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Akhmedullin R, Kyrgyzbay G, Kimadiev D, Utebekov Z. New-onset psychogenic nonepileptic seizures after intracranial neurosurgery: A meta-analysis. Seizure 2024; 119:12-16. [PMID: 38761671 DOI: 10.1016/j.seizure.2024.04.023] [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: 03/19/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND The epidemiology of psychogenic non-epileptic seizures (PNES) is still unclear. Although approximately 14 million people need neurosurgical care annually, there is a dearth of thorough analysis on PNES occurrence following surgery. This study seeks to estimate the proportion of newly diagnosed PNES. METHODS We conducted a literature search of the PubMed, Ovid, CINAHL, and Cochrane Library databases up to December 2023. We identified studies using an observational design on the occurrence of PNES in patients who underwent intracranial surgery, and confirmed diagnosis using video-EEG. Estimates are reported as proportions using random effects models. We reported both 95 % CIs and prediction intervals (PI). We assessed the risk of bias and identified the pooled odds ratio (OR) for mutually exclusive groups. The heterogeneity was investigated using the I² statistic and significance determined using Cochran's Q-test. Post-hoc Egger's regression test, and several sensitivity analyses were performed. This study was registered in PROSPERO (CRD42023488611). RESULTS Of the 1766 unique studies identified, 86 were selected for full-text review. Eight studies (n = 3,699) were eligible for inclusion. Studies, spanning from 1995 to 2017, primarily focused on epilepsy surgeries. The pooled proportion was 3 % (95 % CI 2 %-5 %; 95 % PI 0 %-11 %). Temporal resections indicated twofold increase of PNES comparing to either resections (OR 2.05, 95 %CI 0.81-5.19). The risk of bias assessment indicated satisfactory quality for included studies, and heterogeneity in estimates was mainly explained by publication year of studies and their rounded sample size. CONCLUSIONS Given the estimations, there is expected impact of intracranial procedures on functional seizures epidemiology. Further efforts need to understand the contribution of brain resections to PNES incidence.
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Affiliation(s)
- Ruslan Akhmedullin
- Department of Medicine, Nazarbayev University School of Medicine, Kazakhstan
| | - Gaziz Kyrgyzbay
- Epileptology Centre, RSE Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan, Kazakhstan.
| | - Darkhan Kimadiev
- Epileptology Centre, RSE Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan, Kazakhstan
| | - Zhasulan Utebekov
- Epileptology Centre, RSE Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan, Kazakhstan
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Gonçalves-Pinho M, Martins B, Costa A, Ribeiro JP, Freitas A, Azevedo E, Fernandes L. Psychiatric Comorbidities in Neurologic Hospitalizations in Portugal: A Nationwide Retrospective Observational Study. ACTA MEDICA PORT 2024; 37:455-466. [PMID: 38848702 DOI: 10.20344/amp.20969] [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: 11/19/2023] [Accepted: 03/27/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION Psychiatric comorbidities have a significant impact on patients' quality of life and often go undetected in neurologic practice. The aim of this study was to describe and characterize psychiatric comorbidities among patients hospitalized due to a neurologic disorder in mainland Portugal. METHODS A retrospective observational study was performed by analyzing hospitalization with a primary diagnosis of neurologic disorder defined as categories 76, 77, 79 - 85, 95, 109 of the Clinical Classification Software for International Classification of Diseases, Ninth Revision, Clinical Modification, occurring between 2008 and 2015 in adult patients (≥ 18 years of age). Psychiatric comorbidities were determined as the presence of a secondary diagnosis belonging to the Clinical Classification Software categories 650 to 670. RESULTS A total of 294 806 hospitalization episodes with a primary diagnosis of a neurologic disorder were recorded in adult patients between 2008 - 2015 in Portuguese public hospitals. Approximately 26.9% (n = 79 442) of the episodes had a recorded psychiatric comorbidity (22.1%; 32.2%, female versus male hospitalizations). Patients with registered psychiatric comorbidities were younger (66.2 ± 16.2 vs 68.6 ± 17.2 with no psychiatric comorbidities, p < 0.001), presented lower all-cause in-hospital mortality rates, and significantly longer mean hospital stays. 'Delirium, dementia, amnestic and other cognitive disorders' were recorded in 7.4% (n = 21 965) of the hospitalizations, followed by alcohol-related disorders in 6.5% (n = 19 302) and mood disorders in 6.1% (n = 18 079). Epilepsy/seizures were the neurologic disorders with the highest proportion of recorded psychiatric comorbidities (39.9%). CONCLUSION Psychiatric comorbidities were recorded in more than a quarter of the hospitalizations with a primary diagnosis of a Neurologic disorder. Psychiatric comorbidities varied among neurological disorders and were associated with different demographic and clinical features.
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Affiliation(s)
- Manuel Gonçalves-Pinho
- *Shared first co-authorship. CINTESIS@RISE. Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto; Department of Psychiatry and Mental Health. Unidade Local de Saúde do Tâmega e Sousa. Penafiel. Portugal
| | - Bárbara Martins
- *Shared first co-authorship. Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto; Department of Neurology. Unidade Local de Saúde de São João. Porto. Portugal
| | - Andreia Costa
- Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto; Department of Neurology. Unidade Local de Saúde de São João. Porto. Portugal
| | - João Pedro Ribeiro
- Department of Psychiatry and Mental Health. Unidade Local de Saúde do Tâmega e Sousa. Penafiel. Portugal
| | - Alberto Freitas
- CINTESIS@RISE, MEDCIDS. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Elsa Azevedo
- Department of Neurology. Unidade Local de Saúde de São João. Porto; UnIC@RISE. Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Lia Fernandes
- CINTESIS@RISE. Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto; Psychiatry Service. Unidade Local de Saúde de São João. Porto. Portugal
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Elshetihy A, Nergiz L, Cloppenborg T, Woermann FG, Müffelmann B, Bien CG. A complex case with generalized epilepsy, probable focal seizures, and functional seizures. Epilepsy Behav Rep 2024; 27:100684. [PMID: 38953098 PMCID: PMC11215947 DOI: 10.1016/j.ebr.2024.100684] [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: 01/22/2024] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
In this patient, now 42 years old, genetic generalized epilepsy (juvenile myoclonic epilepsy) manifested itself at the age of 13. At the age of 39, she experienced a status episode with prolonged ICU treatment. She was left with a left-sided hippocampal sclerosis and probably focal seizures. In addition, since the age of 24, the patient also experiences functional seizures on the background of a borderline personality disorder. While generalized epileptic seizures could be controlled with antiseizure medication (ASM), the patient was multiple times admitted to Emergency Departments for her functional seizures with subsequent intensive care treatments, including intubation. As a complication, the patient developed critical illness polyneuropathy and myopathy, resulting in wheelchair dependence. Additionally, she acquired a complex regional pain syndrome after extravasation of ASM. The report demonstrates the uncommon development of hippocampal sclerosis after a generalized tonic-clonic status epilepticus and the poor treatability of functional seizures as compared to generalized and focal seizures.
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Affiliation(s)
- Ahmed Elshetihy
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
| | - Lema Nergiz
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
| | - Thomas Cloppenborg
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
| | - Friedrich G. Woermann
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany
| | - Birgitt Müffelmann
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
| | - Christian G. Bien
- Dept. of Epileptology, Krankenhaus Mara, Bethel Epilepsy Center, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
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Massey I, Yadav S, Kumar D, Maharia RS, Kumari K, Singh P. An insight for the inhibition of anxiolytic and anti-convulsant effects in zebrafish using the curcumins via exploring molecular docking and molecular dynamics simulations. Mol Divers 2024:10.1007/s11030-024-10865-1. [PMID: 38758508 DOI: 10.1007/s11030-024-10865-1] [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: 02/21/2024] [Accepted: 03/28/2024] [Indexed: 05/18/2024]
Abstract
In the contemporary landscape, anxiety and seizures stand as major areas of concern, prompting researchers to explore potential drugs against them. While numerous drugs have shown the potential to treat these two neurological conditions, certain adverse effects emphasize the need for development of safer alternatives. This study seeks to employ an in silico approach to evaluate natural compounds, particularly curcumins, as potential inhibitors of GABA-AT to mitigate anxiety and seizures. The proposed methodology includes generating a compound library, minimizing energy, conducting molecular docking using AutoDock, molecular dynamics simulations using Amber, and MM-GBSA calculations. Remarkably, CMPD50 and CMPD88 exhibited promising binding affinities of - 9.0 kcal/mol and - 9.1 kcal/mol with chains A and C of GABA-AT, respectively. Further, MM-GBSA calculations revealed binding free energies of - 10.88 kcal/mol and - 10.72 kcal/mol in CMPD50 and CMPD88, respectively. ADME analysis showed that these compounds contain drug-likeness properties and might be considered as potential drug candidates. The findings from this study will have practical applications in the field of drug discovery for the development of safer and effective drugs for treatment of anxiety and seizures. Overall, this study will lay the groundwork for providing valuable insights into the potential therapeutic effects of curcumins in alleviating anxiety and seizures, establishing a computational framework for future experimental validation.
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Affiliation(s)
- Iona Massey
- Department of Chemistry, Atma Ram Sanatan Dharma College, University of Delhi, Delhi, India
- Amity Institute of Biotechnology, Amity University, Noida, India
| | - Sandeep Yadav
- Department of Chemistry, Atma Ram Sanatan Dharma College, University of Delhi, Delhi, India
- Department of Chemistry, Faculty of Engineering and Technology, SRM Institute of Science and Technology, NCR Campus, Ghaziabad, Uttar Pradesh, India
| | - Durgesh Kumar
- Department of Chemistry, Maitreyi College, University of Delhi, Delhi, India.
| | - Ram Swaroop Maharia
- Department of Chemistry, Atma Ram Sanatan Dharma College, University of Delhi, Delhi, India
| | - Kamlesh Kumari
- Department of Zoology, University of Delhi, Delhi, India.
| | - Prashant Singh
- Department of Chemistry, Atma Ram Sanatan Dharma College, University of Delhi, Delhi, India.
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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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Beattie BC, Batista García-Ramó K, Biggs K, Boissé Lomax L, Brien DC, Gallivan JP, Ikeda K, Schmidt M, Shukla G, Whatley B, Woodroffe S, Omisade A, Winston GP. Literature review and protocol for a prospective multicentre cohort study on multimodal prediction of seizure recurrence after unprovoked first seizure. BMJ Open 2024; 14:e086153. [PMID: 38582538 PMCID: PMC11002401 DOI: 10.1136/bmjopen-2024-086153] [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: 03/06/2024] [Accepted: 03/22/2024] [Indexed: 04/08/2024] Open
Abstract
INTRODUCTION Epilepsy is a common neurological disorder characterised by recurrent seizures. Almost half of patients who have an unprovoked first seizure (UFS) have additional seizures and develop epilepsy. No current predictive models exist to determine who has a higher risk of recurrence to guide treatment. Emerging evidence suggests alterations in cognition, mood and brain connectivity exist in the population with UFS. Baseline evaluations of these factors following a UFS will enable the development of the first multimodal biomarker-based predictive model of seizure recurrence in adults with UFS. METHODS AND ANALYSIS 200 patients and 75 matched healthy controls (aged 18-65) from the Kingston and Halifax First Seizure Clinics will undergo neuropsychological assessments, structural and functional MRI, and electroencephalography. Seizure recurrence will be assessed prospectively. Regular follow-ups will occur at 3, 6, 9 and 12 months to monitor recurrence. Comparisons will be made between patients with UFS and healthy control groups, as well as between patients with and without seizure recurrence at follow-up. A multimodal machine-learning model will be trained to predict seizure recurrence at 12 months. ETHICS AND DISSEMINATION This study was approved by the Health Sciences and Affiliated Teaching Hospitals Research Ethics Board at Queen's University (DMED-2681-22) and the Nova Scotia Research Ethics Board (1028519). It is supported by the Canadian Institutes of Health Research (PJT-183906). Findings will be presented at national and international conferences, published in peer-reviewed journals and presented to the public via patient support organisation newsletters and talks. TRIAL REGISTRATION NUMBER NCT05724719.
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Affiliation(s)
- Brooke C Beattie
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Karla Batista García-Ramó
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Krista Biggs
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Lysa Boissé Lomax
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Donald C Brien
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Jason P Gallivan
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Kristin Ikeda
- Department of Medicine/Neurology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthias Schmidt
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Garima Shukla
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Benjamin Whatley
- Department of Medicine/Neurology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephanie Woodroffe
- Department of Medicine/Neurology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Gavin P Winston
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Tinsae T, Shumet S, Melkam M, Segon T, Medfu Takelle G, Rtbey G, Nakie G, Fentahun S, Andualem F, Getinet W. Psychiatric comorbidity in people with epilepsy in Ethiopia: Systematic review and meta-analysis. Epilepsy Behav 2024; 152:109648. [PMID: 38277847 DOI: 10.1016/j.yebeh.2024.109648] [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: 06/10/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Psychiatric comorbidity is a double burden among people with epilepsy. Since people with epilepsy are more vulnerable to psychiatric illnesses. So, the implementation of an appropriate intervention to minimize the double burden of comorbidity is very important. Therefore, this systematic review and meta-analysis aimed to assess the prevalence and associated factors of psychiatric comorbidity among people with epilepsy in Ethiopia. METHODS This systematic review and meta-analysis followed the Preferred Reporting Item Review and Meta-analysis (PRISMA) guideline. Searching databases were PubMed, PsycINFO, Web of Science, Cochrane Library, Google Scholar, and HINARI.The quality of the included articles was assessed using the Newcastle-Ottawa Scale (NOS). The pooled meta-logistic regression was computed to estimate the pooled prevalence and the risk factors with a 95% CI. RESULTS The pooled prevalence of psychiatric comorbidity in people with epilepsy was 34.69 % (95 % CI: 29.27, 40.10). Frequent seizures (POR = 2.94: 95 % CI: 1.08, 8.00) and a history of divorce (POR = 2.00: 95 % CI: 1.09, 3.81) were associated factors of psychiatric comorbidity in people with epilepsy. CONCLUSIONS This systematic review and meta-analysis revealed that the pooled prevalence of psychiatric comorbidity among people with epilepsy was found to be higher compared with the general population. Therefore, among people with epilepsy, parallel psychiatric evaluation is very important along with neurological evaluation.
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Affiliation(s)
- Techilo Tinsae
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Ethiopia.
| | - Shegaye Shumet
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Ethiopia.
| | - Mamaru Melkam
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Ethiopia.
| | - Tesfaye Segon
- Department of Psychiatry, College of Health Science, Mettu University, Mettu, Ethiopia.
| | - Girmaw Medfu Takelle
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Ethiopia.
| | - Gidey Rtbey
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Ethiopia.
| | - Girum Nakie
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Ethiopia.
| | - Setegn Fentahun
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Ethiopia.
| | - Fantahun Andualem
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Ethiopia.
| | - Wondale Getinet
- University of Gondar, College of Medicine and Health Science, Department of Psychiatry, Ethiopia.
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Devinsky O, Elder C, Sivathamboo S, Scheffer IE, Koepp MJ. Idiopathic Generalized Epilepsy: Misunderstandings, Challenges, and Opportunities. Neurology 2024; 102:e208076. [PMID: 38165295 PMCID: PMC11097769 DOI: 10.1212/wnl.0000000000208076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/19/2023] [Indexed: 01/03/2024] Open
Abstract
The idiopathic generalized epilepsies (IGE) make up a fifth of all epilepsies, but <1% of epilepsy research. This skew reflects misperceptions: diagnosis is straightforward, pathophysiology is understood, seizures are easily controlled, epilepsy is outgrown, morbidity and mortality are low, and surgical interventions are impossible. Emerging evidence reveals that patients with IGE may go undiagnosed or misdiagnosed with focal epilepsy if EEG or semiology have asymmetric or focal features. Genetic, electrophysiologic, and neuroimaging studies provide insights into pathophysiology, including overlaps and differences from focal epilepsies. IGE can begin in adulthood and patients have chronic and drug-resistant seizures. Neuromodulatory interventions for drug-resistant IGE are emerging. Rates of psychiatric and other comorbidities, including sudden unexpected death in epilepsy, parallel those in focal epilepsy. IGE is an understudied spectrum for which our diagnostic sensitivity and specificity, scientific understanding, and therapies remain inadequate.
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Affiliation(s)
- Orrin Devinsky
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
| | - Christopher Elder
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
| | - Shobi Sivathamboo
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
| | - Ingrid E Scheffer
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
| | - Matthias J Koepp
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
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Krauss GL, Chung SS, Ferrari L, Stern S, Rosenfeld WE. Cognitive and psychiatric adverse events during adjunctive cenobamate treatment in phase 2 and phase 3 clinical studies. Epilepsy Behav 2024; 151:109605. [PMID: 38184949 DOI: 10.1016/j.yebeh.2023.109605] [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: 09/29/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Cognitive and psychiatric adverse events in patients with epilepsy are important determinants of therapeutic outcomes and patient quality of life. We assessed the relationship between adjunctive cenobamate treatment and selected cognitive and psychiatric treatment-emergent adverse events (TEAEs) in adults with uncontrolled focal epilepsy. METHODS This was a retrospective analysis of pooled populations of patients with focal epilepsy from two phase 2, randomized, double-blind clinical trials; two open-label extensions (OLEs) of those trials; and a long-term, open-label, phase 3 safety study. Occurrence of cognitive and psychiatric TEAEs in patients treated with adjunctive cenobamate or placebo during double-blind treatment were evaluated. Exposure-adjusted incidence rates of the cognitive and psychiatric TEAEs, defined as the number of TEAEs per patient-year of treatment, during up to 7 years of long-term adjunctive cenobamate treatment, were determined in the pooled OLE and phase 3 patient populations. RESULTS The pooled randomized trials resulted in a population of 442 patients treated with cenobamate (100 mg/day: n = 108; 200 mg/day: n = 223; 400 mg/day: n = 111) and 216 placebo-treated patients. The combined open-label studies resulted in pooled populations of cenobamate-treated patients ranging from n = 1690 during Year 1 to n = 103 during Year 7. Among cenobamate-treated (all doses) and placebo-treated patients during double-blind treatment, cognitive TEAEs were reported by ≤ 1.9 % (range, 0 %-1.9 %) and ≤ 0.5 % (range, 0 %-0.5 %), respectively, and psychiatric TEAEs by ≤ 3.6 % (range, 0 %-3.6 %) and ≤ 3.2 % (range, 0 %-3.2 %), respectively. During up to 7 years of open-label adjunctive cenobamate treatment, exposure-adjusted incidence rates of cognitive and psychiatric TEAEs were < 0.018 and < 0.038 events per patient-year, respectively. Discontinuation of adjunctive cenobamate due to cognitive or psychiatric TEAEs assessed in this study during double-blind or open-label treatment occurred in ≤ 0.3 % and ≤ 1.7 % of patients, respectively. CONCLUSIONS Cognitive and psychiatric TEAEs were reported by similar numbers of cenobamate- and placebo-treated patients during double-blind adjunctive cenobamate treatment (< 4 % of patients), and exposure-adjusted incidence rates of these TEAEs remained low during open-label cenobamate treatment for up to 7 years. Treatment discontinuations due to these TEAEs were rare. The results of this post-hoc analysis indicate that adjunctive cenobamate treatment exhibits a low incidence of cognitive or psychiatric TEAEs in patients with uncontrolled focal seizures.
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Affiliation(s)
- Gregory L Krauss
- Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Steve S Chung
- Neuroscience Institute, Banner-University Medical Center, 755 East McDowell Road, Phoenix, AZ 85006.
| | - Louis Ferrari
- SK Life Science, Inc., 461 From Road, Fifth Floor, Paramus, NJ 07652, USA.
| | - Sean Stern
- SK Life Science, Inc., 461 From Road, Fifth Floor, Paramus, NJ 07652, USA.
| | - William E Rosenfeld
- Comprehensive Epilepsy Care Center for Children and Adults, 11134 Conway Road, St. Louis, MO 63131, USA.
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10
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Shao C, Li D, Zhang X, Xiang F, Zhang X, Wang X. Inhibitory control deficits in patients with mesial temporal lobe epilepsy: an event-related potential analysis based on Go/NoGo task. Front Neurol 2024; 14:1326841. [PMID: 38264090 PMCID: PMC10804952 DOI: 10.3389/fneur.2023.1326841] [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: 10/24/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024] Open
Abstract
Objective Neuropsychiatric comorbidities are common among patients with mesial temporal lobe epilepsy (MTLE). One of these comorbidities, impulsivity, can significantly impact the quality of life and prognosis. However, there have been few studies of impulsivity in these patients, and the existing findings are inconsistent. The present study investigates impulsivity in MTLE patients from the perspective of inhibitory control and its underlying processes using event-related potentials (ERPs) initiated using a Go/NoGo task. Methods A total of 25 MTLE patients and 25 age-, gender-, and education-matched healthy controls (HCs) completed an unequal visual Go/NoGo task. Different waveforms as well as behavioral measures were analyzed between Go and NoGo conditions (N2d and P3d). Impulsivity was also assessed using self -rating scales, and clinical variables that may be related to ERPs were explored. Results Compared with HCs, MTLE patients exhibited significantly longer reaction time (RT) (p = 0.002) and lower P3d especially at the frontal electrode sites (p = 0.001). In the MTLE group, the seizure frequency (p = 0.045) and seizure types (p < 0.001) were correlated with the P3d amplitude. A self-rated impulsivity assessment revealed that MTLE patients had higher non-planning (p = 0.017) and total scores (p = 0.019) on the BIS-11 as well as higher DI (p = 0.010) and lower FI (p = 0.007) on the DII. Conclusion The findings demonstrate that the presence of inhibitory control deficits in patients with MTLE are characterized by deficits in the late stage of inhibition control, namely the motor inhibition stage. This study improves our understanding of impulsivity in MTLE patients and suggests that ERPs may constitute a sensitive means of detecting this trait.
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Affiliation(s)
- Chenjing Shao
- Medical School of Chinese PLA, Beijing, China
- Department of Neurology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Desheng Li
- Department of Neurology, The First Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Xu Zhang
- Department of Neurology, The First Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Feng Xiang
- Department of Neurology, The First Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Xi Zhang
- Department of Neurology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xiangqing Wang
- Department of Neurology, The First Medical Centre of Chinese PLA General Hospital, Beijing, China
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11
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Khan MSI, Jelinek HF. Point of Care Testing (POCT) in Psychopathology Using Fractal Analysis and Hilbert Huang Transform of Electroencephalogram (EEG). ADVANCES IN NEUROBIOLOGY 2024; 36:693-715. [PMID: 38468059 DOI: 10.1007/978-3-031-47606-8_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Research has shown that relying only on self-reports for diagnosing psychiatric disorders does not yield accurate results at all times. The advances of technology as well as artificial intelligence and other machine learning algorithms have allowed the introduction of point of care testing (POCT) including EEG characterization and correlations with possible psychopathology. Nonlinear methods of EEG analysis have significant advantages over linear methods. Empirical mode decomposition (EMD) is a reliable nonlinear method of EEG pre-processing. In this chapter, we compare two existing EEG complexity measures - Higuchi fractal dimension (HFD) and sample entropy (SE), with our newly proposed method using Higuchi fractal dimension from the Hilbert Huang transform (HFD-HHT). We present an example using the three complexity measures on a 2-minute EEG recorded from a healthy 20-year-old male after signal pre-processing. Furthermore, we showed the usefulness of these complexity measures in the classification of major depressive disorder (MDD) with healthy controls. Our study is in line with previous research and has shown an increase in HFD and SE values in the full, alpha and beta frequency bands suggestive of an increase in EEG irregularity. Moreover, the HFD-HHT values decreased in those three bands for majority of electrodes which is suggestive of a decrease in irregularity in the frequency-time domain. We conclude that all three complexity measures can be vital features useful for EEG analysis which could be incorporated in POCT systems.
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Affiliation(s)
| | - Herbert F Jelinek
- Department of Medical Sciences and Biotechnology Center, Khalifa University, Abu Dhabi, UAE
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12
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Bhandary RP, John S, Nagaraj AKM, Praharaj SK, Rao CR, Kulkarni MM, Agarwal SK. A close critical look of India's National Mental Health Survey 2016. Indian J Psychiatry 2023; 65:1313-1316. [PMID: 38298879 PMCID: PMC10826867 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_837_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
The National Mental Health Survey 2016 (NMHS 2016) was a large epidemiological study, one of its kind, conducted by the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru to overcome the shortcomings of the previous surveys. The detailed report of the study is available in two parts- 'mental health systems' and 'prevalence, pattern and outcomes'. Though done comprehensively, there are some inevitable limitations. The private sector, a substantial health care provider in the country was not a participant in the survey. Though MINI version 6.0 is a standard and structured instrument, it does not cover many commonly encountered mental illnesses like somatoform disorders. Further, the methodology of the survey makes it difficult for an accurate calculation of the prevalence of individual major psychiatric disorders. The survey has been appraised using a standard checklist for prevalence studies. The detailed qualitative data has not been shared in the report. The contribution of the traditional indigenous systems of healthcare and accessibility of services in rural areas have not been elaborated. Thus, the need for a comprehensive and culturally sensitive assessment tool, involvement of the private sector, and enhancing funding provision to improve the infrastructure are emphasized as future directions for the subsequent phases of the survey.
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Affiliation(s)
- Rajeshkrishna P. Bhandary
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Soyuz John
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anil Kumar M. Nagaraj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Samir K. Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chythra R. Rao
- Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Muralidhar M. Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sheena K. Agarwal
- Department of Psychiatry, Institute for Psychological Health, Thane, Mumbai, Maharashtra, India
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13
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Özge A, Domaç FM, Tekin N, Sünbül EA, Öksüz N, Atalar AÇ, Çallı SY, Fidan YS, Evlice A, Beştepe EE, İzci F, Küsbeci ÖY, Demirel EA, Velioğlu SK, Ungan M. One Patient, Three Providers: A Multidisciplinary Approach to Managing Common Neuropsychiatric Cases. J Clin Med 2023; 12:5754. [PMID: 37685821 PMCID: PMC10488785 DOI: 10.3390/jcm12175754] [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: 07/27/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Neuropsychiatric cases require a multidisciplinary approach for effective management. This paper presented case-based discussions on migraine, dementia, epilepsy, mood disorders, neuralgia, and psychosis from the perspectives of a family physician, neurologist, and psychiatrist. The goal was to highlight the importance of collaboration between healthcare providers in managing these complex cases. METHODS The paper was based on the proceedings of the Mediterranean Neuropsychiatry Symposium, where experts from family medicine, neurology, and psychiatry came together for comprehensive case-based discussions. The CARE framework (Case Report, Appraisal, Research, and Education) was developed to guide reporting and evaluation of case reports in clinical practice. RESULTS Six cases were presented and discussed, highlighting the importance of a multidisciplinary approach in managing neuropsychiatric cases. The cases included chronic migraine with medication overuse, memory dysfunction with language and behavioral problems, refractory epileptic seizures with subjective sensory symptoms, bipolar affective disorder with normal pressure hydrocephalus, postherpetic neuralgia in a case with bipolar affective disorder, and psychosis with recurrent attacks with the abuse of several substances. CONCLUSION A biopsychosocial multidisciplinary approach is essential for managing neuropsychiatric cases effectively on behalf of the patients and public health of the country. The CARE framework can guide the reporting and evaluation of case reports in clinical practice, ensuring that patients receive comprehensive and effective care. Healthcare providers should collaborate to provide the best possible care for patients with complex and multifaceted needs.
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Affiliation(s)
- Aynur Özge
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Türkiye;
| | - Füsun Mayda Domaç
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye;
| | - Nil Tekin
- Department of Family Medicine, Izmir Faculty of Medicine, University of Health Sciences, İzmir 35330, Türkiye;
- Department of Family Medicine, Tepecik Education and Research Hospital, University of Health Sciences, İzmir 35330, Türkiye
| | - Esra Aydın Sünbül
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Nevra Öksüz
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Türkiye;
| | - Arife Çimen Atalar
- Neurology Department, Kanuni Sultan Süleyman Education and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye;
| | - Sümeyye Yasemin Çallı
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Yağmur Sever Fidan
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Ahmet Evlice
- Department of Neurology, School of Medicine, Çukurova University, Adana 01330, Türkiye;
| | - Engin Emrem Beştepe
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Filiz İzci
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Özge Yılmaz Küsbeci
- Neurology Department, Medical Faculty, Izmir University of Economics, Izmir 35330, Türkiye;
| | - Esra Acıman Demirel
- Department of Neurology, Zonguldak Bulent Ecevit University of Medicine, Zonguldak 67100, Türkiye;
| | - Sibel K. Velioğlu
- Clinical Neurophysiology Unit, Neurology Department, Medical Faculty, Karadeniz Technical University, Trabzon 61080, Türkiye;
| | - Mehmet Ungan
- Department of Family Medicine, Medical Faculty, Ankara University, Ankara 06100, Türkiye;
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Laskar S, Chaudhry N, Choudhury C, Garg D. Gender differences in quality of life and psychiatric comorbidities among persons with juvenile myoclonic epilepsy: A single-center cross-sectional study. J Neurosci Rural Pract 2023; 14:482-487. [PMID: 37692809 PMCID: PMC10483207 DOI: 10.25259/jnrp_34_2023] [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: 01/16/2023] [Accepted: 05/19/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives Juvenile myoclonic epilepsy (JME) is the most common idiopathic generalized/genetic epilepsy syndrome. Gender differences are known in clinical presentation, with a well-identified female predilection. We aimed to study gender-based differences in quality of life (QoL) and psychiatric comorbidities among persons with JME. Materials and Methods This was a cross-sectional study conducted at a teaching hospital in Delhi, India. Persons above 11 years of age with JME diagnosed according to the International League Against Epilepsy criteria established in 2001 were enrolled. QoL assessment was made using Quality of Life in Epilepsy Inventory-Adolescents-48 (QOLIE-AD-48) and Patient-Weighted Quality of Life in Epilepsy Inventory 31 (QOLIE-31-P) for adolescent and adult patients, respectively. For the assessment of psychiatric comorbidities, participants were administered the Mini-International Neuropsychiatric Interview (M.I.N.I). Participants who tested positive for psychiatric comorbidities on M.I.N.I subsequently underwent the Diagnostic and Statistical Manual-5 categorization. Results We enrolled 50 patients with JME. Eighteen (36%) were male and 32 (64%) were female patients. The median age of males at study enrollment was 23.5 (range 15-38) years. The median age of females was 22 (16-48) years. The median QOLIE-31-P score among males was 68.31 (37.13-91.82) and for females was 66.9 (31.7-99.1). The median overall QoL score for males was 65 (25-87.5), which qualified as "fair" QoL. For females, the median overall QoL score was 62.5 (10-87.5) which also qualified as "fair" QoL. No significant difference was noted between genders in QoL (P = 0.723). Among males, 55.5% had psychiatric comorbidity. Of these, two had mild depression and eight had anxiety. Among female patients, 34.4% had comorbid psychiatric issues; 6 had anxiety and 5 had depression. No significant difference was noted between genders (P = 0.9136). Conclusion Persons with JME do not have gender-stratified differences in terms of psychiatric comorbidities and QoL despite differences in exposure to antiseizure medications and other gender-related factors. All persons with JME should be screened for psychiatric comorbidities, specifically anxiety, and depression.
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Affiliation(s)
- Sanghamitra Laskar
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Neera Chaudhry
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Cankatika Choudhury
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Divyani Garg
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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15
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Mangaard S, Gesche J, Krøigård T, Beier CP. Association of symptoms of psychiatric disease and electroencephalographic patterns in idiopathic generalized epilepsy. Epilepsy Behav 2023; 145:109293. [PMID: 37315408 DOI: 10.1016/j.yebeh.2023.109293] [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: 03/16/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Idiopathic generalized epilepsies (IGE) are genetic epilepsies with alterations of thalamo-frontocortical circuits that play a major role in seizure generation and propagation. Psychiatric diseases and drug resistance are strongly associated, but it remains unknown if they are symptoms of the same pathophysiological process. Hypothesizing that the same network alterations are associated with the frequency of epileptic discharges (ED) and psychiatric symptoms, we here tested the association of self-reported psychiatric symptoms and IGE severity estimated by electroencephalographic (EEG) biomarkers. METHODS Idiopathic generalized epilepsies patients were asked to fill out four validated psychiatric screening tools assessing symptoms of personality disorders (Standard Assessment of Personality- Abbreviated Scale), depression (Major Depression Inventory), impulsiveness (Barratt Impulsiveness Scale), and anxiety (brief Epilepsy Anxiety Survey Instrument). Blinded to results and clinical data on the patients, we analyzed the patients' EEGs, assessed, and quantified ED. The number and duration of ED divided by the duration of the EEG served as a proxy for the severity of IGE that was correlated with the results of the psychiatric screening. RESULTS Paired data from 64 patients were available for analysis. The duration of EDs per minute EEG was inversely associated with the time since the last seizure. The number of patients with generalized polyspike trains (n = 2), generalized paroxysmal fast activity (n = 3), and prolonged epileptiform discharges (n = 10) were too low for statistically meaningful analyses. Self-reported symptoms of depression, personality disorder, and impulsivity were not associated with EDs. In contrast, the duration of EDs per minute EEG was associated with self-reported symptoms of anxiety in univariate analyses, not significant, however, following adjustment for time since the last seizure in regression models. SIGNIFICANCE Self-reported symptoms of psychiatric diseases were not strongly associated with EDs as the best available quantifiable biomarker of IGE severity. As expected, the duration of EDs per minute and anxiety was inversely associated with time since the last seizure. Our data argue against a direct link between the frequency of EDs - as an objective proxy of IGE severity - and psychiatric symptoms.
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Affiliation(s)
- Sofie Mangaard
- Department of Neurology, Odense University Hospital, Denmark
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Thomas Krøigård
- Department of Neurophysiology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; OPEN, University of Southern Denmark, Denmark.
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Oddo S, Sarudiansky M, Myers L, D'Alessio L. Editorial: Psychiatric comorbidities in patients with epilepsy: diagnosis and treatment. Front Psychiatry 2023; 14:1217656. [PMID: 37346901 PMCID: PMC10280719 DOI: 10.3389/fpsyt.2023.1217656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/24/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Silvia Oddo
- Epilepsy Center, El Cruce Hospital and Ramos Mejía Hospital, Studies in Neurosciences and Complex Systems-National Scientific and Technical Research Council (ENYS-CONICET), Buenos Aires University, Buenos Aires, Argentina
| | - Mercedes Sarudiansky
- Faculty of Psychology, National Scientific and Technical Research Council (CONICET), Buenos Aires University, Buenos Aires, Argentina
| | - Lorna Myers
- Department of Clinical Psychology, Psychogenic non-epileptic Seizures Program, Northeast Regional Epilepsy Group, New York, NY, United States
| | - Luciana D'Alessio
- Epilepsy Center, Ramos Mejía Hospital, Institute of Cell Biology and Neurosciences-National Scientific and Technical Research Council (IBCN-CONICET), Buenos Aires University, Buenos Aires, Argentina
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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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18
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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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Charfi N, Abid S, Farhat N, Elleuch O, Daoud S, Dammak M, Omri S, Thabet JB, Bouali MM, Mhiri C, Maâlej M. Psychiatric comorbidities in epilepsy patients: results of a Tunisian study. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2023. [DOI: 10.1002/pnp.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Nada Charfi
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Salma Abid
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Nouha Farhat
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Oumayma Elleuch
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Saoussen Daoud
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Mariem Dammak
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Sana Omri
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Jihène Ben Thabet
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Manel Maâlej Bouali
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Chokri Mhiri
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Mohamed Maâlej
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
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Schabert VF, Stern S, Ferrari L, Wade CT, Willke RJ, Hauser WA. Incidence of mental health conditions by seizure control among adults with epilepsy in the United States. Epilepsy Behav 2022; 134:108865. [PMID: 35952507 DOI: 10.1016/j.yebeh.2022.108865] [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: 06/02/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mental health conditions (MHCs) are frequent comorbidities among people with epilepsy; however, the influence of seizure control on the incidence of MHCs is not well reported. This retrospective observational cohort study based on claims data evaluated the effects of indicators of poor seizure control on the incidence of MHCs among MHC-naïve people with epilepsy. We hypothesized that poor seizure control is associated with new-onset MHC diagnoses and/or new prescription drugs for MHCs. METHODS This study utilized a sample of patients from HealthVerity Marketplace, which includes more than 150 US commercial, Medicare, and Medicaid payers, to identify a cohort of adults (age ≥18 years) with prevalent epilepsy. Follow-up started on day 1 (January 1) after a 1-year eligibility assessment period occurring in calendar year 2017 or 2018. Patients were followed up until the occurrence of an incident MHC event (primary outcome), defined as a mental health diagnosis or psychotropic drug prescription. Time from follow-up to incident MHC diagnosis or to a drug prescription specific to depression or anxiety disorder was analyzed as a secondary outcome. Multivariate Cox proportional hazards regressions were estimated with time-varying covariates, measured in 6-month intervals during follow-up. Time-varying covariates were based on the occurrence of 4 variables used as indicators of poor seizure control in the prior period: epilepsy-related emergent care admissions, epilepsy-related inpatient admissions, epilepsy electroencephalography referrals, and exposure to one or more new antiseizure medications (ASMs). RESULTS From a random sample of 40,000 people with epilepsy, 2563 (mean age 46.1 years; 50.6% male) were included in the analysis. Incident MHC events were observed in 27.7% (incidence rate 24.4 events per 100 person-years over 2,915.7 total person-years of follow-up). Mean (standard deviation [SD]) time to event was 232.7 (186.3) days. Among the 4 variables, epilepsy-related emergent care admissions were associated with an increased risk of incident MHC events in the following 6-month period (hazard ratio [HR] = 1.676, 95% confidence interval [CI]: 1.386, 2.026, p < 0.001) as were prescriptions for new ASMs in the previous period (HR = 1.702, 95% CI: 1.359, 2.132, p < 0.001). Previous epilepsy-related emergent care admissions (HR = 1.650, 95% CI: 1.347, 2.021, p < 0.001) and new ASMs (HR = 1.632, 95% CI: 1.280, 2.081, p < 0.001) also predicted an increased risk of incident depression or anxiety in the following 6-month period. CONCLUSIONS Previous indicators of poor seizure control, including epilepsy-related emergent care admissions and new ASMs, predicted increased risk of new MHC events, including depression and anxiety, during the following 6-month interval in MHC-naïve patients with prevalent epilepsy. These data suggest that poor seizure control can increase the subsequent risk of new mental health diagnoses and treatment among people with epilepsy.
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Affiliation(s)
| | - Sean Stern
- SK Life Science, Inc., 461 From Road, Fifth Floor, Paramus, NJ 07652, USA.
| | - Louis Ferrari
- SK Life Science, Inc., 461 From Road, Fifth Floor, Paramus, NJ 07652, USA.
| | - Clarence T Wade
- SK Life Science, Inc., 461 From Road, Fifth Floor, Paramus, NJ 07652, USA.
| | - Richard J Willke
- ISPOR - International Society for Pharmacoeconomics and Outcomes, 505 Lawrence Square Blvd South, Lawrenceville, NJ 08648, USA.
| | - W Allen Hauser
- Departments of Neurology and Epidemiology, Gertrude M. Sergievsky Center, Columbia University, 630 West 168 St., New York, NY 10032, USA.
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21
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Peña-Salazar C, Alfonso-Ramos M, Arroyo-Uriarte P, Serrano-Blanco A, Aznar-Lou I. Is epilepsy related to psychiatric disorders in people with intellectual disability? A systematic review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022:17446295221116506. [PMID: 35925864 DOI: 10.1177/17446295221116506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The prevalence of psychiatric disorders in people with Intellectual Disability (ID) is statistically higher than in the general population. There is a lack of consensus on the role that epilepsy plays in psychiatric disorders in people with ID. We carried out a systematic review of articles published between 1960 and 2022, focusing on high-quality, case-control original research studies that only included adult populations. The primary outcome was the prevalence of psychiatric disorders in people with intellectual disability with and without epilepsy. Six articles were finally included. Results were varied; some reported a statistical increase, whereas others did not find any statistical difference. Due to the current controversy on the role of epilepsy in psychiatric disorders in people with ID and the small number of publications on the topic, we cannot affirm a relationship between epilepsy and psychiatric disorders in people with ID.
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Affiliation(s)
- Carlos Peña-Salazar
- Mental Health and Intellectual disability services, 221703Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Neurology Department, 221703Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Teaching, Research & Innovation Unit, 221703Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
| | - Miqueu Alfonso-Ramos
- Teaching, Research & Innovation Unit, 221703Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Paula Arroyo-Uriarte
- Teaching, Research & Innovation Unit, 221703Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Teaching, Research & Innovation Unit, 221703Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Antoni Serrano-Blanco
- Teaching, Research & Innovation Unit, 221703Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
| | - Ignacio Aznar-Lou
- Teaching, Research & Innovation Unit, 221703Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
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22
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Asadi-Pooya AA, Rostamihosseinkhani M, Farazdaghi M. Seizure and social outcomes in patients with juvenile myoclonic epilepsy (JME). Seizure 2022; 97:15-19. [DOI: 10.1016/j.seizure.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022] Open
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23
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Sammarra I, Martino I, Caligiuri ME, Giugno A, Fortunato F, Labate A, Gambardella A. The impact of one-year COVID-19 containment measures in patients with mesial temporal lobe epilepsy: A longitudinal survey-based study. Epilepsy Behav 2022; 128:108600. [PMID: 35151188 PMCID: PMC8801317 DOI: 10.1016/j.yebeh.2022.108600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND We assessed levels of depression, anxiety, stress, anhedonia, somatization, psychological distress, sleep, and life quality in patients with mesial temporal lobe epilepsy (MTLE) after one year of containment measures started in Italy to stem the COVID-19 pandemic. METHODS We consecutively enrolled 51 patients with MTLE, administering an online survey that compared the year before and after the COVID-19 propagation. We analyzed clinical data (e.g., seizure frequency, life quality) and neuropsychological assessment through Somatic Symptom Scale-8 (SSS-8), Beck Depression Inventory (BDI-2), State-Trait Anxiety Inventory (STAI-Y), Depression, Anxiety and Stress Scale (DASS-21), Pittsburgh Sleep Quality Index (PSQI), Snaith-Hamilton Pleasure Scale (SHAPS), Impact of Event Scale-Revised (IES-R). The BDI-2 and STAI-Y scores were compared to those acquired in the same patients before the COVID-19 outbreak. RESULTS Comparing our population with MTLE before and after COVID-19 outbreak, we found a significant worsening in life quality (p = 0.03), SSS-8 (p = 0.001), BDI-2 (p = 0.032), and STAI-Y scores (p < 0.001). After one year of pandemic, 88.2% of patients obtained pathological scores at PSQI, 19.6% at SHAPS, 29.4% at IES-R. Reduction of life quality correlated with anxiety, depression, stress, and somatization. Higher levels of anhedonia correlated with stress, depression, and anxiety. Somatization correlated with depression, anxiety, and sleep quality. Distress levels correlated with anxiety, somatization, and depression. CONCLUSIONS We demonstrated a significant worsening of depression, anxiety, life quality, and somatization in patients with MTLE after one year of COVID-19 beginning. Concomitantly, results suggest that the pandemic had a negative impact on sleep quality, psychological distress, and anhedonia, but not on epilepsy itself.
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Affiliation(s)
- Ilaria Sammarra
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Iolanda Martino
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Maria Eugenia Caligiuri
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Alessia Giugno
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy.
| | - Angelo Labate
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy.
| | - Antonio Gambardella
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.
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24
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Asadi-Pooya AA, Karimi A, Rahgoshay M, Rostamihosseinkhani M, Nemati H. Educational needs of physicians (in training) for management of patients with epilepsy. Epilepsy Behav 2021; 124:108375. [PMID: 34757260 DOI: 10.1016/j.yebeh.2021.108375] [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: 08/31/2021] [Revised: 09/25/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the opinions of medical students, residents in different disciplines, and clinical attendings in various disciplines on the educational needs and learning objectives about epilepsy at the basic and intermediate levels of medical education. METHODS On July 15th, 2021, we posted an online invitation including a questionnaire to all the medical students, residents, and attendings of Shiraz University of Medical Sciences, Iran. The survey anonymously collected data about the participants [sex, age, educational level, and their disciplines (attendings)], and answers to the questions about their opinions about the educational needs and learning objectives of the medical students and residents about epilepsy. RESULTS Five hundred and seventy-eight trainees and 53 attendings participated in the study. Trainees at different educational levels and in various disciplines had significantly different opinions on their educational needs and learning objectives about epilepsy. At the undergraduate level, the opinions of the trainees and their attendings were similar and the most reported needs by both groups included: Terminology and definitions, Physiopathology and etiology, Semiology and clinical characteristics, Medical treatment, Comorbidities. For the residents in neurology, psychiatry, and neurosurgery, the most reported needs included: all aspects of epilepsy. SIGNIFICANCE Trainees at various educational levels/disciplines in medicine have different educational needs and learning objectives with regard to epilepsy and management of PWE. Policy makers in medical education should consider the observations of this study in order to design tailored and targeted educational curricula about epilepsy for various educational levels/disciplines in medicine.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Afrooz Karimi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Rahgoshay
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hamid Nemati
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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25
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Sere P, Zsigri N, Raffai T, Furdan S, Győri F, Crunelli V, Lőrincz ML. Activity of the Lateral Hypothalamus during Genetically Determined Absence Seizures. Int J Mol Sci 2021; 22:ijms22179466. [PMID: 34502374 PMCID: PMC8431596 DOI: 10.3390/ijms22179466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/17/2021] [Accepted: 08/26/2021] [Indexed: 12/14/2022] Open
Abstract
(1) Background: Absence seizures (ASs) are sudden, transient lapses of consciousness associated with lack of voluntary movements and generalized 2.5–4 Hz spike-wave discharges (SWDs) in the EEG. In addition to the thalamocortical system, where these pathological oscillations are generated, multiple neuronal circuits have been involved in their modulation and associated comorbidities including the serotonergic system. Neuronal activity in one of the major synaptic input structures to the brainstem dorsal raphé nucleus (DRN), the lateral hypothalamus (LH), has not been characterized. (2) Methods: We used viral tract tracing and optogenetics combined with in vitro and in vivo electrophysiology to assess the involvement of the LH in absence epilepsy in a genetic rodent model. (3) Results: We found that a substantial fraction of LH neurons project to the DRN of which a minority is GABAergic. The LH to DRN projection can lead to monosynaptic iGluR mediated excitation in DRN 5-HT neurons. Neuronal activity in the LH is coupled to SWDs. (4) Conclusions: Our results indicate that a brain area involved in the regulation of autonomic functions and heavily innervating the RN is involved in ASs. The decreased activity of LH neurons during SWDs could lead to both a decreased excitation and disinhibition in the DRN. These results support a long-range subcortical regulation of serotonergic neuromodulation during ASs and further our understanding of the state-dependence of these seizures and some of their associated comorbidities.
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Affiliation(s)
- Péter Sere
- Department of Physiology, Anatomy and Neuroscience, Faculty of Sciences University of Szeged, 6726 Szeged, Hungary; (P.S.); (N.Z.); (T.R.); (S.F.); (F.G.)
- Department of Physiology, Faculty of Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Nikolett Zsigri
- Department of Physiology, Anatomy and Neuroscience, Faculty of Sciences University of Szeged, 6726 Szeged, Hungary; (P.S.); (N.Z.); (T.R.); (S.F.); (F.G.)
- Department of Physiology, Faculty of Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Timea Raffai
- Department of Physiology, Anatomy and Neuroscience, Faculty of Sciences University of Szeged, 6726 Szeged, Hungary; (P.S.); (N.Z.); (T.R.); (S.F.); (F.G.)
- Department of Physiology, Faculty of Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Szabina Furdan
- Department of Physiology, Anatomy and Neuroscience, Faculty of Sciences University of Szeged, 6726 Szeged, Hungary; (P.S.); (N.Z.); (T.R.); (S.F.); (F.G.)
| | - Fanni Győri
- Department of Physiology, Anatomy and Neuroscience, Faculty of Sciences University of Szeged, 6726 Szeged, Hungary; (P.S.); (N.Z.); (T.R.); (S.F.); (F.G.)
| | - Vincenzo Crunelli
- Neuroscience Division, Cardiff University, Museum Avenue, Cardiff CF10 3AX, UK;
| | - Magor L. Lőrincz
- Department of Physiology, Anatomy and Neuroscience, Faculty of Sciences University of Szeged, 6726 Szeged, Hungary; (P.S.); (N.Z.); (T.R.); (S.F.); (F.G.)
- Department of Physiology, Faculty of Medicine, University of Szeged, 6720 Szeged, Hungary
- Neuroscience Division, Cardiff University, Museum Avenue, Cardiff CF10 3AX, UK;
- Correspondence:
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