapeutic point of view. Some antiseizure medications (ASMs), namely valproic acid, carbamazepine, and lamotrigine, have mood-stabilising effects and are routinely used for the treatment of bipolar disorder in patients who do not have epilepsy. Pregabalin and, to a lesser extent, gabapentin, exerts anxiolytic effects. However, several ASMs, in particular levetiracetam, topiramate, and perampanel, may contribute to psychiatric disorders, including depression, aggressive behaviour, and even psychosis. If these ASMs are prescribed, the patient should be monitored closely. A careful selection should be made also with psychotropic drugs. Although most of these can be safely used at therapeutic doses, bupropion, some tricyclic antidepressants, maprotiline, and clozapine may alter seizure threshold and facilitate epileptic seizures. Interactions between ASMs and psychotropic medication may make it difficult to predict individual response. Pharmacokinetic interactions can be assessed with drug monitoring and are consequently much better documented than pharmacodynamic interactions. Another aspect that needs a careful evaluation is patient adherence to treatment. Prevalence of non-adherence in PWE and psychiatric comorbidities is reported to reach values even higher than 70%. A careful evaluation of all these aspects contributes in optimizing therapy with a positive impact on seizure control, psychiatric wellbeing, and quality of life.
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Affiliation(s)
- Francesco Pisani
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | | | | | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA and Psychiatry and Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Italy
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