Epilepsy, suicidal behaviour, and depression: Do they share common pathogenic mechanisms?
[Show abstract] [Hide abstract] ABSTRACT: Psychiatric disorders seem to be more frequent in patients with epilepsy (PWE) than the general population. Although researchers have documented a strong association between epilepsy and psychiatric comorbidities, the nature of this relationship is poorly understood. According to this, psychiatric diseases are often underdiagnosed and undertreated in PWE with further decrease of the quality of life of patients. The aim of the review was to examine the most frequent psychiatric comorbidities in adults with epilepsy (AWE) and the main psychiatric comorbidities in children with epilepsy (CWE) in order to better understand the relationship between epilepsy and the development of psychiatric disorders.0Comments 5Citations
- "Several studies have confirmed that epilepsy is associated with high rates of premature mortality highlighting the substantial contribution of psychiatric comorbidity, in particular depression, to this mortality. It is also suggested that suicidality, depression, and epilepsy may share common pathogenic mechanisms . Almost half of epilepsy-related deaths occur in those younger than 55 years and the period immediately after the first diagnosis of epilepsy seems to be the most dangerous . "
[Show abstract] [Hide abstract] ABSTRACT: Hippocampal sclerosis (HS) is considered the most frequent neuropathological finding in patients with mesial temporal lobe epilepsy (MTLE). Hippocampal specimens of pharmacoresistant MTLE patients that underwent epilepsy surgery for seizure control reveal the characteristic pattern of segmental neuronal cell loss and concomitant astrogliosis. However, classification issues of hippocampal lesion patterns have been a matter of intense debate. International consensus classification has only recently provided significant progress for comparisons of neurosurgical and clinic-pathological series between different centers. The respective four-tiered classification system of the International League Against Epilepsy subdivides HS into three types and includes a term of "gliosis only, no-HS". Future studies will be necessary to investigate whether each of these subtypes of HS may be related to different etiological factors or with postoperative memory and seizure outcome. Molecular studies have provided potential deeper insights into the pathogenesis of HS and MTLE on the basis of epilepsy-surgical hippocampal specimens and corresponding animal models. These include channelopathies, activation of NMDA receptors, and other conditions related to Ca(2+) influx into neurons, the imbalance of Ca(2+)-binding proteins, acquired channelopathies that increase neuronal excitability, paraneoplastic and non-paraneoplastic inflammatory events, and epigenetic regulation promoting or facilitating hippocampal epileptogenesis. Genetic predisposition for HS is clearly suggested by the high incidence of family history in patients with HS, and by familial MTLE with HS. So far, it is clear that HS is multifactorial and there is no individual pathogenic factor either necessary or sufficient to generate this intriguing histopathological condition. The obvious variety of pathogenetic combinations underlying HS may explain the multitude of clinical presentations, different responses to clinical and surgical treatment. We believe that the stratification of neuropathological patterns can help to characterize specific clinic-pathological entities and predict the postsurgical seizure control in an improved fashion.0Comments 14Citations
- "While HS may be produced by seizures (in particular during status epilepticus), the development of MTLE as a syndrome does not depend solely on cell loss or neuroplasticity within the hippocampus [34,60]. This would be a gross oversimplification and cannot account for frequent associated features, as for example, the bi-directional relationship between depression and MTLE . "
[Show abstract] [Hide abstract] ABSTRACT: Purpose We aimed to assess and compare the psychometric properties of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Hospital Anxiety and Depression Scale Depression Subscale (HADS-D), and Beck Depression Inventory (BDI) as screening instruments for depression and suicidality in people with epilepsy. Methods One hundred twenty-six people (54% women) diagnosed with epilepsy were recruited and evaluated on their sociodemographic and clinical features. Depression and suicide risk were assessed with a structured psychiatric interview, the Mini International Neuropsychiatric Interview (MINI-Plus), and the performance of NDDI-E, HADS-D, and BDI was evaluated. Results The sensitivity and specificity of BDI for the diagnosis of depression was around 90%; HADS-D and NDDI-E have sensitivity higher than 80%, and specificity was greater than 75%. For identifying suicide risk, the NDDI-E sensitivity was 92.9%, and HADS-D sensitivity was 85.7%, and a reasonable specificity (68%) was observed for both instruments. All instruments showed a negative predictive value of over 90%. Comparisons of the areas under the ROC curve for these instruments were not significantly different regarding depression or moderate/severe risk of suicide. Conclusion All three instruments evaluated have clinical utility in the screening of depression in people with epilepsy. Both NDDI-E and HADS-D are brief efficient screening instruments to identify depression in people with epilepsy. The BDI is a more robust instrument, but it takes longer to apply, which hampers its use by busy clinicians and by people with cognitive impairment.0Comments 4Citations
- "The clinical profile of the people in this study is similar to those described in specialized centers for the treatment of medically intractable epilepsy, with most having complex partial seizures of temporal lobe origin [17,18]. As previously observed, we found a high frequency of major depression (27.8%) and of moderate/severe risk of suicide (11.1%) [5,19,20]. A good screening method for the diagnosis of major depressive episode must be practical and reliable, exhibiting an adequate balance between sensitivity and specificity. "
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