Article

Cognitive-behavioral therapy for depression in patients with temporal lobe epilepsy: A pilot study

Neuropsychiatry Unit, Mexico's National Institute of Neurology and Neurosurgery, México City, México.
Epilepsy & Behavior (Impact Factor: 2.06). 12/2011; 23(1):52-6. DOI: 10.1016/j.yebeh.2011.11.001
Source: PubMed

ABSTRACT Depression has a high prevalence among patients with temporal lobe epilepsy (TLE). A pilot study was carried out to evaluate group cognitive-behavioral therapy (CBT) as a treatment for depression in patients with TLE. Twenty-three outpatients with TLE and major depressive disorder, according to DSM-IV criteria, were enrolled and divided into two groups to receive 16 weekly sessions of CBT. The primary outcome measures were depression severity (assessed with the Beck Depression Inventory) and quality of life (measured with the Quality of Life in Epilepsy-31). Sixteen patients (70%) completed at least 80% of the sessions. From week 8, CBT had a significant positive effect on severity of depression that lasted until the end of treatment. A significant improvement in quality of life was also observed. CBT seems to be a useful intervention for treating depression and improving quality of life in patients with TLE.

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Available from: Jesús Ramírez-Bermúdez, Aug 30, 2015
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    • "The main limitation is its small sample size, which reduces its power and, therefore, may not reveal possible differences between groups. We also had patients who dropped out in the two groups — 28.5% for CBT and 12.5% for SSRIs — figures that are expected in most clinical trials and psychotherapeutic processes of any modality, either individual or group therapy [40], and that are also close to those reported in another pilot study [30]. "
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    ABSTRACT: There is a high prevalence of depression in patients with epilepsy, which negatively impacts their quality of life (QOL) and seizure control. Currently, the first-line of treatment for depression in patients with epilepsy is based on selective serotonin reuptake inhibitors (SSRIs). The main objective of this pilot study was to compare cognitive behavioral therapy (CBT) versus SSRIs for the treatment of major depressive disorder (MDD) in patients with temporal lobe epilepsy (TLE). Seven patients who received group CBT were compared with eight patients treated with SSRIs. All were diagnosed with MDD and TLE. Patients were assessed at baseline before treatment and at six and 12weeks during treatment with the Quality of Life in Epilepsy Scale of 31 items (QOLIE 31), the Beck Depression Inventory (BDI), and the Hospital Anxiety and Depression Scale (HADS). Seizure records were also taken on a monthly basis. After 12weeks of treatment, both groups showed improved QOL and reduced severity of depression symptoms. There were no statistically significant group differences in the final scores for the BDI (p=0.40) and QOLIE 31 (p=0.72), although the effect size on QOL was higher for the group receiving CBT. In conclusion, the present study suggests that both CBT and SSRIs may improve MDD and QOL in patients with TLE. We found no significant outcome differences between both treatment modalities. These findings support further study using a double-blind controlled design to demonstrate the efficacy of CBT and SSRIs in the treatment of MDD and QOL in patients with TLE. Copyright © 2015 Elsevier Inc. All rights reserved.
    Epilepsy & Behavior 07/2015; 15(51):176. DOI:10.1016/j.yebeh.2015.07.033 · 2.06 Impact Factor
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    • "Moreover, the improvements in anxiety, negative affect, and depressed mood symptoms in our study could be an intermediate variable to explain the effect of biofeedback in seizure frequency. Indeed, it was found that anxiety [47] and depression [48] are important components to manage with psychological interventions in order to improve seizure frequency. However, the lack of any relationship in our study between seizure reduction and reduced anxiety and depression scores is not in favor of this hypothesis. "
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    ABSTRACT: The present proof-of-concept study investigated the feasibility of skin conductance biofeedback training in reducing seizures in adults with drug-resistant temporal lobe epilepsy (TLE), whose seizures are triggered by stress. Skin conductance biofeedback aims to increase levels of peripheral sympathetic arousal in order to reduce cortical excitability. This might seem somewhat counterintuitive, since such autonomic arousal may also be associated with increased stress and anxiety. Thus, this sought to verify that patients with TLE and stress-triggered seizures are not worsened in terms of stress, anxiety, and negative emotional response to this nonpharmacological treatment. Eleven patients with drug-resistant TLE with seizures triggered by stress were treated with 12 sessions of biofeedback. Patients did not worsen on cognitive evaluation of attentional biases towards negative emotional stimuli (P > .05) or on psychometric evaluation with state anxiety inventory (P = .059); in addition, a significant improvement was found in the Negative Affect Schedule (P = .014) and in the Beck Depression Inventory (P = .009). Biofeedback training significantly reduced seizure frequency with a mean reduction of − 48.61% (SD = 27.79) (P = .005). There was a correlation between the mean change in skin conductance activity over the biofeedback treatment and the reduction of seizure frequency (r(11) = .62, P = .042). Thus, the skin conductance biofeedback used in the present study, which teaches patients to achieve an increased level of peripheral sympathetic arousal, was a well-tolerated nonpharmacological treatment. Further, well-controlled studies are needed to confirm the therapeutic value of this nonpharmacological treatment in reducing seizures in adults with drug-resistant TLE with seizures triggered by stress.
    Epilepsy & Behavior 11/2014; 41. DOI:10.1016/j.yebeh.2014.10.017 · 2.06 Impact Factor
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    ABSTRACT: Epilepsy is a common neurological disorder that is complicated by psychiatric, cognitive, and social comorbidities that have become a major target of concern and investigation in view of their adverse effect on the course and quality of life. In this report we define the specific psychiatric, cognitive, and social comorbidities of paediatric and adult epilepsy, their epidemiology, and real life effects; examine the relation between epilepsy syndromes and the risk of neurobehavioural comorbidities; address the lifespan effect of epilepsy on brain neurodevelopment and brain ageing and the risk of neurobehavioural comorbidities; consider the overarching effect of broader brain disorders on both epilepsy and neurobehavioural comorbidities; examine directions of causality and the contribution of selected epilepsy-related characteristics; and outline clinic-friendly screening approaches for these problems and recommended pharmacological, behavioural, and educational interventions.
    The Lancet 09/2012; 380(9848):1180-92. DOI:10.1016/S0140-6736(12)61455-X · 45.22 Impact Factor
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