Depression in adults with epilepsy: Relationship to psychobiological variables

Depression and associated factors among people with epilepsy at Wolaita Sodo University Hospital, South Ethiopia

BACKGROUND

Epilepsy is one of the most common neurological disorders in the world and contributes to various psychiatric illnesses. Depression is one of the most frequent comorbid psychiatric disorders that affect the quality of life in people with epilepsy. Despite this impact, depression continues to be under-recognized and undertreated. Therefore, this study aimed to assess the magnitude of depression and its associated factors among people with epilepsy at Wolaita Sodo University Hospital, South Ethiopia, 2021.

METHODS

A hospital-based cross-sectional study was conducted from April 2021 to May 2021. A systematic random sampling technique was used to select 423 samples of people with epilepsy, and interviewer-administered structured questionnaires were employed. The Patient Health Questionnaire with 9 items was used to assess depression. A logistic regression model was used to determine the association between the outcome and independent variables. A 95% CI and odds ratio with a corresponding p-value < 0.05 were used to determine the strength of association.

RESULT

The overall magnitude of depression among people with epilepsy in this study was 49.2%. Educational status; unable to read and write (AOR = 3.43, 95% CI 1.09, 10.7), being female (AOR = 2.54, 95% CI 1.43, 4.52), perceived stigma (AOR = 5.96, 95% CI 2.88, 12.3), poor social support (AOR = 2.88, 95% CI 1.28, 6.48), poor medication adherence (AOR = 4.60, 95% CI 2.46, 8.63), and seizure frequency above 5 times per month (AOR = 5.59, 95% CI 1.72, 18.1) were independent predictors of depression among people with epilepsy at p-value < 0.05.

CONCLUSION AND RECOMMENDATION

In this study nearly half of the people with epilepsy had depression. Educational status; inability to read and write, being female, perceived stigma, poor social support, poor medication adherence, and seizure frequency of above 5 times per month were independent predictors of depression among people with epilepsy. Therefore, screening depression in people with epilepsy and appropriate management critically needed attention to reduce the effects of the problems.

Comorbid depression and its associated factors in patients with epilepsy treated with single and multiple drug therapy: A cross-sectional study from Himalayan country

INTRODUCTION

Depressive disorder is the most common psychiatric comorbidity in individuals with epilepsy (IWE) and is associated with a significant negative impact with increased morbidity and mortality rate. However, the magnitude of comorbid depression in such patients in the Nepalese setting is still poorly understood. Therefore, we aimed to determine the magnitude of depression in individuals diagnosed as having epilepsy and further examine the influencing factors associated with it.

METHODS

This cross-sectional observational study was conducted from April 2018 to September 2018 at Nepal Epilepsy Center, Lazimpat, Kathmandu, Nepal. One hundred and forty-two eligible subjects were enrolled for analysis. The core outcome variable evaluated in this study was depressive disorder, whereas age, gender, types of epilepsy, frequency of seizures, duration of epilepsy, and drug use were evaluated as covariates. The mean ages of the patients were 31.45 ± 12.05 years, and 87 (61.3%) were male. The prevalence of depression was found to be 31% (95% confidence interval [CI]; lower limit: 23.39% and upper limit: 38.60%), with majority subjects had a mild type of depression, and 63.63% (95% CI; lower limit: 55.05% and upper limit: 70.94%). The frequency of drug use remained a significant predictor for depression in individuals with epilepsy (P = 0.002), and the odds of having depression in individuals receiving polytherapy were 3.82 higher than in those receiving monotherapy (95%: 1.61-9.05, P = 0.002).

CONCLUSION

Our study indicated a high rate of depression in a substantial number of IWE in the Nepalese setting. Polytherapy emerged as an independent predictor for depression. The high coexistence of depression in this vulnerable population and an increased risk for comorbid in polytherapy necessitate incorporating depression screening and proper treatment into the existing epilepsy program. Furthermore, revising treatment guidelines on comorbid depression to reduce polytherapy and encouraging health education on epilepsy to reduce stigma may also be warranted.

Sexual functions in women with focal epilepsy: Relationship to demographic, clinical, hormonal and psychological variables

OBJECTIVES

Sexual dysfunctions [SDs] are common in women with epilepsy [WWE] but related studies were neglected in our locality. We aimed to determine the frequencies and severities of SDs and their clinical, hormonal and psychological determinants in WWE.

PATIENTS AND METHODS

This study included 120 adults [mean age: 36.35 ± 2.89yrs] with temporal [63.33 %] and frontal [36.67 %] lobe epilepsies and treated with carbamazepine [CBZ] [n = 60] or oxcarbazepine [OXC] [n = 60] for mean duration of 18.63 ± 4.33yrs. Patients were assessed using Female Sexual Function Index [FSFI] questionnaire, Beck Depression Inventory [BDI-II] and Hamilton Anxiety Rating Scale [HAM-A]. Total testosterone, sex hormone binding globulin [SHBG] and free androgen index [FAI] were measured to assess endocrinal status.

PATIENTS AND METHODS

This study included 120 adults [mean age: 36.35 ± 2.89yrs] with temporal [63.33 %] and frontal [36.67 %] lobe epilepsies and treated with carbamazepine [CBZ] [n = 60] or oxcarbazepine [OXC] [n = 60] for mean duration of 18.63 ± 4.33yrs. Patients were assessed using Female Sexual Function Index [FSFI] questionnaire, Beck Depression Inventory [BDI-II] and Hamilton Anxiety Rating Scale [HAM-A]. Total testosterone, sex hormone binding globulin [SHBG] and free androgen index [FAI] were measured to assess endocrinal status.

RESULTS

The majority had occasional/rare frequency of seizures [76.67 %] and well controlled on antiepileptic drugs [AEDs] [81.67 %]. Compared to healthy women, WWE had lower total testosterone and FAI and higher SHBG levels. Compared to women on CBZ, those on OXC had lower frequency and well controlled seizures on medication [P = 0.0001 for both], higher testosterone [P = 0.01] and FAI [P = 0.001] and lower SHBG [P = 0.001] levels. Compared to controls, WWE had significantly higher frequencies and severities of SDs [total sexual function, desire, arousal, lubrication, orgasm, satisfaction and pain] and depression and anxiety symptoms. OXC therapy was associated with lower SDs [FSFI: P = 0.033] and anxiety symptoms [P = 0.025] compared to CBZ therapy. In multiple logistic regression analyses, determinants of SDs were the higher seizures frequency, increasing severities of depression and anxiety but not lower androgen levels or type of epilepsy or AEDs.

CONCLUSIONS

Different aspects of SD and depression and anxiety symptoms were frequent in WWE. Determinants of SDs were the higher frequency of seizures and increasing severities of depression and anxiety. OXC had better control on seizures and thus lower frequencies and severities of SDs and depression and anxiety symptoms. Thus optimizing seizure control is important for psychological state and healthy sexual function in WWE.

Prevalence of depression and associated factors among epileptic patients at Ilu Ababore zone hospitals, South West Ethiopia, 2017: a cross‑sectional study

BACKGROUND

Depression is one of the most common and overwhelming mental disorder in patients with epilepsy. Despite its high prevalence, depression continues to be under-recognized and undertreated. This study aimed to assess the prevalence of depression and its associated factors among epileptic patients attending the outpatient department of Ilu Ababore zone hospitals, Southwest Ethiopia, 2017.

METHODS

Institution-based cross-sectional study was carried out among 402 individual with epilepsy. The participants were selected using systematic random sampling technique. Depression was measured using Beck's Depression Inventory II. Oslo 3 Social Support Scale was used to assess social support. Perceived Stress Scale was used to assess the stress level of epileptic patients. The data were entered into Epi Info version 7 and analyzed by the SPSS version 20 software. We computed bivariate and multivariate binary logistic regressions to assess factors associated with depression. Statistical significance was declared at p-value < 0.05.

RESULTS

A total of 402 study participants were interviewed with a response rate of 96.2%. The prevalence of depression was found to be 48.1%. In the final multivariate analysis, educational status [unable to read and write (AOR = 4.01,95% CI = 3.82, 8.28), primary (AOR = 3.43, 95% CI = 3.12,9.29), secondary (AOR = 2.01, 95% CI = 1.89,7.24)], high perceived stress (AOR = 3.21, 95% CI = 2.70, 8.41), poor social support (AOR = 2.04, 95% CI = 1.42, 2.78), onset of illness < 6 year (AOR = 2.40, 95%CI = 2.10,7.91), seizure frequency of [1-11 per year (AOR = 2.34, 95% = 1.41, 4.36), ≥ 12/year (AOR = 3.49, 95% CI = 3.43, 6.40)], and polytherapy (AOR = 2.73, 95%CI = 2.52, 7.14) were independent predictors of depression among epileptic patients at p-value < 0.05.

CONCLUSION AND RECOMMENDATION

Overall, the prevalence of depression was found to be high. Having lower educational status, early onset of illness, poor social support, high perceived stress, high seizure frequency, and polytherapy were factors statistically associated with depression. Clinicians need to give emphasis to epileptic patients with high perceived stress, low educational status, and poor social support. An early depression-focused regular screening for epileptic patient should be carried out by trained health professionals. Linkage with mental health service providers also needs to be considered.

Psychosis in adults with epilepsy and its relationship to demographic, clinical and treatment variables

Objectives: Psychiatric symptoms and disorders are commonly reported with epilepsy. This study aimed to determine the prevalence of interictal psychosis (IIP) in adults with epilepsy and its risk predictors. Methods: The study included 710 patients (mean age: 36.40 years; age at onset: 13.58 years; duration of epilepsy: 22.80 years). All underwent neurological and psychiatric interviewing, electroencephalography and brain imaging. Results: IIP was reported in 20.65%, of them 50% had temporal lobe epilepsy with impaired awareness and/or to bilateral tonic clonic, 42.47% had frontal lobe epilepsy with impaired awareness and/or to bilateral tonic clonic and 7.53% had generalized tonic-clonic seizures. Compared to patients without psychosis, patients with psychosis were older at age of examination, had earlier age at onset, frequent seizures, longer duration of epilepsy and long-term antiepileptic drugs therapy and many relatives with epilepsy. Nearly 76.71% had history of postictal psychosis (PIP). The mean age of onset of IIP was 30.45 years and its mean duration was 3.84 months. Approximately 22% of patients with IIP had family history of psychosis. Patients developed IIP 10 years or more after epilepsy onset. Multivariate logistic regression analyses showed that predictors for IIP were the age at onset and duration of epilepsy, number of seizures, family history of epilepsy or psychosis, history of PIP and different types of epilepsy. Conclusion: IIP is not infrequent with chronic epilepsy regardless to its type. These findings emphasize the importance of optimizing patients' treatment and early recognition and management of IIP. Abbreviations: IIP: interictal psychosis; PIP: post-ictal psychosis; TLE: temporal lobe epilepsy; FLE: frontal lobe epilepsy; GTC: generalized tonic clonic; AEDs: antiepileptic drugs; CBZ: carbamazepine; VPA: valproate; LEV: levetiracetam; APDs: antipsychotic drugs.

The auditory and vestibular toxicities induced by antiepileptic drugs

Epilepsy is a chronic medical disease in one third of patients and is associated with comorbid adverse somatic conditions due to epilepsy itself or its long-term treatment with antiepileptic drugs (AEDs). Data from experimental, cross-sectional and prospective studies have evidence for the deleterious effect of some AEDs on the auditory and vestibular systems. These abnormalities may be reversible or irreversible. Areas covered: This article review the evidence that long-term treatment with some antiepileptic drugs (AEDs) [e.g. carbamazepine, phenytoin, valproate, lamotrigine, gabapentin, vigabatrin and oxcarbazepine] (even in therapeutic drug doses) may result in tinnitus, phonophobia, sensorineural hearing loss, dizziness, ataxia, disequilibrium, imbalance, nystagmus, abnormalities in saccadic and pursuit eye movements and delayed conduction within the cochlea, auditory nerve and brainstem auditory pathways evidenced by abnormalities in Brainstem auditory evoked potentials and nystagmography recordings indicating auditory and central and/or peripheral vestibular dysfunctions. Expert opinion: Identification of monitoring of patients at high risk for developing audio-vestibular manifestations is necessary for appropriate preventive and therapeutic measures.

Vestibular Function in Adults With Epilepsy of Unknown Etiology

OBJECTIVE

This study aimed to evaluate vestibular function in adults with chronic epilepsy of unknown etiology in the inter-ictal period.

BACKGROUND

Epilepsy is a chronic medical disorder. Life-long therapy may be required in one-third of patients. Epilepsy is associated with comorbid somatic conditions which impairs patients' quality of life.

METHODS

This cross-sectional study included 28 with generalized tonic clonic (GTC) convulsions and 14 and 3 with temporal (TLE) and frontal lobe (FLE) epilepsies with secondary generalization (all were on regular carbamazepine therapy) and 40 healthy control subjects. The patients' mean age was 34.97 ± 7.35 years and the duration of illness was 18.75 ± 7.99 years. All underwent videonystagmography (VNG).

RESULTS

Compared with controls, patients had frequent vestibular symptoms including dizziness (62.22%) (p = 0.0001) and sense of imbalance (44.44%) (p = 0.0001). Eleven patients (24.44%) had central vestibular dysfunction (p = 0.0001); 9 (20%) had mixed vestibular dysfunction and one (2.22%) had peripheral vestibular dysfunction (p = 0.0001). Abnormalities were observed in saccadic (44.4%) and pursuit (42.2%) eye movements, optokinetic nystagmus (42.2%) and positioning/positional (11.11%) and caloric (13.33%) testing. TLE and FLE were associated with more VNG abnormalities than GTC. No significant differences were observed in the demographic and clinical characteristics between patients with and without VNG abnormalities.

CONCLUSION

Vestibular manifestations are frequent in patients with epilepsy. This may be a result of the permanent damaging effect of chronic epilepsy on the vestibular cortical areas and/or a toxic effect from prolonged carbamazepine therapy on the peripheral and central vestibular systems.

Evaluation of penile vascular status in men with epilepsy with erectile dysfunction

PURPOSE

Erectile dysfunction (ED) is common in males with epilepsy, likely of multifactorial etiology, including possible systemic vascular comorbidities and medication effects. Here we examined male patients for the possibility of a vasculogenic element of ED.

METHODS

Research participants included 47 men with epilepsy (mean age=30.98 years; duration of illness=13.98 years) and 25 healthy matched men (mean age=30.36). Erectile function was assessed using the International Index of Erectile Function Questionnaire (IIEF-5). Penile blood flow was assessed using Duplex Ultrasonography (PDU) after intracavernous alprostadil injection. Penile peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI) were the functional parameters analyzed. Carotid artery intima media thickness (CA-IMT) was also measured.

RESULTS

Thirteen of the 47 men with epilepsy (23.40% versus 0% for controls) reported ED, and of these patients, 11 (84.62%) had abnormal PDU [PSV=28.23 ± 6.1cm/s, P=0.0001; EDV=2.22 ± 5.71 cm/s, P=0.004; RI=0.89 ± 0.22, P=0.071] suggesting vasculogic ED. Penile arterial insufficiency was identified in 5 (45.45%), while 6 (54.54%) had mixed arterial insufficiency and venous leak. Compared to patients with high PSV, patients with low PSV had lower IIED-5 scores, higher EDV, lower RI, higher diastolic blood pressure and higher CA-IMT values. There were no differences in depression, anxiety or concentrations of sex hormones. Significant correlations were evident between PDU variables and duration of illness, depression and anxiety scores and CA-IMT values. In multivariate analysis, the association between PDU parameters and CA-IMT values remained significant even after adjustment for other confounding variables.

CONCLUSIONS

Vasculogenic ED is frequent with epilepsy and its relationship to systemic atherosclerosis cannot be excluded.

Evaluation of penile vascular status in men with epilepsy with erectile dysfunction

PURPOSE

Erectile dysfunction (ED) is common in males with epilepsy, likely of multifactorial etiology, including possible systemic vascular comorbidities and medication effects. Here we examined male patients for the possibility of a vasculogenic element of ED.

METHODS

Research participants included 47 men with epilepsy (mean age=30.98 years; duration of illness=13.98 years) and 25 healthy matched men (mean age=30.36). Erectile function was assessed using the International Index of Erectile Function Questionnaire (IIEF-5). Penile blood flow was assessed using Duplex Ultrasonography (PDU) after intracavernous alprostadil injection. Penile peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI) were the functional parameters analyzed. Carotid artery intima media thickness (CA-IMT) was also measured.

RESULTS

Thirteen of the 47 men with epilepsy (23.40% versus 0% for controls) reported ED, and of these patients, 11 (84.62%) had abnormal PDU [PSV=28.23 ± 6.1cm/s, P=0.0001; EDV=2.22 ± 5.71 cm/s, P=0.004; RI=0.89 ± 0.22, P=0.071] suggesting vasculogic ED. Penile arterial insufficiency was identified in 5 (45.45%), while 6 (54.54%) had mixed arterial insufficiency and venous leak. Compared to patients with high PSV, patients with low PSV had lower IIED-5 scores, higher EDV, lower RI, higher diastolic blood pressure and higher CA-IMT values. There were no differences in depression, anxiety or concentrations of sex hormones. Significant correlations were evident between PDU variables and duration of illness, depression and anxiety scores and CA-IMT values. In multivariate analysis, the association between PDU parameters and CA-IMT values remained significant even after adjustment for other confounding variables.

CONCLUSIONS

Vasculogenic ED is frequent with epilepsy and its relationship to systemic atherosclerosis cannot be excluded.

Atherosclerosis in epilepsy: its causes and implications

Evidence from epidemiological, longitudinal, prospective, double-blinded clinical trials as well as case reports documents age-accelerated atherosclerosis with increased carotid artery intima media thickness (CA-IMT) in patients with epilepsy. These findings raise concern regarding their implications for age-accelerated cognitive and behavioral changes in midlife and risk of later age-related cognitive disorders including neurodegenerative processes such as Alzheimer's disease (AD). Chronic epilepsy, cerebral atherosclerosis, and age-related cognitive disorders including AD share many clinical manifestations (e.g. characteristic cognitive deficits), risk factors, and structural and pathological brain abnormalities. These shared risk factors include increased CA-IMT, hyperhomocysteinemia (HHcy), lipid abnormalities, weight gain and obesity, insulin resistance (IR), and high levels of inflammatory and oxidative stresses. The resulting brain structural and pathological abnormalities include decreased volume of the hippocampus, increased cortical thinning of the frontal lobe, ventricular expansion and increased white matter ischemic disease, total brain atrophy, and β-amyloid protein deposition in the brain. The knowledge that age-accelerated atherosclerosis may contribute to age-accelerated cognitive and behavioral abnormalities and structural brain pathologies in patients with chronic epilepsy represents an important research path to pursue future clinical and management considerations.

Psychopathological and peripheral levels of neurobiological correlates of obsessive-compulsive symptoms in patients with epilepsy: a hospital-based study

OBJECTIVES

Obsessive-compulsive symptoms (OCSs) and disorder (OCD) are often underdiagnosed in the out-patient epilepsy clinic. This work aimed at determining the risks and comorbidities (psychopathological and neurobiological correlates) of OCSs in treated adults with idiopathic epilepsy recruited from a university hospital.

METHODS

Psychiatric evaluation was done using DSM-IV (The Diagnostic and Statistical Manual of Mental Health Disorders). Obsessive-compulsive disorder was identified using the Mini International Neuropsychiatric Interview (MINI). The Beck Depression Inventory (BDI-II), Hamilton Anxiety Rating Scale (HAM-A), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) were used to determine the severity of the related psychiatric symptoms.

RESULTS

Out of 474 patients screened, included in this study were 107 with no psychiatric symptoms and 188 with OCSs [classified as those with at least OCSs=93; mild OCSs=36; moderate, severe, and extreme OCSs=59]. A hundred healthy subjects were included as controls. Blood concentrations of serotonin, adrenaline, noradrenaline, and dopamine were measured. Compared with controls, patients with OCSs had higher frequencies of depression and anxiety. Low concentrations of serotonin, adrenaline, noradrenaline, and dopamine were reported regardless of the presence or the absence of psychiatric symptoms, OCS severities, and antiepileptic drug (AED)-related variables (dose and serum drug level). Significant correlations were identified between Y-BOCS, BDI-II, and HAM-A scores, age, age at onset, and concentrations of noradrenaline.

CONCLUSION

This study indicates that a) OCSs are common in patients with epilepsy. Male sex, age, duration of illness, seizure focus, lateralization, and intractability to AEDs are its main risks; b) depression and anxiety are comorbid psychopathologies; and c) serotonin, catecholamines, and dopamine are linked to epilepsy-related variables and its comorbid psychopathies but not to its medications.

Effect of saponin fraction from Ficus religiosa on memory deficit, and behavioral and biochemical impairments in pentylenetetrazol kindled mice

In our previous study, the saponin-rich fraction (SRF) of adventitious root extract of Ficus religiosa L. (Moraceae) was shown to have an anticonvulsant effect in acute animal models of convulsions. The present study was envisaged to study the effect of SRF in the pentylenetetrazol (PTZ) kindling mouse model and its associated depression and cognition deficit. Treatment with the SRF (1, 2 and 4 mg/kg; i.p.) for 15 days in kindled mice significantly decreased seizure severity on days 5, 10 and 15 when challenged with PTZ (35 mg/kg; i.p.). Marked protection against kindling-associated depression was also observed on days 10 and 15 in the SRF-treated groups when tested using the tail-suspension test. However, the SRF treatment failed to protect kindling-associated learning and memory impairments in the passive shock avoidance paradigm. The observed behavioral effects were corroborated with modulation in the levels of noradrenaline, dopamine, serotonin, GABA and glutamate in discrete brain regions.