Marco Mula

Marco Mula
St George's, University of London | SGUL · Atkinson Morley Regional Neuroscience Centre

MD PhD FRCP FEAN

About

252
Publications
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Introduction
Marco Mula is Consultant in Neurology and Epileptology at the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust and Reader in Neurology at the Institute of Medical and Biomedical Education, St George's University of London. Dr Mula is an epileptologist with a special interest in comorbidities of epilepsy and their management.

Publications

Publications (252)
Article
The aim of this document is to provide evidence‐based recommendations for the medical treatment of depression in adults with epilepsy. The working group consisted of members of an ad hoc Task Force of the International League Against Epilepsy (ILAE) Commission on Psychiatry, ILAE Executive and the International Bureau for Epilepsy (IBE) representat...
Article
Full-text available
Background A large amount of literature surrounds the differences between dissociative neurological symptom disorder with non-epileptic seizures (DNSD-S) and epilepsy. Aims To explore the research gap on phenotypic differences between DNSD-S and other psychiatric disorders. Method We conducted a case–control study of 1860 patients (620 patients w...
Chapter
Epilepsy is one of the commonest neurological disorders, affecting approximately 50 million people worldwide, and it is now recognized as a disorder of the brain characterized not only by recurrent seizures, but also by its neurobiological, cognitive, psychological, and social consequences. In general, psychiatric disorders show a uniformly increas...
Article
Full-text available
Purpose People with Intellectual Disability (ID) and epilepsy are more likely to experience psychiatric conditions, challenging behaviour (CB), treatment resistance and adverse effects of anti-seizure medications (ASM) than those without. This population receives care from various professionals, depending on local care pathways. This study evaluate...
Article
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Background Epilepsy and mental illness share similar problems in terms of stigma, as a result of centuries of superstition, ignorance and misbeliefs. Stigma leads not only to discrimination and civil and human rights violations but also to poor access to healthcare and non-adherence or decreased adherence to treatment, ultimately increasing morbidi...
Article
Full-text available
Objective Dissociative traits represent a disturbance in selfhood that may predispose to, and trigger, functional seizures (FSs). The predictive representation and control of the internal physiological state of the body (interoception) are proposed to underpin the integrity of the sense of self (“minimal selfhood”). Therefore, discrepancies between...
Article
Purpose of review: To review the latest evidence concerning the epidemiology, clinical implications and management of psychiatric disorders in epilepsy. Recent findings People with epilepsy have a 2 to 5 times increased risk of developing any psychiatric disorder and 1 in 3 patients with epilepsy have a lifetime psychiatric diagnosis. Psychiatric...
Article
Behavioural Neurology of Antiepileptic Drugs: A Practical Guide By Andrea E. Cavanna Oxford University Press. 2018. $38.95 (pb). 180 pp. ISBN: 9780198791577 - Volume 216 Issue 1 - Marco Mula
Article
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Objective We aimed to characterize the demographics of adults with dissociative (nonepileptic) seizures, placing emphasis on distribution of age at onset, male:female ratio, levels of deprivation, and dissociative seizure semiology. Methods We collected demographic and clinical data from 698 adults with dissociative seizures recruited to the screen...
Article
Traumatic brain injury (TBI) represents one of the most common causes of death and disability in young people, and posttraumatic epilepsy (PTE) accounts for 10% to 20% of all symptomatic epilepsies. However, PTE is still a relatively underappreciated condition. This paper aimed at reviewing current knowledge about psychiatric comorbidities of PTE,...
Article
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Psychotic disorders represent a relatively rare but serious comorbidity in epilepsy. Current epidemiological studies are showing a point prevalence of 5.6% in unselected samples of people with epilepsy going up to 7% in patients with temporal lobe epilepsy, with a pooled odds ratio of 7.8 as compared with the general population. This is a narrative...
Article
Deficits in social cognition are an increasingly recognized complication of epilepsy and contribute to the deficits in social functioning and well-being experienced by patients with epilepsy. Although there has been an increase in studies exploring the measurement and biology of social cognition in patients with epilepsy, there are relatively few e...
Conference Paper
Objectives The continuity and integrity of a conscious sense of self, is proposed to be dependent upon the control of internal physiological state and its predictive representation through interoception, that is, the sensing of internal bodily changes. We investigated dissociation, interoception and their relationship, in patients with functional s...
Article
Objective evidence is limited for the value of transition programs for youth with chronic illness moving from pediatric to adult care; however, such programs intuitively “make sense”. We describe the strengths and weaknesses of a variety of transition programs from around the world for adolescents with epilepsy. Consequences of poorly organized tra...
Article
Full-text available
Objective: Although many studies have attempted to describe treatment outcomes in patients with drug-resistant epilepsy, results are often limited by the adoption of nonhomogeneous criteria and different definitions of seizure freedom. We sought to evaluate treatment outcomes with a newly administered antiepileptic drug (AED) in a large population...
Article
Introduction: Depression is one of the most frequent comorbidities in epilepsy affecting between 17% and 22% of patients but it is still underdiagnosed and undertreated. Areas covered: This paper discusses recent advances about screening, diagnosis and treatment of depression in epilepsy taking into account the heterogeneity of clinical scenarios w...
Article
Full-text available
Depression is one of the most frequent comorbidities in patients with epilepsy affecting 1 in 4 patients, and this is due to psychological and neurobiological reasons. This is a narrative review of the epidemiological, neurobiological, and clinical aspects of depression in epilepsy. References have been identified through Medline/PubMed searches ti...
Article
This is a case series of 25 patients with drug-resistant epilepsy and psychiatric comorbidities who started on brivaracetam (BRV) at St George's University Hospitals and Frimley Health in London. Median BRV dose was 150 mg for a median follow-up period of 8 months. Twenty had focal epilepsy, four had generalized epilepsies, and one had unclassified...
Article
Full-text available
Objective To evaluate interrater agreement in categorizing treatment outcomes and drug responsiveness status according to the International League Against Epilepsy (ILAE) definition of drug‐resistant epilepsy. Methods A total of 1053 adults with focal epilepsy considered by the investigators to meet ILAE criteria for drug resistance were enrolled...
Article
Introduction: Depression is the most frequent psychiatric comorbidity among people with epilepsy. It can impact on quality of life and increases the risk of morbidity and premature mortality. Areas covered: The authors review the available data on current and emerging drug treatments for depression in epilepsy. Sources have been identified through...
Article
Full-text available
Objective Functional seizures are a common functional neurological disorder. Given their chronic nature, and the bio‐psycho‐social factors involved in their aetiology, GPs play a crucial role in the care of these patients. However, little is known about GP attitudes to, and knowledge of, functional seizures. Methods The Atkinson Morley Regional Ne...
Article
Introduction: Anxiety disorders represent one of the most frequently encountered comorbidities in patients with epilepsy, affecting quality of life and increasing, morbidity, mortality and healthcare costs. However, they are still underdiagnosed and undertreated. Areas covered: This is a narrative review of the pharmacological treatment of anxiety...
Article
Introduction: Epilepsy is one of the most serious neurological conditions, affecting almost 50 million people around the world. Despite more than 20 antiepileptic drugs (AEDs) available, seizures are still uncontrolled in one third of patients. Areas covered: The present paper reviews current compounds in preclinical and clinical development for th...
Article
The recognition and treatment of psychosis in persons with epilepsy (PWE) is recommended with the apparent dilemma between treating psychosis and opening the possibility of exacerbating seizures. The pooled prevalence estimate of psychosis in PWE is 5.6%. It has been proposed that a 'two hit' model, requiring both aberrant limbic activity and impai...
Article
Psychiatric illness and epilepsy commonly co-occur in adults and in children and adolescents. Theories of comorbidity are complex, but recurring associations between the conditions suggest overlap that is more than simple co-occurrence. Common underlying pathophysiology may imply that epilepsy itself may constituently include psychiatric symptoms....
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Background: Thirty-percent of patients with epilepsy are drug-resistant, and might benefit from effective noninvasive therapeutic interventions. Evidence is accumulating on the efficacy of autonomic biofeedback therapy using galvanic skin response (GSR; an index of sympathetic arousal) in treating epileptic seizures. This study aimed to extend pre...
Article
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Background. Epilepsy is among the most frequent neurological conditions and it is estimated that approximately 8% of the population experience a seizure at some time in their lives. Aim. To examine the characteristics of patients referred to a First Seizure Clinic (FSC) at a University Hospital in South-West London. Methods. All subjects referred t...
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Purpose of review The pharmacological treatment of patients with epilepsy and psychiatric comorbidities may sometimes represent a therapeutic challenge. This review is focused on the pharmacological management of patients with epilepsy and psychiatric problems in terms of rationalization of the antiepileptic drug (AED) treatment and the pharmacolog...
Article
Background: Sexual dysfunction is very common in patients with epilepsy. Objective: We sought to review the published literature around sexual dysfunction in epilepsy, and particularly the role played by anti-convulsant drugs. Method: We searched all related articles on PubMed using the search terms sexual dysfunction, various AEDs and epileps...
Article
Introduction: Brivaracetam (BRV) is a new AED currently licensed for the adjunctive treatment of adult patients with focal epilepsies. It is a ligand of the ubiquitous synaptic vesicle glycoprotein 2A (SV2A). Areas covered: This paper covers the preclinical and subsequent clinical development of BRV focusing on the discovery of the SV2A protein as...
Article
Background and purpose: People with epilepsy are at increased risk of accidents and injuries but, despite several studies on this subject, data regarding preventable causes are still contradictory. The aim of this study was to investigate the relationship between injuries, side effects of antiepileptic drugs (AEDs) and depression. Methods: Data...
Article
Purpose To examine the prevalence and clinical correlates of fatigue as an adverse event (AE) of antiepileptic drug (AED) treatment in patients with epilepsy. Methods Data from 443 adult outpatients with epilepsy assessed with the Adverse Event Profile (AEP) and the Neurological Disorder Depression Inventory for Epilepsy (NDDIE) were analysed. Re...
Article
Psychiatric disorders are relatively frequent comorbidities in epilepsy and they have an impact on morbidity, mortality, and quality of life. This is a report from the Task Force on Education of the ILAE Commission on Neuropsychiatry based on a survey about educational needs of epileptologists regarding management of the psychiatric comorbidities o...
Article
Purpose of review: To review some aspects of the relationship between epilepsy and depression that have recently received increasing attention and may become major research topics in the near future. Recent findings: Epidemiological studies show that depression and suicide are, in some cases, premorbid symptoms preceding the onset of the epileps...
Article
This is the third of three papers that summarize the second symposium on Transition in Epilepsies held in Paris in June 2016. This paper focuses on treatment issues that arise during the course of childhood epilepsy and make the process of transition to adult care more complicated. Some AEDs used during childhood, such as stiripentol, vigabatrin, a...
Article
Benzodiazepines represent the first-line treatment for the acute management of epileptic seizures and status epilepticus. The emergency use of benzodiazepines must be timely, and because most seizures occur outside of the hospital environment, there is a significant need for delivery methods that are easy for nonclinical caregivers to use and admin...
Article
Purpose: A number of studies have suggested that depressed mood is one of the most important predictors of quality of life (QoL) in patients with epilepsy. However, the QoL measure used in previous studies was limited to the Quality of Life in Epilepsy (QOLIE) scales. It could be questioned whether correlation of QOLIE with measures of depression...
Article
Full-text available
Anxiety disorders represent a common psychiatric comorbidity in patients with epilepsy, affecting prognosis and quality of life. However, they are still underdiagnosed and undertreated. In clinical practice, a number of compounds are currently used as anxiolytics, with benzodiazepines being the most popular. Other drug classes, especially antiepile...
Article
Full-text available
Epilepsy is one of the most serious neurological conditions and has an impact not only on the affected individual but also on the family and, indirectly, on the community. A global approach to the individual must take into account cognitive problems, psychiatric comorbidities and all psychosocial complications that often accompany epilepsy. We disc...
Article
Introduction: Drugs marketed during the last few years (i.e. Lacosamide, Ruifinamide, Eslicarbazepine acetate, Brivaracetam and Perampanel) are increasingly regarded as third generation AEDs. This paper presents available data about monotherapy with third generation drugs and on-going clinical trials with special attention to the existing debate a...
Article
Full-text available
Antiepileptic drugs (AEDs) have many benefits but also many side effects, including aggression, agitation, and irritability, in some patients with epilepsy. This article offers a comprehensive summary of current understanding of aggressive behaviors in patients with epilepsy, including an evidence-based review of aggression during AED treatment. Ag...
Article
Objective: Standard mortality ratio for suicide in patients with epilepsy is three times higher than in the general population, and such a risk remains high even after adjusting for clinical and socioeconomic factors. It is thus important to have suitable screening instruments and to implement care pathways for suicide prevention in every epilepsy...
Article
People with epilepsy report that stress is their most common trigger for seizures and some believe it caused their epilepsy in the first place. The extensive preclinical, epidemiological and clinical studies examining the link between stress and epilepsy have given confusing results; the clinical studies in particular are fraught with confounders....
Article
Introduction The social and economic impact of mood disorders and suicide is extremely high. In depression, suicide is included among the cognitive disturbances, together with guilt, paranoid and obsessive-compulsive symptoms, depersonalization/derealization and agitation [1,2] . The aim of this report is to study a sample of depressed patients wit...
Article
Introduction Misidentification phenomena and Capgras Syndrome (CS) occur in different psychiatric (psychotic or major affective illnesses) and neurological (traumatic brain injury, epilepsy, neurosyphilis, etc.) disorders [1,2] . The aim of this report is to redefine dissociative spectrum dimensions inside CS and misidentification syndromes in pati...
Article
In this paper, we review in brief the development of ideas that over time have tried to explain why some individuals are more creative than others and what may be the neurobiological links underlying artistic creativity. We note associations with another unique human idea, that of genius. In particular, we discuss frontotemporal dementia and bipola...
Article
Objectives: To investigate clinical correlates of memory complaints (MC) during anti-epileptic drug (AEDs) treatment in adults with epilepsy with special attention to the role of depression, using user-friendly standardized clinical instruments which can be adopted in any outpatient setting. Materials & methods: Data from a consecutive sample of...
Chapter
Despite the substantial literature on mood disorders in epilepsy, the majority of authors focused on depression with limited data on manic symptoms. Historically, this was due to the general impression that both psychomotor excitation and overt mania were rarely encountered in epilepsy. However, recent studies demonstrated that manic symptoms can b...
Chapter
Antiepileptic drugs (AEDs) suppress seizures by acting on a variety of mechanisms and molecular targets involved in the regulation of neuronal excitability. These include inhibitory (GABAergic) and excitatory (glutamatergic) neurotransmission, as well as ion (sodium and calcium) conductance through voltage-gated channels. However, these mechanisms...
Book
This book is an up-to-date, comprehensive review of the neuropsychiatry of epilepsy, by active authorities in the field, with an emphasis on clinical and management issues. A critical appraisal of the methodology and limitations of current research on the neuropsychiatry of epilepsy is provided, and unanswered questions and controversies are addres...
Article
Objective: Standard mortality ratio for suicide in patients with epilepsy is three times higher than in the general population, and such a risk remains high even after adjusting for clinical and socioeconomic factors. It is thus important to have suitable screening instruments and to implement care pathways for suicide prevention in every epilepsy...
Article
For more than 30 years, antiepileptic drug development has been based on specific assumptions regarding the neurobiology of epilepsy but all marketed drugs have not changed the proportion of drug refractory patients. It is, therefore, evident that new molecular targets need to be identified. Advances in neurobiology and molecular pharmacology are b...
Article
Full-text available
Neurobehavioral and cognition problems are highly prevalent in epilepsy, but most research studies to date have not adequately addressed the precise nature of the relationship between these comorbidities and seizures. To address this complex issue and to facilitate collaborative, innovative research in the rising field of neurobehavior-al comorbidi...
Article
Epilepsy is both a disease of the brain and the mind. Here, we present the first of two papers with extended summaries of selected presentations of the Third International Congress on Epilepsy, Brain and Mind (April 3-5, 2014; Brno, Czech Republic). Epilepsy in history and the arts and its relationships with religion were discussed, as were overvie...
Article
Objective Depersonalization (DP) and derealization (DR) may be detected both in healthy and pathological conditions, but the prevalence and clinical correlates of dissociative symptoms in bipolar disorder have received limited attention in literature (1). The aim of this study is to discuss new treatment possibilities of derealization and depersona...
Article
Introduction: Years after the US FDA issued an alert on an increased risk of suicide ideation and behavior in people with epilepsy treated with antiepileptic drugs (AEDs), this issue still remains controversial. The FDA alert was based on a meta-analysis of clinical trials of AEDs in all indications. Areas covered: We discuss major methodologica...
Article
A variety of factors can affect cognitive functions in patients with epilepsy, with the majority of cognitive problems having a multifactorial origin. In routine clinical practice, it can be difficult to dissect out the contribution of all of the different variables, because they are often interlinked together. In this article, all of the major var...
Article
This White Paper builds on the publication of the International League Against Epilepsy (ILAE) and International Bureau for Epilepsy (IBE) report "Listening for a change-medical and social needs of people with intellectual disability who have epilepsy" (Listening for a change the medical and social needs of people with epilepsy and intellectual dis...
Article
As captured by the proposed new definition, epilepsy is increasingly recognized as a disorder characterized not only by an enduring predisposition to recurrent seizures but explicitly also by the neurobiological, cognitive, psychological and social consequences of this condition. Further, both in the estimated 15 million people worldwide who have o...
Article
This article is part of a Special 15th Anniversary Issue. Copyright © 2014 Elsevier Inc. All rights reserved.
Article
Midazolam is a short-acting benzodiazepine that has clearly demonstrated to be an effective option for the acute management of epileptic seizures. It has the advantage of being water-soluble, with a rapid onset of action and it can be administered orally or intranasally, implementing an early intervention at the pre-hospital setting. This article a...
Article
Brivaracetam (BRV) is a new antiepileptic drug structurally related to levetiracetam but with a 15 to 30-fold increased affinity for the same molecular target, namely the SV2A ligand. BRV is currently under Phase III development as adjunctive treatment for partial onset seizures but data from some Phase III suggest also potential efficacy for prima...
Chapter
Mood and anxiety disorders represent the most frequent psychiatric comorbidity in patients with epilepsy and reasons for such a close link are both biological and psychosocial. On one hand, epilepsy is a chronic disorder that brings about a number of social limitations (e.g. driving license, job opportunities etc.) and social discriminations leadin...

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