12 research outputs found
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Depression in Epilepsy: A Common but Often Unrecognized Comorbid Malady
Depressive disorders (DDs) represent the most frequent psychiatric comorbidity in epilepsy (1–5). Despite their relatively high prevalence, DDs remain unrecognized and untreated in many patients with epilepsy. The purpose of this review is to examine the reasons behind the failure to recognize and treat DDs in epilepsy. We highlight the essential epidemiologic, etiopathogenic, and clinical aspects that need to be considered in the evaluation of every epileptic patient and dedicate the last section of this paper to the review of the most relevant treatment issues. If we are successful in our goals, the reader will be impressed by the significant impact of DDs on the quality of life of these patients, and by the need to investigate treatment modalities with the same scientific rigor used in the assessment of efficacy of antiepileptic drugs in the control of seizures
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Neuropsychiatric complications of epilepsy
Psychiatric complications of epilepsy are multiple and result from the complex interaction between endogenous, genetic, therapeutic, and environmental factors. The relationship between epilepsy and psychiatric disorders may be much closer than previously appreciated. Recent studies have suggested the existence of a bi-directional relationship between depression and epilepsy, whereby patients with epilepsy have a higher risk than the general population of suffering from depression, not only after, but also before the onset of epilepsy. Furthermore, similar neurotransmitter changes have been identified in depression and epilepsy, suggesting the possibility that these two disorders share common pathogenic mechanisms. Although the clinical manifestations of psychiatric disorders in epilepsy are often indistinguishable from those of nonepileptic patients, certain types of depression and psychotic disorders may present with clinical characteristics that are particular to epilepsy patients. These include the psychosis of epilepsy, postictal psychotic disorders, alternative psychosis (or forced normalization), and certain forms of interictal depressive disorders
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Should Epilepsy Surgery Be Used in the Treatment of Autistic Regression?
Medically intractable temporal lobe epilepsy in patients with normal MRI: Surgical outcome in twenty-one consecutive patients
Abnormal MRI findings localizing to the mesial temporal lobe predict a favorable outcome in temporal lobe epilepsy surgery. The purpose of this study is to summarize the surgical outcome of patients who underwent a tailored antero-temporal lobectomy (ATL) with normal 1.5
T MRI. Specifically, factors that may be associated with favorable post-surgical seizure outcome are evaluated.
A retrospective analysis of the Rush University Medical Center surgical epilepsy database between 1992 and 2003 was performed. Patients who underwent an ATL and had a normal MRI study documented with normal volumetric measurements of hippocampal formations and the absence of any other MRI abnormality were selected for this study. Demographic information was collected on all patients. Seizure outcomes were evaluated using Engel's classification. A two-sided Fisher exact test with Bonferroni correction was performed in statistical analyses.
Twenty-one (21) patients met the inclusion criteria of normal 1.5
T MRI and underwent a tailored temporal lobectomy. Mean age at time of surgery was 28
years (SD
=
8.1, range 11–44) and mean duration of the seizure disorder was 13.4
years (range 2–36). Risk factors for epilepsy included head injury (
n
=
4), encephalitis (
n
=
3), febrile seizures (
n
=
2), and 12 patients had no risk factors. Pathological evaluation of resected tissue revealed no abnormal pathology in 12/21 patients (57%). After a mean 4.8
years follow-up post-surgical period, 15/21 (71%) patients were free of disabling seizures (Engel I outcome). At 8.3
years follow-up, 13/21 (62%) patients had similar results. Absence of prior epilepsy risk factors was the only statistically significant predictor of an Engel class I outcome (
p
<
0.0022).
Patients with medically intractable epilepsy and normal MRI appear to benefit from epilepsy surgery. Absence of prior epilepsy risk factors may be a positive prognostic factor
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Epidural cylinder electrodes for presurgical evaluation of intractable epilepsy: technical note
This is a technical report describing a different technique for the insertion of epidural electrodes in the preoperative evaluation of epilepsy surgery. Our experience in 67 cases using this technique is analyzed.
Cylinder electrodes with multiple recording nodes spaced 1 cm apart along a Silastic core are placed into the epidural space under general anesthesia through single or multiple burr holes. We reviewed the data on 67 cases of medically intractable epilepsy requiring intracranial monitoring that had epidural cylinder electrodes placed. The electrodes were placed bilaterally or contralateral to subdural grids in 64 of the 67 cases. Continuous monitoring was performed from 1 to 3 weeks.
This method was most useful when used bilaterally or contralateral to subdural grids. Definitive surgery was rendered in 48 of 67 cases. After monitoring, all electrodes were removed at bedside or upon return to the operating room for definitive surgery. There were no mortalities, infections, cerebrospinal fluid leaks, neurologic deficits, or electrode malfunctions. Two patients (2/67, 3%) did develop subdural hematomas early in our series after dural injury near the pterion; however, these patients did not sustain permanent deficit.
Epidural cylinders are another option for preoperative monitoring, useful for determining lobe or laterality of seizure genesis. They offer an alternate method to EPEs in cases where epidural recording is desirable. The cylinder electrodes are easy to place and can be removed without a return to the operating theater. The electrodes' minimal mass effect allows them to be safely placed bilaterally or contralateral to subdural grids. The epidural cylinders can monitor cortex with a greater density of nodes and can access regions not amenable to EPEs