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Wu Y, Zhao K, Chen Y, Wu L, Qiu F, Yuan Y, Shen G, Wang K, Kang Y, Jiang Y, Wang W, Chen L, Liu Y, Pan X, Wang F, Xie L. The interaction between the major vault protein rs4788186 polymorphism, alcohol dependence, and depression among male Chinese problem drinkers. Front Psychiatry 2023; 14:1111712. [PMID: 37547216 PMCID: PMC10402753 DOI: 10.3389/fpsyt.2023.1111712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/16/2023] [Indexed: 08/08/2023] Open
Abstract
Objective Alcohol use disorder (AUD) is the second most prevalent mental disorder and might be related to depression. Major vault protein (MVP) is a cytoplasmic protein related to vesicle transport. The present study aimed to investigate the interaction between a genetic variant (MVP rs4788186) and depression in adult male Han Chinese with AUD during withdrawal. Methods All participants (N = 435) were diagnosed with AUD. Alcohol dependence level was measured using the Michigan Alcoholism Screening Test, and depression was measured using the self-rating depression scale. Genomic DNA was extracted from peripheral blood and genotyped. Results Hierarchical regression analysis identified an interaction between MVP rs4788186 and alcohol dependence level for depression (β = -0.17, p < 0.05). Then, a region of significance test was performed to interpret the interaction effect. Re-parameterized regression models revealed that the interaction between MVP rs4788186 and alcohol problem severity fit the strong differential susceptibility model (R2 = 0.08, p < 0.001), suggesting that the AA homozygotes would be more likely subjects with the G allele to experience major depression symptoms. Conclusion Carriers of the AA homozygote of MVP rs4788186 may be more susceptible to severe alcohol problems and higher levels of depression during withdrawal.
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Affiliation(s)
- Yuyu Wu
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou, China
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Ke Zhao
- Lishui Second Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Yingjie Chen
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, China
| | - Liujun Wu
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou, China
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, China
- Applied Psychology (Ningbo) Research Center, Wenzhou Medical University, Ningbo, China
| | - Feng Qiu
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Yuying Yuan
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Guanghui Shen
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou, China
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Kexin Wang
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou, China
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yimin Kang
- Key Laboratory of Psychosomatic Medicine, Inner Mongolia Medical University, Huhhot, China
| | - Yongsheng Jiang
- The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, China
| | - Wei Wang
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou, China
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Li Chen
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou, China
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yanlong Liu
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou, China
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Xuebo Pan
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Fan Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Longteng Xie
- The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, China
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Visoná de Figueiredo NS, Jardim AP, Mazetto L, Corso Duarte JT, Comper SM, Alonso NB, da Silva Noffs MH, Scorza CA, Cavalheiro EA, Centeno RS, de Araújo Filho GM, Yacubian EMT. Do Hippocampal Neurons Really Count for Comorbid Depression in Patients With Mesial Temporal Lobe Epilepsy and Hippocampal Sclerosis? A Histopathological Study. Front Integr Neurosci 2021; 15:747237. [PMID: 34916913 PMCID: PMC8669141 DOI: 10.3389/fnint.2021.747237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Depression is the most frequent psychiatric comorbidity seen in mesial temporal lobe epilepsy (MTLE) patients with hippocampal sclerosis (HS). Moreover, the HS is the most frequent pathological hallmark in MTLE-HS. Although there is a well-documented hippocampal volumetric reduction in imaging studies of patients with major depressive disorder, in epilepsy with comorbid depression, the true role of the hippocampus is not entirely understood. This study aimed to verify if patients with unilateral MTLE-HS and the co-occurrence of depression have differences in neuronal density of the hippocampal sectors CA1-CA4. For this purpose, we used a histopathological approach. This was a pioneering study with patients having both clinical disorders. However, we found no difference in hippocampal neuronal density when depression co-occurs in patients with epilepsy. In this series, CA1 had the lowest counting in both groups, and HS ILAE Type 1 was the most prevalent. More studies using histological assessments are needed to clarify the physiopathology of depression in MTLE-HS.
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Affiliation(s)
| | - Anaclara Prada Jardim
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Lenon Mazetto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Jeana Torres Corso Duarte
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sandra Mara Comper
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Neide Barreira Alonso
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Carla Alessandra Scorza
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Esper Abrão Cavalheiro
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Ricardo Silva Centeno
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Gerardo Maria de Araújo Filho
- Department of Psychiatry and Medical Psychology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, Brazil
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de Figueiredo NSV, Gaça LB, Assunção-Leme IB, Mazetto L, Garcia MTFC, Sandim GB, Alonso NB, Centeno RS, Filho GMDA, Jackowski AP, Júnior HC, Yacubian EMT. A pioneering FreeSurfer volumetric study of a series of patients with mesial temporal lobe epilepsy and hippocampal sclerosis with comorbid depression. Psychiatry Res Neuroimaging 2021; 311:111281. [PMID: 33836383 DOI: 10.1016/j.pscychresns.2021.111281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
Depression is the most frequent psychiatric comorbidity in patients with mesial temporal lobe epilepsy (MTLE) and hippocampal sclerosis (HS). This study aimed to confirm whether patients with comorbid depression have different volumetric patterns on magnetic resonance imaging, analysing the influence of HS sides. Psychiatrists conducted semi-structured interviews with 75 patients, who were divided into non-depression group (NDG, n = 52) and depression group (DG, n = 23), and compared with 98 controls. The FreeSurfer software was used in the volumetric analysis of the estimated total intracranial volume (eTIV), bilateral cortical and subcortical regions of interest (ROIs), and for presence of left (L-, n = 41) or right (R-, n = 34) MTLE-HS. Twenty-three (30.7%) patients had depression, of whom 14 (34.1%) had l-MTLE-HS and 9 (26.5%) had R-MTLE-HS. No difference was observed between DG and NDG vs. controls in terms of eTIV and cortical ROIs, regardless of the severity of depression. In patients with l-MTLE-HS, the eTIV in the DG was reduced in comparison with that in the NDG and control group, with a small effect size. Hippocampal reduction occurred ipsilateral to HS in the l-MTLE-HS and R-MTLE-HS subgroups when DG and NDG were compared with controls, as expected according to Enhancing Neuro Imaging Genetics through Meta-Analysis (2018).
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Affiliation(s)
- Nathália Stela Visoná de Figueiredo
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 650, 1st floor. Postal number: 04039-002 Vila Clementino, São Paulo, Brazil.
| | - Larissa Botelho Gaça
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 650, 1st floor. Postal number: 04039-002 Vila Clementino, São Paulo, Brazil
| | - Idaiane Batista Assunção-Leme
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 669, 3rd floor. Postal number: 04039-032 Vila Clementino, São Paulo, Brazil
| | - Lenon Mazetto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 650, 1st floor. Postal number: 04039-002 Vila Clementino, São Paulo, Brazil
| | - Maria Teresa Fernandes Castilho Garcia
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 650, 1st floor. Postal number: 04039-002 Vila Clementino, São Paulo, Brazil
| | - Gabriel Barbosa Sandim
- Departament of Diagnosis by Imaging, Universidade Federal de São Paulo (UNIFESP), Napoleão de Barros Street, 800. Postal number: 04024-002 Vila Clementino, São Paulo, Brazil
| | - Neide Barreira Alonso
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 650, 1st floor. Postal number: 04039-002 Vila Clementino, São Paulo, Brazil
| | - Ricardo Silva Centeno
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 650, 1st floor. Postal number: 04039-002 Vila Clementino, São Paulo, Brazil
| | - Gerardo Maria de Araújo Filho
- Department of Psychiatry and Medical Psychology, Faculdade de Medicina de São José do Rio Preto (FAMERP), Brigadeiro Faria Lima Avenue, 5416. Postal number: 15090-000 Vila São José, São José do Rio Preto, Brazil
| | - Andrea Parolin Jackowski
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 669, 3rd floor. Postal number: 04039-032 Vila Clementino, São Paulo, Brazil
| | - Henrique Carrete Júnior
- Departament of Diagnosis by Imaging, Universidade Federal de São Paulo (UNIFESP), Napoleão de Barros Street, 800. Postal number: 04024-002 Vila Clementino, São Paulo, Brazil
| | - Elza Márcia Targas Yacubian
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Pedro de Toledo Street, 650, 1st floor. Postal number: 04039-002 Vila Clementino, São Paulo, Brazil
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Lima EM, Gois J, Paiva ML, Vincentiis S, Moschetta S, Valente KDR. Anxiety symptoms are the strongest predictor of quality of life in temporal lobe epilepsy. Seizure 2021; 88:78-82. [PMID: 33838568 DOI: 10.1016/j.seizure.2021.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE It is established that the severity of depressive and anxiety symptoms is associated with poorer quality of life (QOL) in persons with drug-resistant epilepsy. We aimed to verify the presence of subsyndromic depressive episodes (SDEs) and subsyndromic anxiety episodes (SAEs) in persons with temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) compared to healthy controls and to determine the impact of depressive and anxiety symptoms on patients' QOL. METHODS We prospectively evaluated 35 persons with TLE-HS and 90 healthy controls. QOL was assessed by the Epilepsy Surgery Inventory (ESI) and QOL in Epilepsy Inventory-31 (QOLIE-31). The Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI-X) were used to assess symptoms, and SDEs and SAEs diagnosis were made considering the total scores of BDI (<9) and STAI-Trait (<49), respectively. RESULTS Persons with TLE-HS had higher symptoms on BDI, STAI-S, and STAI-T. They have 3.011 greater odds of presenting SDEs and 7.056 times odds, SAEs. The depressive and anxiety symptoms, added in the model with epilepsy-related factors, accounted for a significant increase in the variance in several aspects of QOL. Anxiety-trait symptoms are the most critical individual determinant of the QOL. CONCLUSION Our results demonstrated that persons with TLE-HS had greater odds of presenting SDE and SAE than healthy controls. Besides, there was a relationship between anxiety and depressive symptoms and worse QOL in TLE-HS. It is essential to be aware of psychiatric symptoms, even though these symptoms do not meet the criteria to be considered a "disorder."
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Affiliation(s)
- Ellen Marise Lima
- Department of Psychiatry, Hospital das Clínicas, University of São Paulo Medical School (IPq/HCFMUSP), Brazil.
| | - Juliana Gois
- Department of Psychiatry, Hospital das Clínicas, University of São Paulo Medical School (IPq/HCFMUSP), Brazil
| | - Maria Luisa Paiva
- Department of Psychiatry, Hospital das Clínicas, University of São Paulo Medical School (IPq/HCFMUSP), Brazil
| | - Silvia Vincentiis
- Department of Psychiatry, Hospital das Clínicas, University of São Paulo Medical School (IPq/HCFMUSP), Brazil
| | - Sylvie Moschetta
- Department of Psychiatry, Hospital das Clínicas, University of São Paulo Medical School (IPq/HCFMUSP), Brazil
| | - Kette Dualibi Ramos Valente
- Department of Psychiatry, Hospital das Clínicas, University of São Paulo Medical School (IPq/HCFMUSP), Brazil
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Figueiredo NSVD, Cavalcanti MM, Gaça LB, Noffs MHDS, Sousa AVM, Alonso NB, Mazetto L, de Araújo Filho GM, Yacubian EMT, Guilhoto LM. Neuropsychological findings related to the presence of pre-surgical comorbid depression in Latin-American patients with mesial temporal lobe epilepsy and hippocampal sclerosis. Seizure 2020; 81:96-103. [PMID: 32771825 DOI: 10.1016/j.seizure.2020.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the neuropsychological findings related to the presence of pre-surgical comorbid depression in Latin-American patients with mesial temporal lobe epilepsy (MTLE) and unilateral hippocampal sclerosis (HS). METHOD Patients with drug-resistant MTLE and unilateral, left (L-) or right (R-) HS were studied. To diagnose depression, psychiatrists with expertise in epilepsy applied a semi-structured interview based on DSM. The depression group (DG) included patients with a psychiatric diagnosis in addition to a Beck Depression Inventory (BDI) score >16 points, and the non-depression group (NDG) included those without this diagnosis and with a BDI score ≤16. We analysed two clusters of neuropsychological tests, which evaluated memory (Complex Rey Figure III, Logical Memory II and RAVLT VII) and attention plus executive functions (Stroop I/II/III and Trail Making A/B). Moreover, we calculated the z-scores (Zs) using a local control group. The DG was compared to the NDG, independently and according to the HS side, using non-parametrical analyses. Due to the multivariate analysis, the p-value was corrected by applyingpost hoc Bonferroni adjustment. RESULTS We analysed 65 patients. The NDG included 51 (78.4 %) patients, and the DG included 14 (21.5 %) patients. Pre-surgical comorbid depression occurred in eight patients with L- (n = 29) and in six patients with R-MTLE-HS (n = 36). All of these groups had similar gender, age, IQs, and years of schooling. Compared to the healthy subjects, the L-MTLE-HS patients had lower Zs in verbal episodic memory tests [Logical Memory II (p < 0.001), and RAVLT VII (p < 0.001)], and the R-MTLE-HS patients had lower scores in visual episodic memory [Complex Rey Figure III (p < 0.001)]. In the analysis of the DGvs. NDG, there were no differences in the clusters of tests of memory or in those of attention and executive functions. Moreover, when we analysed the patients according to HS side, no neuropsychological difference was observed in the DG and NDG in terms of L- and R-MTLE-HS. CONCLUSIONS The patients with MTLE and unilateral HS in this study showed no differences in memory, attention and executive functions in relation to the presence of pre-surgical comorbid depression and independently of HS side. In this series from Latin-America, this psychiatric comorbidity did not affect cognition more than epilepsy alone.
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Affiliation(s)
- Nathália Stela Visoná de Figueiredo
- Epilepsy Research and Treatment Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Maryane Mendes Cavalcanti
- Epilepsy Research and Treatment Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Larissa Botelho Gaça
- Epilepsy Research and Treatment Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Maria Helena da Silva Noffs
- Epilepsy Research and Treatment Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Arthur Victor Menezes Sousa
- Epilepsy Research and Treatment Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Neide Barreira Alonso
- Epilepsy Research and Treatment Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Lenon Mazetto
- Epilepsy Research and Treatment Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Gerardo Maria de Araújo Filho
- Department of Psychiatry and Medical Psychology, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Elza Márcia Targas Yacubian
- Epilepsy Research and Treatment Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Laura Maria Guilhoto
- Epilepsy Research and Treatment Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
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Brandalise MH, de Araujo Filho GM, Centeno RS, Yacubian EMT, Jackowski AP. Effects of a brief psychotherapeutic intervention on resilience and behavior in patients with drug-resistant mesial temporal lobe epilepsy and late seizure recurrence after surgery. Epilepsy Behav 2019; 100:106512. [PMID: 31574426 DOI: 10.1016/j.yebeh.2019.106512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 11/15/2022]
Abstract
Seizure recurrence (SR) after epilepsy surgery in patients with medically resistant temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) can compromise medical treatment and quality of life (QOL). However, there is a scarcity of interventions specifically addressing this issue in the literature. We aimed to evaluate the impact of a four-week psychotherapeutic intervention on the levels of resilience, behavioral symptoms, and QOL of patients with drug-resistant TLE-MTS who underwent corticoamygdalohippocampectomy (CAH) and who presented with late SR. Fifty patients who had been diagnosed with TLE-TMS, undergone CAH, and presented with late SR were included. The study instruments included a clinical and sociodemographic questionnaire and the Brazilian versions of the Connor-Davidson Resilience Scale (CD-RISC-10), the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Interictal Dysphoric Disorder Inventory (IDDI), and the Quality of Life in Epilepsy Inventory (QOLIE-31). Significant reductions in the IDDI (p < 0.001) and NDDI-E (p < 0.001) scores, improvements in the CD-RISC-10 (p < 0.001) and QOLIE-31 (p < 0.001) scores, and positive correlations between resilience levels and QOL (p < 0.01), as well as a negative correlation between depressive symptoms and resilience (p < 0.01) and QOL (p < 0.01), were observed after the psychotherapeutic intervention. Improvements in the resilience levels and QOL, with concomitant reductions in depressive symptoms, were observed in patients with TLE-MTS and late SR after a brief psychotherapeutic intervention. Since there is a lack of studies that measured the impact of interventions in this patient subpopulation, these results may support the development of treatment strategies for this specific group.
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Affiliation(s)
| | - Gerardo Maria de Araujo Filho
- Universidade Federal de Sao Paulo (UNIFESP), Department of Psychiatry, Brazil; Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), Department of Psychiatry and Medical Psychology, Brazil.
| | - Ricardo Silva Centeno
- Universidade Federal de Sao Paulo (UNIFESP), Department of Neurology and Neurosurgery, Brazil
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Mandel M, Figueiredo EG, Mandel SA, Tutihashi R, Teixeira MJ. Minimally Invasive Transpalpebral Endoscopic-Assisted Amygdalohippocampectomy. Oper Neurosurg (Hagerstown) 2015; 13:2-14. [DOI: 10.1227/neu.0000000000001179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 11/24/2015] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND: Although anterior temporal lobectomy may be a definitive surgical treatment for epileptic patients with mesial temporal sclerosis, it often results in verbal, visual, and cognitive dysfunction. Studies have consistently reported the advantages of selective procedures compared with a standard anterior temporal lobectomy, mainly in terms of neuropsychological outcomes.
OBJECTIVE: To describe a new technique to perform a selective amygdalohippocampectomy (SAH) through a transpalpebral approach with endoscopic assistance.
METHODS: A mini fronto-orbitozygomatic craniotomy through an eyelid incision was performed in 8 patients. Both a microscope and neuroendoscope were used in the surgeries. An anterior SAH was performed in 5 patients who had the diagnosis of temporal lobe epilepsy with mesial temporal sclerosis. One patient had a mesial temporal lesion suggesting a ganglioglioma. Two patients presented mesial temporal cavernomas with seizures originating from the temporal lobe.
RESULTS: The anterior approach allowed removal of the amygdala and hippocampus. The image-guided system and postoperative evaluation confirmed that the amygdala may be accessed and completely removed through this route. The hippocampus was partially resected. All patients have discontinued medication with no more epileptic seizures. The patients with cavernomas and ganglioglioma also had their lesions completely removed. One-year follow-up has shown no visible scars.
CONCLUSION: The anterior route for SAH is a rational and direct approach to the mesial temporal lobe. Anterior SAH is a safe, less invasive procedure that provides early identification of critical vascular and neural structures in the basal cisterns. The transpalpebral approach provides a satisfactory cosmetic outcome.
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Affiliation(s)
- Mauricio Mandel
- Department of Neurosurgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eberval Gadelha Figueiredo
- Department of Neurosurgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | - Suzana Abramovicz Mandel
- Department of Neurosurgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rafael Tutihashi
- Hospital Sírio Libanês, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Plastic Surgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Department of Neurosurgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
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Alonso NB, Mazetto L, de Araújo Filho GM, Vidal-Dourado M, Yacubian EMT, Centeno RS. Psychosocial factors associated with in postsurgical prognosis of temporal lobe epilepsy related to hippocampal sclerosis. Epilepsy Behav 2015; 53:66-72. [PMID: 26520878 DOI: 10.1016/j.yebeh.2015.09.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 11/28/2022]
Abstract
We examined the long-term psychosocial trajectory in a consecutive and homogeneous series of 120 patients followed up for five years after corticoamygdalohippocampectomy (CAH). Evaluation of psychosocial variables at baseline and at five-year follow-up were compared. After five years of CAH, a significant improvement in educational level (p=0.004) and employment status (p<0.001) was observed, although retirement (p<0.001) and divorce (p=0.021) rates increased. In a long-term follow-up, a tendency to have similar QOL profile was observed between Engel classes IA and IB (p>0.05). A more favorable surgical outcome (Engel IA) was related to better psychiatric status (p=0.012). Poor psychosocial adjustment before surgery was the most important predictor of QOL outcome (p<0.05). Patients' trajectory after surgical treatment showed positive effects mainly in those with better seizure outcome. Our results emphasized the influence regarding baseline psychosocial functioning on postoperative psychosocial adjustment. Furthermore, many psychosocial gains and difficulties after surgery may be similar in developing and developed countries.
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Affiliation(s)
| | - Lenon Mazetto
- Department of Neurology, Escola Paulista de Medicina/UNIFESP, São Paulo, Brazil
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da Conceição PO, Nascimento PP, Mazetto L, Alonso NB, Yacubian EMT, de Araujo Filho GM. Are psychiatric disorders exclusion criteria for video-EEG monitoring and epilepsy surgery in patients with mesial temporal sclerosis? Epilepsy Behav 2013; 27:310-4. [PMID: 23523814 DOI: 10.1016/j.yebeh.2013.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/07/2013] [Accepted: 02/16/2013] [Indexed: 11/30/2022]
Abstract
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 (93h) 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.
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Safety of video-EEG monitoring and surgical outcome in patients with mesial temporal sclerosis and psychosis of epilepsy. Seizure 2012; 21:583-7. [DOI: 10.1016/j.seizure.2012.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 06/04/2012] [Accepted: 06/05/2012] [Indexed: 11/22/2022] Open
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Monteiro EDA, Osório FDL, Veriano A, Molina RS, Funayama SS, Terra VC, Velasco TR, Guarnieri R, Bianchin M, Assirati JA, Sakamoto AC, Hallak JEC. Validation of the Subjective Handicap of Epilepsy (SHE) in Brazilian patients with epilepsy. Epilepsy Behav 2012; 24:345-51. [PMID: 22658433 DOI: 10.1016/j.yebeh.2012.04.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 04/09/2012] [Accepted: 04/21/2012] [Indexed: 11/19/2022]
Abstract
The objectives of the study were to translate and adapt the Subjective Handicap of Epilepsy (SHE) instrument to Brazilian Portuguese and to determine its psychometric properties for the evaluation of quality of life in patients with epilepsy. A sample of 448 adult patients with epilepsy with different clinical profiles (investigation, preoperative period, postoperative period, and drug treatment follow-up) was evaluated with the SHE and the Epilepsy Surgery Inventory (ESI-55). Exploratory factorial analysis demonstrated that four factors explained 60.47% of the variance and were sensitive to discriminate the different clinical groups, with the preoperative group having the poorest quality of life. Internal consistency ranged from 0.92 to 0.96, and concurrent validity with the ESI-55 was moderate/strong (0.32-0.70). Test-retest reliability was confirmed, with an ICC value of 0.54 (2 days), 0.91 (7 days), and 0.97 (30 days). The SHE had satisfactory psychometric qualities for use in the Brazilian population, similar to those of the original version. The instrument seems to be more adequate in psychometric terms for the postoperative and drug treatment follow-up groups, and its use should be encouraged.
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Affiliation(s)
- Edna de Almeida Monteiro
- Department of Neuroscience and Behavior, Medical School of Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes 3900, CEP 14048-900, Ribeirão Preto, São Paulo, Brazil
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Seiam AHR, Dhaliwal H, Wiebe S. Determinants of quality of life after epilepsy surgery: systematic review and evidence summary. Epilepsy Behav 2011; 21:441-5. [PMID: 21697015 DOI: 10.1016/j.yebeh.2011.05.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 05/04/2011] [Accepted: 05/06/2011] [Indexed: 11/27/2022]
Abstract
We systematically reviewed evidence-based determinants of health-related quality of life (QOL) in adults undergoing epilepsy surgery and assessed the effect of study methods. Medline, Embase, and the Cochrane library (1950-2008) were searched systematically. Two authors independently performed every step of the review. We obtained the proportion of studies reporting statistically significant positive or negative impact on QOL. Of 39 eligible studies, 32 assessed the impact of surgery on QOL and 29 (90.6%) found a significant positive effect. The most prevalent preoperative determinant was psychological function. Seizure freedom was the most prevalent postoperative determinant (80% of studies), followed by antiepileptic drug adverse events, employment status, and psychological function. Psychosocial (95%), physical (91%), and overall QOL (90%) domains improved most frequently, whereas role limitation (63%) and cognition (78%) improved least frequently. Methods, choice of instrument, and time of measurement influenced QOL outcomes and should be carefully chosen in future studies.
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Affiliation(s)
- Abdel-Hamid R Seiam
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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Assessment of psychosocial adjustment in patients with temporal lobe epilepsy using a standard measure. Epilepsy Behav 2011; 20:89-94. [PMID: 21145288 DOI: 10.1016/j.yebeh.2010.10.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 10/29/2010] [Accepted: 10/30/2010] [Indexed: 11/23/2022]
Abstract
Despite the growing evidence of poor psychosocial adjustment, at present there is no formal method of assessment of social adjustment in patients with temporal lobe epilepsy (TLE). First, we assessed social adjustment in patients with TLE using a self-report questionnaire and compared the results with those from quality-of-life (QOL) scales. Second, we verified the influence of cognitive performance and clinical variables of epilepsy on social adjustment and QOL. We evaluated 35 people with TLE and 38 healthy controls. Patients had worse social adjustment, and it was correlated with worse perception of cognitive function. Attention and verbal memory dysfunctions were negatively correlated with social adjustment. However, there was no significant correlation between cognitive performance and QOL. Regarding clinical variables, persons with left TLE showed worse social adjustment and patients with frequent seizures showed worse QOL. These findings indicate the relevance of evaluating social adjustment and emphasize the importance of cognitive rehabilitation to improved social adjustment.
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Alonso NB, Azevedo AM, Centeno RS, Guilhoto LMFF, Caboclo LOSF, Yacubian EMT. Employment and quality of life in mesial temporal lobe epilepsy with hippocampal sclerosis: is there a change after surgical treatment? ACTA ACUST UNITED AC 2009. [DOI: 10.1590/s1676-26492009000200008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE: The aim of this study was to evaluate in patients with mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS): (1) employment patterns before and three years after epilepsy surgery and their impact in Quality of Life (QOL); (2) demographic and clinical variables associated with employment. METHODS: Data from 58 patients with diagnosis of refractory MTLE with HS who had corticoamygdalo-hippocampectomy were analyzed. The subjects answered to Brazilian validated version of the Epilepsy Surgery Inventory (ESI-55) before, and three years after surgery. In a semi-structured interview, sociodemographic and clinical characteristics were obtained. Changes in employment after surgery were classified in one of the three categories: (i) improvement status: those who were unemployed, no-formal employed, students, housewives and subjects who have never worked to employed category; (ii) unchanged status: no change in occupation; this category included subjects who were employed before and after the surgery, housewives, students, and the group who remained unemployed, receiving ill-health benefits or retired after the surgical treatment; and (iii) worsened status: loss of employment. RESULTS: Employment status did not show any significant change after surgery: in 51(87.9%) it remained unchanged, in six (10.3%) it improved, and one patient (1.7%), who was employed before the surgery, retired after that. In a subgroup of 22 patients employed after surgery, ten (45.5%) were seizure-free, seven (31.8%) had only rare auras, and five (22.7%) had seizures. In the group of improvement, 12 patients (70.5%) had no-formal employment and five (29.5%) had a formal job before surgery. After three years, 14 (63.6%) of 22 subjects were formally employed. Our data suggested that the employability was strongly correlated (p<0.05) with a positive perception of health-related quality of life measured by ESI-55, before and after surgical evaluation. CONCLUSION: Our study demonstrated in a homogeneous group of MTLE with HS, a modest, but positive relationship between surgical outcome and work gain, and that QOL had strong correlation with the fact of being employed.
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Validity and reliability of the Portuguese-Brazilian version of the Quality of Life in Epilepsy Inventory-89. Epilepsy Behav 2009; 14:465-71. [PMID: 19138756 DOI: 10.1016/j.yebeh.2008.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Revised: 12/02/2008] [Accepted: 12/13/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this article was to report the translation of the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) into a Portuguese-Brazilian version and evaluate its reliability and validity. METHODS This study involved 105 outpatients: 54 patients with refractory temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS) and 51 with juvenile myoclonic epilepsy (JME). Reliability and test-retest reliability were assessed. Relationships between QOLIE-89 domains and other questionnaires (Nottingham Health Profile, Beck Depression Inventory, Adverse Event Profile, Neuropsychological Evaluation), and external measures such as demographic and clinical variables were analyzed to examine construct validity. RESULTS Internal consistency (Cronbach's alpha=0.73-0.92) and test-retest reliability (intraclass correlation coefficient=0.60-0.84) for individual domains were acceptable. For construct validity, we verified high correlations between the QOLIE-89 and the Nottingham Health Profile, Beck Depression Inventory, Adverse Event Profile, and Neuropsychological Evaluation. For clinical characteristics, the patients with juvenile myoclonic epilepsy had better quality-of-life scores on 11 of 17 QOLIE-89 subscales compared with patients with temporal lobe epilepsy (P<0.05). CONCLUSION These results support the reliability and validity of the Portuguese-Brazilian translation of QOLIE-89.
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Kondziella D, Alvestad S, Vaaler A, Sonnewald U. Which clinical and experimental data link temporal lobe epilepsy with depression? J Neurochem 2007; 103:2136-52. [PMID: 17887964 DOI: 10.1111/j.1471-4159.2007.04926.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The association of temporal lobe epilepsy with depression and other neuropsychiatric disorders has been known since the early beginnings of neurology and psychiatry. However, only recently have in vivo and ex vivo techniques such as Positron Emission Tomography, Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy in combination with refined animal models and behavioral tests made it possible to identify an emerging pattern of common pathophysiological mechanisms. We now have growing evidence that in both disorders altered interaction of serotonergic and noradrenergic neurons with glutamatergic systems is associated with abnormal neuronal circuits and hyperexcitability. Neuronal hyperexcitability can possibly evoke seizure activity as well as disturbed emotions. Moreover, decreased synaptic levels of neurotransmitters and high glucocorticoid levels influence intracellular signaling pathways such as cAMP, causing disturbances of brain-derived and other neurotrophic factors. These may be associated with hippocampal atrophy seen on Magnetic Resonance Imaging and memory impairment as well as altered fear processing and transient hypertrophy of the amygdala. Positron Emission Tomography studies additionally suggest hypometabolism of glucose in temporal and frontal lobes. Last, but not least, in temporal lobe epilepsy and depression astrocytes play a role that reaches far beyond their involvement in hippocampal sclerosis and ultimately, therapeutic regulation of glial-neuronal interactions may be a target for future research. All these mechanisms are strongly intertwined and probably bidirectional such that the structural and functional alterations from one disease increase the risk for developing the other. This review provides an integrative update of the most relevant experimental and clinical data on temporal lobe epilepsy and its association with depression.
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Affiliation(s)
- Daniel Kondziella
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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Alonso NB, Silva TID, Westphal-Guitti AC, Azevedo AM, Caboclo LOSF, Sakamoto AC, Yacubian EMT. Quality of life related to surgical treatment in patients with temporal lobe epilepsy due to mesial temporal sclerosis. ACTA ACUST UNITED AC 2006. [DOI: 10.1590/s1676-26492006000700009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION: Surgery is widely accepted as a modality of treatment for medically intractable seizures and the main goals of surgery as reduction or elimination of seizures without significant compromise in neurological function and improving QOL. PURPOSE: To assess QOL pre- and post-surgery in a sample of patients with temporal lobe epilepsy (TLE) due to mesial temporal sclerosis (MTS). METHODS: Thirty-five consenting subjects who had undergone corticoamygdalo-hipocampetomy were included in this study. They answered the ESI-55 before and six months after surgical treatment. Analyses of Variance (ANOVA) was used to study the changes in QOL and we also determined the effect-size of the sample. RESULTS: After surgical treatment 18 (51%) subjects were seizure free, 10 (29%) had only auras and seven (20%) had partial seizures. The post-operative mean scores were higher than pre-operative scores, except for Cognitive Function and Limitation due to Cognitive Problems in the group with seizures. A significant improvement in QOL post-surgery was observed in the domains Health-Perception (1.24), Emotional-Well-being (1.32) and Energy/Fatigue (1.43). CONCLUSION: A long-term follow-up is necessary to identify meanigful changes after the surgery.
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