Psychiatric and behavioral effects of the antiepileptic drugs and their action as mood stabilizers

INTRODUCTION: The association between epilepsy, psychiatric disorders (PD) and antiepileptic drugs (AED) is among the most frequent and important aspects of epileptology. According to most recent data in literature, AED can act as protecting or predisposing to psychiatric disorders. OBJECTIVE: Data regarding the psychiatric and behavioral effects of AED and its action as mood stabilizers were reviewed. In addition, we discuss the relationship between AED effects in predisposing or protect against PD and its respective mechanism of action. CONCLUSION: AED do not have only antiepileptic properties, but may be associated to positive or negative behaviors. However, the appearance of PD is associated to both AED mechanism of action and the patient's individual predisposing.INTRODUÇÃO: Um dos aspectos mais estudados da epileptologia atual é a associação existente entre os transtornos psiquiátricos (TP) e as drogas antiepilépticas (DAE). De acordo com dados recentes na literatura, as DAE podem exercer um papel protetor ou de predisposição ao aparecimento de TP. OBJETIVO: O presente trabalho tem como objetivo fazer uma revisão dos efeitos psiquiátricos e comportamentais das DAE e de sua ação como estabilizadores do humor, bem como de relacionar seu papel protetor ou de predisposição ao aparecimento de TP com seus respectivos mecanismos de ação. CONCLUSÃO: As DAE não apresentam apenas propriedades antiepilépticas, possuindo também efeitos comportamentais positivos ou negativos. O aparecimento de TP, no entanto, está associado tanto ao mecanismo de ação da DAE como à predisposição individual e à condição emocional preexistente do paciente.Universidade Federal de São Paulo (UNIFESP) Departamento de Neurologia e NeurocirurgiaUNIFESP, Depto. de Neurologia e NeurocirurgiaSciEL

Safety of video-EEG monitoring and surgical outcome in patients with mesial temporal sclerosis and psychosis of epilepsy

Purpose: Cortico-amygdalohippocampectomy (CAH) has become an important treatment option for patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS); it has resulted in a 60-70% seizure remission rate and significant quality of life (QOL) improvements. Video-electroencephalography (VEEG) monitoring has been widely used in epilepsy centers for pre-surgical evaluation. A major concern in epilepsy surgery is whether to consider CAH treatment in patients with psychosis of epilepsy (POE). This study analyzed the safety and adverse events (AEs) of VEEG monitoring and the post-surgical outcomes of patients with refractory TLE-MTS and POE who underwent CAH.Method: Clinical, sociodemographic and VEEG data from 18 patients with TLE-MTS and POE were analyzed. Psychiatric evaluations were performed using DSM-IV and ILAE criteria. the seizure outcome was evaluated using Engel's criteria.Results: Two patients (11.2%) presented AEs that did not result in increased lengths of hospitalization. of the 10 patients (55.5%) who underwent CAH, 6 (60%) became free of disabling seizures (Engel I). the psychiatric and QOL evaluations revealed improvements of psychotic symptoms (p = 0.01) and in Physical Health (p = 0.01) following surgery.Conclusion: These data reinforce that VEEG monitoring is a safe method to evaluate patients with refractory TLE-MTS and POE in epilepsy centers. (C) 2012 British Epilepsy Association. Published by Elsevier B.V. All rights reserved.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo UNIFESP, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, LiNC, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, LiNC, São Paulo, BrazilWeb of Scienc

Psychiatric comorbidity in patients with two prototypes of focal versus generalized epilepsy syndromes

The frequency of psychiatric disorders (PD) in a homogeneous series of patients with temporal lobe epilepsy with mesial temporal sclerosis (TLE-MTS) compared to patients with juvenile myoclonic epilepsy (JME) was evaluated, aiming to determine the frequency of PD and possible differences in psychiatric diagnoses between these two epileptic syndromes. Data from 248 patients with refractory TLE-MTS and from 124 JME patients were reviewed and compared. There was a high prevalence of PD in both groups of epilepsy patients, present in 100 TLE-MTS (41%) and in 58 JME patients (46.7%). Mood (23.7%), anxiety (13.7%) and psychotic (11.6%) disorders were the most frequent diagnoses in TLE-MTS group, while mood and anxiety disorders (25% and 21%, respectively) were the most common PD among JME. Psychoses were significantly associated with TLE-MTS (p = 0.01). These observations are concordant with our previous study, reforcing the existence of a possible anatomic correlation of PD and brain structures involved in both epilepsy syndromes. (C) 2011 British Epilepsy Association. Published by Elsevier B.V. All rights reserved.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo UNIFESP, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, Lab Interdisciplinar Neurociencias Clin LiNC, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, Lab Interdisciplinar Neurociencias Clin LiNC, São Paulo, BrazilWeb of Scienc

Transtorno disforico interictal: uma comorbidade psiquiatrica frequente entre pacientes com epilepsia acompanhados em dois servicos terciarios

Psychiatric disorders are frequent among patients with epilepsy. Data in the literature have shown a heterogeneous clinical presentation of psychiatric disorders in patients with epilepsy. Interictal dysphoric disorder could be a specific psychiatric comorbidity associated with epilepsy, primarily in patients treated in tertiary centers.Objective The present study aimed to determine the prevalence of interictal dysphoric disorder among patients with epilepsy who were followed in two tertiary epilepsy services in Brazil. Method Sixty-five patients with epilepsy completed the Portuguese version of the Interictal Dysphoric Disorder Inventory. Results Thirty-three (50.7%) patients fulfilled the diagnostic criteria for interictal dysphoric disorder, although all participants answered positively to having at least one key symptom. Conclusion The high rate of patients with epilepsy who fulfilled the diagnosis of interictal dysphoric disorder confirms an association between epilepsy and psychiatric disorders. However, there is clearly a need to improve diagnostic tools to allow better differentiation between interictal dysphoric disorder and other psychiatric disorders.Transtornos psiquiátricos são frequentes entre pacientes com epilepsia. Estudos evidenciam apresentações clínicas heterogêneas neste grupo. O transtorno disfórico interictal pode um transtorno específico destes pacientes, particularmente naqueles acompanhados em centros terciários.Objetivo Determinar a prevalência de transtorno disfórico interictal entre pacientes com epilepsia atendidos em dois serviços terciários de epilepsia do Brasil. Método Sessenta e cinco pacientes foram convidados a responder a versão brasileira do Interictal Dysphoric Disorder Inventory adaptado e validado para o Português. Resultados Trinta e três pacientes (50,7%) preencheram critérios para transtorno disfórico interictal, embora todos os entrevistados tenham afirmado que são acometidos por ao menos um dos sintomas-chave. Conclusão A alta prevalência de transtorno disfórico interictal em pacientes com epilepsia pode ser um indício da associação entre epilepsia e transtornos psiquiátricos. No entanto, é necessário melhorar a acurácia dos instrumentos de diagnóstico para poder diferenciar casos de transtorno disfórico interictal de outros transtornos psiquiátricos.Universidade Federal de São Paulo (UNIFESP) Department of Neurology and NeurosurgeryUniversidade Federal de Pernambuco Department of Neurology and NeurosurgeryUniversidade Federal de São Paulo (UNIFESP) Department of PsychiatryUNIFESP, Department of Neurology and NeurosurgeryUNIFESP, Department of PsychiatrySciEL

Transtornos de humor pré-cirúrgicos associados ao prognóstico pós-cirúrgico desfavorável em pacientes com epilepsia do lobo temporal e esclerose mesial temporal

OBJECTIVES: This study aims at verifying the impact of pre-surgical PD on seizure outcome in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS). METHODS: After previous consent, retrospective data from 115 surgically treated (corticoamygdalohyppocampectomy) TLE-MTS patients (65 females; 56.5%) were analyzed. Psychiatric evaluations were performed through DSM-IV criteria. Engel IA was established as a favorable prognosis. RESULTS: Forty-five patients (41.6%) were classified as Engel IA, while 47 (40.8%) presented pre-surgical PD. Depression (OR=5.11; p=0.004) appeared as a risk factor associated to a non-favorable seizure outcome. CONCLUSION: In patients with refractory TLE-MTS, the presence of depression predicts an unfavorable outcome.OBJETIVO: No presente trabalho avaliamos o impacto da presença de transtorno psiquiátrico pré-cirúrgico sobre o prognóstico cirúrgico em pacientes com epilepsia do lobo temporal e esclerose mesial temporal (ELT-EMT). METODOLOGIA: Analisamos, retrospectivamente, os dados de 115 pacientes com ELT-EMT (65 mulheres, 56,5%) tratados cirurgicamente (corticoamigdalohipocampectomia). As avaliações psiquiátricas foram feitas de acordo com os critérios DSM-IV. O prognóstico favorável foi definido como ausência de crises desde a cirurgia (Engel IA). RESULTADOS: Dos 115 pacientes tratados, 45 (42,6%) tiveram prognóstico favorável e 47 (40,8%) apresentavam transtorno psiquiátrico pré-operatório. A presença de depressão (OR=5,11; p=0,004) foi associada ao prognóstico cirúrgico desfavorável. CONCLUSÃO: A presença de depressão durante a avaliação psiquiátrica pré-operatória é um fator preditivo de prognóstico desfavorável em pacientes com ELT-EMT.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP) Department of Neurology and NeurosurgeryUniversidade Federal de São Paulo (UNIFESP) Department of Psychiatry Laboratório Interdisciplinar de Neurociências ClínicasUNIFESP, Department of Neurology and NeurosurgeryUNIFESP, Department of Psychiatry Laboratório Interdisciplinar de Neurociências ClínicasSciEL

Translation and cross-cultural adaptation of the Interictal Dysphoric Disorder Inventory (IDDI)

INTRODUCTION: Interictal dysphoric disorder (IDD) is a behavioral syndrome described mainly in epileptic patients. The pleomorphic and unspecific nature of its symptoms makes difficult its recognition. The Interictal Dysphoric Disorder Inventory (IDDI) is an instrument specifically created to evaluate IDD symptoms and to facilitate its diagnosis. PURPOSE: Translation and cross-cultural adaptation of the Interictal Dysphoric Disorder Inventory (IDDI). METHODS: Twenty-one patients regularly accompanied in the outpatient epilepsy clinic of Universidade Federal de São Paulo (UNIFESP) - UNIFESP answered the questionnaire. The original version in English for translation was obtained with one of the authors (Marco Mula). Later, two independent native English-speaking teachers fluent in Portuguese translated this consensus version back into English. Comparison of the back-translation with the original English version showed only a few discrepancies and the English and Portuguese versions were considered conceptually equivalents. RESULTS: Seventeen female (81%) and four male (19%) answered the questionnaire. The mean age was of 32.3 years and seven had primary school, four had completed secondary and two, higher education. After patients had answered the 21 questionnaires, only three of them did not understand question D of the Appendix section, which had to be rewritten. CONCLUSION: Brazilian patients easily understood the questions of IDDI. We believe that after finishing validation of its psychometric properties this instrument will be very helpful to evaluate the IDD in Brazilian people with epilepsy.INTRODUÇÃO: O transtorno disfórico interictal (TDI) se constitui em uma síndrome comportamental descrita principalmente em pacientes com epilepsia. A apresentação pleomófica e inespecífica dos seus sintomas, no entanto, dificulta seu diagnóstico. O Interictal Dysphoric Disorder Inventory (IDDI) é um instrumento recentemente criado com a finalidade de facilitar o diagnóstico do TDI entre os pacientes com epilepsia. OBJETIVO: Tradução e adaptação cultural do Interictal Dysphoric Disorder Inventory (IDD) MÉTODOS: Vinte e um pacientes em acompanhamento regular no ambulatório de Epilepsia do Departamento de Neurologia e Neurocirurgia da Universidade Federal de São Paulo (UNIFESP) - UNIFESP responderam ao questionário. A versão original foi obtida com um dos autores da escala (Marco Mula) que concedeu a versão original em inglês para a tradução. Dois professores de inglês nativos fizeram a retrotradução. As versões em português e a retrotraduzida foram comparadas à original e após consenso foi obtida a versão final. RESULTADOS: Dos pacientes entrevistados, 17 (81%) eram do sexo feminino, com média de idade de 32,3 anos. Sete completaram o ensino fundamental, enquanto quatro completaram o ensino médio e dois, o ensino superior. Após a aplicação dos 21 questionários apenas a questão D do Apêndice não foi compreendida por três pacientes, tendo sido reescrita. CONCLUSÃO: o ITDI demonstrou-se uma escala de fácil aplicação na população brasileira, constituindo-se de grande utilidade para a avaliação do TDI em pacientes com epilepsia.Universidade Federal de São Paulo (UNIFESP) Departamento de Neurologia e NeurocirurgiaUniversidade Federal de São Paulo (UNIFESP) Departamento de PsiquiatriaUniversidade Federal de Minas Gerais Hospital das Clínicas Unidade de NeuropsiquiatriaUNIFESP, Depto. de Neurologia e NeurocirurgiaUNIFESP, Depto. de PsiquiatriaSciEL

Major depressive disorder as a predictor of a worse seizure outcome one year after surgery in patients with temporal lobe epilepsy and mesial temporal sclerosis

Purpose: the association between pre-surgical psychiatric disorders (PDs) and worse seizure outcome in patients with refractory epilepsy submitted to surgery has been increasingly recognized in the literature. the present study aimed to verify the impact of pre- and post-surgical PD on seizure outcome in a series of patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS).Method: Data from 115 TLE-MTS patients (65 females; 56.5%) who underwent cortico-amygdalohip-pocampectomy (CAH) were analyzed. Pre- and post-surgical psychiatric evaluations were performed using DSM-IV and ILAE criteria. the outcome subcategory Engel IA was considered as corresponding to a favorable prognosis. A multivariate logistic regression model was applied to identify possible risk factors associated with a worse seizure outcome.Results: Pre-surgical PDs, particularly major depressive disorder (MDD), anxiety and psychotic disorders, were common, being found in 47 patients (40.8%). Fifty-six patients (48.7%) were classified as having achieved an Engel IA one year after CAH. According to the logistic regression model, the presence of pre-surgical MDD (OR = 5.23: p = 0.003) appeared as the most important risk factor associated with a non-favorable seizure outcome.Conclusion: Although epilepsy surgery may be the best treatment option for patients with refractory TLE-MTS, our findings emphasize the importance of performing a detailed psychiatric examination as part of the pre-surgical evaluation protocol. (C) 2012 British Epilepsy Association. Published by Elsevier B.V. All rights reserved.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo UNIFESP, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, LiNC, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, LiNC, São Paulo, BrazilWeb of Scienc

Psychoses of epilepsy: A study comparing the clinical features of patients with focal versus generalized epilepsies

In the literature, psychosis of epilepsy (POE) has been described as one of the most frequent psychiatric comorbidities of epilepsy, occurring particularly in association with temporal lobe epilepsy. However, the presence of such psychiatric disorders among patients with idiopathic generalized epilepsies has also been mentioned. In this study, we evaluated the clinical features of psychotic disorders in a series of patients with temporal lobe epilepsy related to mesial temporal sclerosis (TLE-MTS) and juvenile myoclonic epilepsy with the aim of describing and comparing the clinical patterns of the psychotic symptoms in such frequent and important epilepsy syndromes. POE occurred most frequently in patients with TLE-MTS (P=0.01), but no differences were observed between the groups with respect to the subtypes and core symptoms of psychoses. The clinical implications of POE in both epilepsy syndromes are discussed. (C) 2011 Elsevier Inc. All rights reserved.CAPES from BrazilFAPESP from Brazi

Are psychiatric disorders exclusion criteria for video-EEG monitoring and epilepsy surgery in patients with mesial temporal sclerosis?

Epilepsy surgery (ES) is a treatment option for patients with refractory temporal lobe epilepsy (TLE). However, psychiatric disorders (PDs) have been a contraindication for presurgical evaluation in many epilepsy centers. the aim of this study was to evaluate the safety of video-EEG (VEEG) and surgical outcome in patients with refractory TLE and mesial temporal sclerosis (TLE-MTS) associated with PDs. We retrospectively analyzed the clinical, sociodemographic, and VEEG data and surgery outcome of patients with refractory TLE-MTS who underwent ES over the period of 2002 to 2011 and compared data between those with and without PDs. Psychiatric evaluation was performed through DSM-IV and ILAE criteria. Safety during presurgical evaluation was analyzed by the rate of adverse events (AEs). Patients' quality of life (QOL) was measured through ESI-55 and the surgical outcome through Engel's classification. Data from 145 patients were included. the mean VEEG length (93 h) was not affected by PDs. Among patients with PDs, 4.91% (3/61) had AEs, and 13.11% (8/61) had psychogenic nonepileptic seizures (PNESs). Among patients without PDs, 4.76% (4/84) had AEs, and 5.95% (5/84) had PNESs. in the first two follow-up years, of the 94 patients who underwent ES, 65.85% (27/41) with PDs and 67.92% (36/53) without PDs became free of disabling seizures (Engel I). No significant differences were observed in the patients' QOL between both groups after surgery. the rate of AEs and seizure outcome did not differ significantly between both groups, reinforcing the idea that PDs should not be absolute exclusion criteria for VEEG monitoring and epilepsy surgery among patients with TLE-MTS. (C) 2013 Elsevier Inc. All rights reserved.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo UNIFESP, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, Lab Interdisciplinar Neurociencias Clin LiNC, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, Lab Interdisciplinar Neurociencias Clin LiNC, São Paulo, BrazilWeb of Scienc