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Alva‐Diaz C, Cabanillas‐Lazo M, Navarro‐Flores A, Martinez‐Rivera RN, Valdeiglesias‐Abarca M, Acevedo‐Marino K, Pacheco‐Barrios K, Ruiz‐Garcia R, Burneo J. Peri-ictal psychiatric manifestations in people with epilepsy: An umbrella review. Epilepsia Open 2024; 9:1166-1175. [PMID: 38816942 PMCID: PMC11296096 DOI: 10.1002/epi4.12949] [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: 07/23/2023] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE We aimed to conduct an umbrella review to summarize the existing evidence regarding the prevalence of peri-ictal psychiatric manifestations (PM) in people with epilepsy (PWE) including pre-ictal, ictal, and postictal stages. METHODS Databases were searched up to June 2023 for systematic reviews (SR) of observational studies that included patients with epilepsy peri-ictal PM. Data selection, data extraction, and risk of bias assessment (with the AMSTAR-2 instrument) were performed by two independent reviewers. We performed a narrative synthesis using previous guidelines. We used a self-developed decision table according to the GRADE system adapted for narrative outcomes if the certainty of outcomes was not determined by systematic review authors. RESULTS Four SRs were included comprising 66 primary studies (n = 10 217). Three SRs evaluated one period (pre-ictal, ictal, and postictal), and one did not determine it. During the pre-ictal period, the more prevalent symptom was confusion, although with a low certainty (due to the heterogeneity and serious risk of bias). One systematic review that only included case reports evaluated the ictal period, finding mood/anxiety disorders, psychosis, and personality changes. The postictal period included the most PM (anxiety: 45.0% and depressive symptoms: 43.0%), with very low certainty, due to risk of bias, potential publication bias, heterogeneity, and failure to report the confidence intervals. SIGNIFICANCE With very low certainty, epileptic periods are characterized by a wide spectrum of PM, being postictal symptoms the most prevalent, predominantly anxiety, and depressive symptoms. Further understanding of these PM of epilepsy could improve the attention of the people with epilepsy. PLAIN LANGUAGE SUMMARY In this review of reviews, we summarize the frequency in which psychiatric manifestations occur in relation to an epileptic seizure. A total of 10 217 patients were reported in the reviews. The most common manifestations included symptoms of anxiety and depression, as well as changes in the normal behavior of the patient. These manifestations occurred most frequently right after the seizure finished.
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Affiliation(s)
- Carlos Alva‐Diaz
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud PúblicaUniversidad Científica del SurLimaPeru
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI)Hospital Daniel Alcides CarriónCallaoPeru
| | | | - Alba Navarro‐Flores
- International Max Planck Research School for Translational Psychiatry (IMPRS‐TP)MunichGermany
| | | | - Maria Valdeiglesias‐Abarca
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI)Hospital Daniel Alcides CarriónCallaoPeru
- Universidad Ricardo PalmaLimaPeru
| | - Krystel Acevedo‐Marino
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI)Hospital Daniel Alcides CarriónCallaoPeru
- Universidad Ricardo PalmaLimaPeru
| | - Kevin Pacheco‐Barrios
- Neuromodulation Center and Center for Clinical Research LearningSpaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Vicerrectorado de Investigación, Unidad de Investigación Para la Generación y Síntesis de Evidencias en SaludUniversidad San Ignacio de LoyolaLimaPeru
| | - Ramiro Ruiz‐Garcia
- Department of NeuropsychiatryNational Institute of Neurology and NeurosurgeryMexico CityMexico
| | - Jorge Burneo
- Epilepsy Program and Neuroepidemiology Unit, Department of Clinical Neurological Sciences, Schulich School of MedicineWestern UniversityLondonOntarioCanada
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Simonetti A, Pais C, Savoia V, Cipriani MC, Tosato M, Janiri D, Bernardi E, Ferrara OM, Margoni S, Kotzalidis GD, Chieffo D, Fantoni M, Liperoti R, Landi F, Bernabei R, Sani G. Association of Delirium and Depression with Respiratory and Outcome Measures in COVID-19 Inpatients. J Pers Med 2023; 13:1207. [PMID: 37623458 PMCID: PMC10456095 DOI: 10.3390/jpm13081207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
Delirium (DEL) and depression (DEP) may impair the course and severity of acute respiratory illness. The impact of such syndromes on respiratory and outcome parameters in inpatients with COVID-19 needs clarification. To clarify the relationship between DEL and DEP and respiratory outcome measures, we enrolled 100 inpatients from COVID-19 units of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS of Rome. Participants were divided into those with DEL, DEP, or absence of either delirium or depression (CONT). Delirium severity was assessed with the Neelson and Champagne Confusion Scale (NEECHAM). Psychopathology was assessed with the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A), and the Brief Psychiatric Rating Scale (BPRS). Dependent variables include: (a) respiratory parameters, i.e., partial pressure of oxygen in arterial blood (PaO2), oxygen saturation (SpO2), ratio between arterial partial pressure of oxygen (PaO2), and fraction of inspired oxygen (PaO2/FiO2); (b) outcome parameters, i.e., duration of hospitalization and number of pharmacological treatments used during the hospitalization. We investigated between-group differences and the relationships between severity of delirium/depression and the dependent variables. Duration of hospitalization was longer for DEL than for either DEP or CONT and for DEP compared to CONT. NEECHAM and HAM-D scores predicted lower PaO2 and PaO2/FiO2 levels in the DEL and DEP groups, respectively. In DEP, BPRS scores positively correlated with duration of hospitalization. Delirium impacted the course of COVID-19 more severely than depression. The mechanisms by which delirium and depression worsen respiratory parameters differ.
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Affiliation(s)
- Alessio Simonetti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA;
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.J.); (O.M.F.); (S.M.); (G.S.)
| | - Cristina Pais
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (M.C.C.); (M.T.); (R.L.); (F.L.); (R.B.)
| | - Vezio Savoia
- Service of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.S.); (D.C.)
| | - Maria Camilla Cipriani
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (M.C.C.); (M.T.); (R.L.); (F.L.); (R.B.)
| | - Matteo Tosato
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (M.C.C.); (M.T.); (R.L.); (F.L.); (R.B.)
| | - Delfina Janiri
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.J.); (O.M.F.); (S.M.); (G.S.)
- Department of Neurology and Psychiatry, Sapienza University of Rome, 00185 Rome, Italy
| | - Evelina Bernardi
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.J.); (O.M.F.); (S.M.); (G.S.)
| | - Ottavia Marianna Ferrara
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.J.); (O.M.F.); (S.M.); (G.S.)
| | - Stella Margoni
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.J.); (O.M.F.); (S.M.); (G.S.)
| | - Georgios D. Kotzalidis
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.J.); (O.M.F.); (S.M.); (G.S.)
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza–Università di Roma, 00189 Rome, Italy
| | - Daniela Chieffo
- Service of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.S.); (D.C.)
- Department of Life Sciences and Public Health, Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Massimo Fantoni
- Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo F. Vito 1, 00168 Rome, Italy;
- Infectious Diseases Section, Department of Safety and Bioethics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Rosa Liperoti
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (M.C.C.); (M.T.); (R.L.); (F.L.); (R.B.)
- Department of Geriatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Landi
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (M.C.C.); (M.T.); (R.L.); (F.L.); (R.B.)
- Department of Geriatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (M.C.C.); (M.T.); (R.L.); (F.L.); (R.B.)
- Department of Geriatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.J.); (O.M.F.); (S.M.); (G.S.)
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Conforti H, Massanobu Maekawa R, Roberto Fernandes Lisboa J, Maria de Araújo Filho G. Interictal Dysphoric Disorder: A disorder with distinct nosography or atypical symptomatology of mood disorders in people with epilepsy? Results from a systematic review. Epilepsy Behav 2023; 145:109231. [PMID: 37300908 DOI: 10.1016/j.yebeh.2023.109231] [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: 03/02/2023] [Revised: 04/09/2023] [Accepted: 04/21/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Mood disorders are the most frequent comorbidities in people with epilepsy. The term Interictal Dysphoric Disorder (IDD) has been used to describe a condition where at least three out of eight symptoms must be present for diagnosis. Symptoms are grouped into three symptom clusters of four "labile depressive" symptoms (anergia, depressed mood, insomnia, and pain), two "labile affective" symptoms (anxiety and fear), and two specific symptoms (euphoric moods and paroxysmal irritability), which are described and can be present in people with epilepsy. There is debate about whether IDD is a distinct disease, or if it is simply a special manifestation of mood disorders in epilepsy. For instance, it may represent an atypical presentation of depression in this population. METHODS We conducted a systematic review of the literature in 3 databases with the terms "Interictal Dysphoric Disorder" and "mood disorder". A total of 130 articles were selected and, after removing the duplicated applying eligibility criteria, 12 articles were included. RESULTS Six articles showed positive evidence for the validation of IDD as an independent nosological entity; in contrast, five articles reported inconclusive findings regarding the question; one explicitly questioned significant differences between IDD and mood disorders as nosological constructs. The data available and presented in this systematic review is insufficient to confirm IDD as a distinct diagnostic category. Nevertheless, it is worth noting other researchers have found some validity in this concept, highlighting the strong connection between mood disorders and epilepsy. CONCLUSION Further research in this area is needed, and additional systematic reviews focusing on other aspects of the construct, such as neurobiological mechanisms, may prove to be helpful.
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Affiliation(s)
- Hernani Conforti
- Department of Neurosciences and Department of Neurosciences and Behavioral Sciences. Faculdade de Medicina de Ribeirão Preto (FMRP-USP), São Paulo, Brazil
| | - Renan Massanobu Maekawa
- Department of Neurosciences and Department of Neurosciences and Behavioral Sciences. Faculdade de Medicina de Ribeirão Preto (FMRP-USP), São Paulo, Brazil
| | - João Roberto Fernandes Lisboa
- Department of Neurosciences and Department of Neurosciences and Behavioral Sciences. Faculdade de Medicina de Ribeirão Preto (FMRP-USP), São Paulo, Brazil
| | - Gerardo Maria de Araújo Filho
- Department of Neurological Sciences, Psychiatry and Medical Psychology. Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), São Paulo, Brazil.
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Sone D, Galovic M, Myers J, Leonhardt G, Rabiner I, Duncan JS, Koepp MJ, Foong J. Contribution of the μ-opioid receptor system to affective disorders in temporal lobe epilepsy: A bidirectional relationship? Epilepsia 2023; 64:420-429. [PMID: 36377838 PMCID: PMC10107876 DOI: 10.1111/epi.17463] [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: 07/29/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Affective disorders are frequent comorbidities of temporal lobe epilepsy (TLE). The endogenous opioid system has been implicated in both epilepsy and affective disorders, and may play a significant role in their bidirectional relationship. In this cross-sectional study, we investigated the association between μ-opioid receptor binding and affective disorders in patients with TLE. METHODS Nine patients with TLE and depression/anxiety underwent 11 C-carfentanil positron emission tomography (CFN PET) and neuropsychiatric assessment, including the Hospital Anxiety and Depression Scale and the Positive and Negative Affect Schedule. The normalized CFN PET scans were compared with those of 26 age-matched healthy controls. Correlation analyses with affective symptoms were performed by region of interest-based analysis focusing on the limbic circuit and orbitofrontal cortex. RESULTS We observed widely reduced CFN binding potential (BP) in bilateral frontal lobes and striata in patients with TLE compared to healthy controls. In the TLE group, more severe anxiety and negative affect were associated with decreased CFN BP in the posterior cingulate gyrus. SIGNIFICANCE In patients with TLE, interictally reduced binding in the opioid system was associated with higher levels of anxiety and negative affect. We speculate that seizure-related agonist-driven desensitization and downregulation of opioid receptors could be a potential underlying pathomechanism.
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Affiliation(s)
- Daichi Sone
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
| | - Marian Galovic
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Jim Myers
- Faculty of Medicine, Imperial College London, London, UK
| | - Georg Leonhardt
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
- Department of Neurosurgery, Carl Gustav Carus University Hospitals, Dresden, Germany
| | | | - John S Duncan
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
| | - Jacqueline Foong
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
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Novak A, Vizjak K, Gacnik A, Rakusa M. Cognitive impairment in people with epilepsy: Montreal Cognitive Assessment (MoCA) as a screening tool. Acta Neurol Belg 2022; 123:451-456. [PMID: 35925540 DOI: 10.1007/s13760-022-02046-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/19/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Although cognitive impairment is common in people with epilepsy, it is often neglected in outpatient clinics. MoCA is a simple and reliable test, which was validated for the cognitive screening of Alzheimer's and vascular dementia. The aim of our study was to evaluate MoCA as a tool for a cognitive screening of people with epilepsy. METHODS Our study included 50 people with epilepsy and 46 healthy individuals. All participants took the Slovenian version of the MoCA. Mean age, education and MoCA scores were compared between the two groups. RESULTS There was no significant difference between people with epilepsy and the controls in age (47.6, SD 18.1 vs 50.9, SD 14.0 years) or education (12.8, SD 2.8 vs 13.4, SD 2.8 years). People with epilepsy had significantly lower total MoCA scores than did the controls (23.3, SD 4.5 vs 27.5, SD 1.9 points; p < 0.001). CONCLUSIONS People with epilepsy achieved a lower score in several cognitive domains compared to the control group. MoCA can be used as an appropriate screening tool for cognitive impairment in people with epilepsy in the outpatient clinic. For a more accurate evaluation, neuropsychological assessments should be used.
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Affiliation(s)
- Ajda Novak
- Divison of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Karmen Vizjak
- Divison of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Albin Gacnik
- Divison of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Martin Rakusa
- Divison of Neurology, University Medical Centre Maribor, Maribor, Slovenia.
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