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Zinchuk M, Kustov G, Pashnin E, Rider F, Sviatskaya E, Popova S, Voinova N, Yakovlev A, Guekht A. Self-injurious thoughts and behaviors in Russian patients with epilepsy: A prospective observational study. Seizure 2023; 107:28-34. [PMID: 36940646 DOI: 10.1016/j.seizure.2023.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE A two-stage study aimed to estimate the prevalence of different types of self-injurious behaviors (suicidal ideation (SI), suicide attempts (SA), and nonsuicidal self-injury (NSSI)) in Russian patients with epilepsy (PWE), to identify factors associated with such behaviors, and to assess their impact on 3-year mortality. METHODS We enrolled 459 consecutive adult PWE from two level 2 outpatient epilepsy centers in Moscow. The study consisted of two phases - first, we assessed all demographic and clinical characteristics and patients' history of SI, SA, and NSSI. In the second phase, three years after the initial screening, we analyzed patients' medical records to assess how self-injurious thoughts and behaviors were related to actual mortality. RESULTS In our sample, the total lifetime and 12-month prevalence of SI was 20% and 5.7%, of SA was 8.3% and 0.7%, and of NSSI was 15.3% and 2.8%, respectively. We found no differences between deceased and alive PWE regarding lifetime and 12-month prevalence of SI, SA, and NSSI. Higher seizure frequency, lifetime NSSI and lifetime diagnosis of mental disorder were associated with SI, whereas traumatic brain injury (TBI), substance abuse, and NSSI were associated with SA in PWE. SIGNIFICANCE Our study adds to the existing data on the prevalence of different types of suicidal behaviors in PWE and advances research on NSSI in this population. However, more research is needed on the long-term consequences of different types of self-injurious behaviors.
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Affiliation(s)
- Mikhail Zinchuk
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation.
| | - Georgii Kustov
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Evgenii Pashnin
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Flora Rider
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | | | - Sofya Popova
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Nadezhda Voinova
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Alexander Yakovlev
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation; Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Alla Guekht
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation; Pirogov Russian National Research Medical University, Moscow, Russian Federation
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2
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Wang H, Zhang Y, Tan G, Chen D, Fu Y, Liu L. Suicidality and epilepsy: A systematic review and meta-analysis. Front Psychiatry 2023; 14:1097516. [PMID: 37065883 PMCID: PMC10090680 DOI: 10.3389/fpsyt.2023.1097516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 04/18/2023] Open
Abstract
Background We aimed to evaluate the association between epilepsy and suicidality, including suicidal ideation, attempts and completed suicide. Methods We systematically searched PubMed, Embase, Cochrane Online Library, and Clinicaltrials.gov from 1946 to June 21, 2021 and assessed the quality of the studies using the Newcastle-Ottawa Scale. We calculated the pooled OR and the crude rate for suicidal ideation, suicide attempts and completed suicide in patients with epilepsy (PWE). Results We screened 2,786 studies and included 88 articles with 1,178,401 PWE and 6,900,657 participants as controls. Search terms included epilepsy and suicide. The pooled rates of suicidal ideation, suicide attempts and completed suicide in PWE were 19.73% (95% CI: 17.00-22.62%), 5.96% (95% CI: 4.82-7.20%), and 0.24% (95% CI: 0.11-0.42%), respectively. Compared to the control group, PWE were at a significantly higher risk of total suicidality (pooled OR, 2.60; 95%: 2.13-3.18), including suicidal ideation (pooled OR, 2.70; 95% CI, 2.21-3.30), suicide attempts (pooled OR, 2.74; 95% CI, 2.08-3.61) and completed suicide (pooled OR, 2.36; 95% CI, 1.45-3.83). Subgroup analyses showed significant differences in the subgroups of the measurement of suicidality. Conclusion The rate of suicidal ideation, suicide attempts and completed suicide in PWE were about 19.73, 5.96, and 0.24%. And there was an increased risk of suicidality in PWE especially temporal lobe epilepsy and drug-resistant epilepsy. Clinicians need to be aware of this risk in PWE with early identification and prevention at the time of diagnosis.Protocol Registration: PROSPERO CRD42021278220.
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Affiliation(s)
- Haijiao Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha City, China
| | - Yu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, China
| | - Ge Tan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Deng Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yaoqi Fu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ling Liu,
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Tedrus GMDAS, Souza DDCMD. I would be better off dead: investigating suicidal ideation in people with epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:718-724. [PMID: 36254445 PMCID: PMC9685829 DOI: 10.1055/s-0042-1755230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND It is known that the risk of suicidal behavior in adult people with epilepsy (PWEs) is high. However, the associated clinical and psychosocial factors are still being discussed. OBJECTIVE To assess the risk of suicide in PWEs and relate it to resilience and quality of life (QoL) as well as with clinical variables. METHODS The item "I'd be better off dead" of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) was related to the resilience scale, clinical aspects, the presence of depression, and the Quality of Life in Epilepsy Inventory (QOLIE-31) scores of PWEs, with a p < 0.05. RESULTS A total of 271 PWEs were assessed, 50.6% were female, with a mean age of 46.6 (± 15.8) years, and a mean age at 1st seizure of 24.1 (± 18.5) years. Risk for suicide occurred in 50 (19.3%) cases. In multiple logistic regression, the factors that explain the risk of suicide were female sex, depression, and lower scores on the QOLIE-31 and on the resilience scale. In the classification and regression trees, the order of importance of the variables was depression > resilience > age > QoL > age at 1st seizure. CONCLUSION The risk of suicide was high, and it was associated with demographic aspects, clinical variables, QoL, and resilience. A higher risk of suicide was associated with lower resilience regardless of the presence or absence of depression. In the presence of depression, a higher risk of suicide was associated with the early onset of epilepsy. In the absence of depression, the risk of suicide was associated with low QoL in young adults.
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Kanner AM. Suicidality in Patients With Epilepsy: Why Should Neurologists Care? Front Integr Neurosci 2022; 16:898547. [PMID: 35712347 PMCID: PMC9196893 DOI: 10.3389/fnint.2022.898547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
Abstract
Suicidality is a relatively common comorbidity in patients with epilepsy (PWE). Population-based studies have revealed lifetime prevalence rates of 25% of suicidal ideation (SI). In addition, PWE without comorbid psychiatric disorders has two to three higher risk of committing suicide and this risk increases by 12- to 32-fold in the presence of various psychiatric disorders. Risk factors are multiple and include socio-demographic, genetic, age and gender, and psychiatric comorbidities. Among the latter, mood, anxiety, and psychotic disorders have been found to be common risk factors for suicidality in PWE, but iatrogenic causes resulting from pharmacotherapy with antiseizure drugs or epilepsy surgery can also cause SI and behavior. Suicidality and epilepsy have a complex bidirectional relation, whereas PWE are at increased risk of suicidality and vice-versa. Common pathogenic mechanisms operant in both conditions may explain this bidirectional relation. SI can be easily identified in outpatient epilepsy clinics with screening instruments and can be treated and thus prevent its escalation to suicidal attempts and completed suicide. The aim of this manuscript is to review these data in detail.
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João RB, Nogueira MH, Morita-Sherman ME, Alvim MKM, Johnny S, Pereira H, Pinheiro HP, Cendes F, Yasuda CL. The Relationship Between Depression and Anxiety Symptoms of Adult PWE and Caregivers in a Tertiary Center. Front Neurol 2022; 13:766009. [PMID: 35356450 PMCID: PMC8959587 DOI: 10.3389/fneur.2022.766009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 02/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Although several studies have emphasized the association between epilepsy and psychiatric disorders, fewer have investigated the impact of epilepsy on caregivers' emotional status, mainly in adult people with epilepsy (PWE). Here we investigated depressive symptoms, suicidal ideation, and anxiety symptoms in a large group of adult PWE and their caregivers. Methods We analyzed symptoms of depression [with the Beck Depression Inventory-II (BDI-II)], suicidal ideation (with BDI-II item 9), and anxiety symptoms (with the Beck Anxiety Inventory) in a large group of adult PWE [N = 548 (60% women; median age 41)] and caregivers [N = 191 (72% women; median age 47)] from a Brazilian tertiary center, considering sociodemographic and clinical aspects. We also applied the Liverpool Adverse Events Profile to assess anti-seizure drugs adverse events. Results While the presence (p = 0.026) (and intensity, p = 0.007) of depressive symptoms and suicidal ideation (p = 0.02) were higher in PWE compared to caregivers, the proportion of clinical anxiety symptoms (p = 0.32) (and the intensity, p = 0.13) was similar in both groups. Although the rates of suicidal ideation were higher in focal epilepsy (20%), both generalized genetic epilepsy and caregivers also presented elevated frequencies (11%) of suicidal ideation. The analyses of 120 patient-caregiver dyads revealed that the intensity of depressive symptoms in PWE (but not anxiety) correlated with the intensity of depressive (r = 0.35; p < 0.001) and anxiety (r = 0.25; p = 0.01) symptoms in their caregivers. In the multivariate analyses of PWE, focal epilepsy (compared to GGE) was associated with clinical depressive symptoms (odds ratio, OR 2.1) and suicidal ideation (OR 3.2), while recurrent seizures (compared to the seizure-free group) were associated with suicidal ideation (OR 2.6) and anxiety symptoms (OR 2.1). Also, caregivers with anxiety symptoms were 8 times more likely to exhibit depressive symptoms, and those with depressive symptoms were 8 times more likely to present anxiety symptoms. Conclusion Our study suggests that specific attention for the caregivers' mental health is as essential as PWE. There is an urgent need for more studies involving caregivers to identify their emotional distress and provide adequate treatment.
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Affiliation(s)
- Rafael Batista João
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Mateus Henrique Nogueira
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Márcia Elisabete Morita-Sherman
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Marina Koutsodontis Machado Alvim
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Steven Johnny
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Haryton Pereira
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Hildete Prisco Pinheiro
- Institute of Mathematics, Statistics and Scientific Computing, University of Campinas, Campinas, Brazil
| | - Fernando Cendes
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
| | - Clarissa Lin Yasuda
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, Brazil
- The Brazilian Institute of Neuroscience and Neurotechnology, University of Campinas, Campinas, Brazil
- *Correspondence: Clarissa Lin Yasuda
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Levetiracetam adjunct to quetiapine for the acute manic phase of bipolar disorder: a randomized, double-blind and placebo-controlled clinical trial of efficacy, safety and tolerability. Int Clin Psychopharmacol 2022; 37:46-53. [PMID: 34864756 DOI: 10.1097/yic.0000000000000383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Unsatisfactory responses to bipolar disorder treatments have necessitated novel therapeutic approaches. Evidence of levetiracetam's effectiveness in mania was reported in previous studies. This study evaluated its efficacy, safety and tolerability as an adjunct to quetiapine in mania. Forty-four patients with Young Mania Rating Scale (YMRS) score ≥20 entered and were randomized to receive levetiracetam plus quetiapine or placebo plus quetiapine for 6 weeks. Patients were assessed using the YMRS and Beck Scale for Suicidal Ideations (BSSI) at baseline and weeks 2, 4 and 6. Changes in the scores, remission rates and response to treatment were compared between the groups. Forty patients completed the trial. The general linear model (GLM) repeated measures demonstrated a significant effect for time × treatment interaction on the YMRS score during the trial (P = 0.04). A greater reduction in YMRS scores was seen in the levetiracetam group compared with the placebo group from baseline to week 4 (P = 0.045). Response to treatment was significantly better in the levetiracetam group (P = 0.046). No significant effect for time × treatment interaction on BSSI score was seen in GLM repeated measures. Finally, there was no significant difference in the frequency of adverse events. Adjunctive levetiracetam is effective, safe and well-tolerated in patients with mania. Further high-quality, large-scale trials are recommended.
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Schraegle WA, Tillman R, Ailion A, Babajani-Feremi A, Titus JB, DeLeon RC, Clarke D, Hermann BP. Behavioral phenotypes of pediatric temporal lobe epilepsy. Epilepsia 2022; 63:1177-1188. [PMID: 35174484 DOI: 10.1111/epi.17193] [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: 11/04/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE A broad spectrum of emotional-behavioral problems have been reported in pediatric temporal lobe epilepsy (TLE), but with considerable variability in their presence and nature of expression, which hampers precise identification and treatment. The present study aimed to empirically identify latent patterns or behavioral phenotypes and their correlates. METHODS Data included parental ratings of emotional-behavioral status on the Behavior Assessment System for Children, 2nd Edition (BASC-2) of 81 children (mean age = 11.79, standard deviation [SD] = 3.93) with TLE. The nine clinical subscales were subjected to unsupervised machine learning to identify behavioral subgroups. To explore concurrent validity and the underlying composition of the identified clusters, we examined demographic factors, seizure characteristics, psychosocial factors, neuropsychological performance, psychiatric status, and health-related quality of life (HRQoL). RESULTS Three behavioral phenotypes were identified, which included no behavioral concerns (Cluster 1, 43% of sample), externalizing problems (Cluster 2, 41% of sample), and internalizing problems (Cluster 3, 16% of sample). Behavioral phenotypes were characterized by important differences across clinical seizure variables, psychosocial/familial factors, everyday executive functioning, and HRQoL. Cluster 2 was associated with younger child age, lower maternal education, and higher rate of single-parent households. Cluster 3 was associated with older age at epilepsy onset and higher rates of hippocampal sclerosis and parental psychiatric history. Both Cluster 2 and 3 demonstrated elevated family stress. Concurrent validity was demonstrated through the association of psychiatric (i.e., rate of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) disorders and psychotropic medication) and parent-rated HRQoL variables. SIGNIFICANCE Youth with TLE present with three distinct behavioral phenotypes that correspond with important clinical and sociodemographic markers. The current findings demonstrate the variability of behavioral presentations in youth with TLE and provide a preliminary framework for screening and targeting intervention to enhance support for youth with TLE and their families.
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Affiliation(s)
- William A Schraegle
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA.,Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Rachael Tillman
- Division of Neuropsychology, Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Alyssa Ailion
- Department of Neurology and Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Abbas Babajani-Feremi
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA.,Department of Neurosurgery, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Jeffrey B Titus
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA
| | - Rosario C DeLeon
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA.,Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Dave Clarke
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Comprehensive Pediatric Epilepsy Center, Dell Children's Medical Center, Austin, Texas, USA.,Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA.,Department of Neurosurgery, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Lin M, Chen J, Li S, Qin Y, Wang X, Liu Y, Abdulaziz ATA, Liu W, Zhou D, Li J. Risk factors for suicidal tendency in people with epilepsy in China: a case-control study. Sci Rep 2021; 11:2742. [PMID: 33531579 PMCID: PMC7854730 DOI: 10.1038/s41598-021-81870-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 01/04/2021] [Indexed: 02/05/2023] Open
Abstract
People with epilepsy (PWE) have an increased suicide prevalence. This study aimed to identify the risk factors for suicidal tendency among PWE in West China. A nested case–control study was designed in a cohort of patients with epilepsy (n = 2087). In total, 28 variates were calculated. In the univariate analysis, unemployment, low income, seizure frequency, seizure-free time, infectious or structural etiology, levetiracetam or phenobarbital use, anxiety, depression, and stigma were associated with suicidal tendency. A multivariate analysis indicated that unemployment (odds ratio [OR] 5.74, 95% confidence interval [CI] 2.13–15.48), levetiracetam use (OR 2.80, 95%CI 1.11–7.05), depression (C-NDDI-E score ≥ 13; OR 3.21, 95%CI 1.26–8.21), and stigma (SSCI score ≥ 16; OR 6.67, 95%CI 1.80–24.69) were independently associated with suicidal tendency. Conditional inference tree analysis indicated that SSCI and C-NDDI-E scores could effectively identify patients with suicidal tendency. Thus, this study suggests that unemployment, levetiracetam use, depression, and stigma are independent risk factors for suicidal tendency in PWE in China.
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Affiliation(s)
- Mintao Lin
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jiani Chen
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Sisi Li
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yingjie Qin
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xuruan Wang
- West China Medical School, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yadong Liu
- West China Medical School, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ammar Taha Abdullah Abdulaziz
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Wenyu Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Jinmei Li
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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Corke M, Mullin K, Angel-Scott H, Xia S, Large M. Meta-analysis of the strength of exploratory suicide prediction models; from clinicians to computers. BJPsych Open 2021; 7:e26. [PMID: 33407984 PMCID: PMC8058929 DOI: 10.1192/bjo.2020.162] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suicide prediction models have been formulated in a variety of ways and are heterogeneous in the strength of their predictions. Machine learning has been a proposed as a way of improving suicide predictions by incorporating more suicide risk factors. AIMS To determine whether machine learning and the number of suicide risk factors included in suicide prediction models are associated with the strength of the resulting predictions. METHOD Random-effect meta-analysis of exploratory suicide prediction models constructed by combining two or more suicide risk factors or using clinical judgement (Prospero Registration CRD42017059665). Studies were located by searching for papers indexed in PubMed before 15 August 2020 with the term suicid* in the title. RESULTS In total, 86 papers reported 102 suicide prediction models and included 20 210 411 people and 106 902 suicides. The pooled odds ratio was 7.7 (95% CI 6.7-8.8) with high between-study heterogeneity (I2 = 99.5). Machine learning was associated with a non-significantly higher odds ratio of 11.6 (95% CI 6.0-22.3) and clinical judgement with a non-significantly lower odds ratio of 4.7 (95% CI 2.1-10.9). Models including a larger number of suicide risk factors had a higher odds ratio when machine-learning studies were included (P = 0.02). Among non-machine-learning studies, suicide prediction models including fewer risk factors performed just as well as those including more risk factors. CONCLUSIONS Machine learning might have the potential to improve the performance of suicide prediction models by increasing the number of included suicide risk factors but its superiority over other methods is unproven.
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Affiliation(s)
- Michelle Corke
- School of Psychiatry, University of New South Wales, Australia
| | - Katherine Mullin
- South Eastern Sydney Local Health District and School of Medicine, University of Notre Dame, Australia
| | | | - Shelley Xia
- South Eastern Sydney Local Health District, Australia
| | - Matthew Large
- South Eastern Sydney Local Health District, Australia; and School of Medicine, University of Notre Dame, Australia
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Kim JS, Kim DY, Jo HJ, Hwang YH, Song JY, Yang KI, Hong SB. Effect of Long-Term Treatment with Vagus Nerve Stimulation on Mood and Quality of Life in Korean Patients with Drug-Resistant Epilepsy. J Clin Neurol 2021; 17:385-392. [PMID: 34184446 PMCID: PMC8242313 DOI: 10.3988/jcn.2021.17.3.385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to determine the long-term effects of vagus nerve stimulation (VNS) treatment on suicidality, mood-related symptoms, and quality of life (QOL) in patients with drug-resistant epilepsy (DRE). We also investigated the relationships among these main effects, clinical characteristics, and VNS parameters. METHODS Among 35 epilepsy patients who underwent VNS implantation consecutively in our epilepsy center, 25 patients were recruited to this study for assessing the effects of VNS on suicidality, mood-related symptoms, and QOL. The differences in these variables between before and after VNS treatment were analyzed statistically using paired t-tests. Multiple linear regression analyses were also performed to determine how the patients' demographic and clinical characteristics influenced the variables that showed statistically significant changes after long-term VNS treatment. RESULTS After VNS, our patients showed significant improvements not only in the mean seizure frequency but also in suicidality, depression, and QOL. The reduction in depression was associated with the improvement in QOL and more-severe depression at baseline. The reduction in suicidality was associated with higher suicidality at baseline, smaller changes in depression, and less-severe depression at baseline. Improved QOL was associated with lower suicidality at baseline. CONCLUSIONS This study found that VNS decreased the mean seizure frequency in patients with DRE, and also improved their depression, suicidality, and QOL. These results provide further evidence for therapeutic effect of VNS on psychological comorbidities of patients with DRE.
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Affiliation(s)
- Jeong Sik Kim
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Yeop Kim
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Jin Jo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Ha Hwang
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Yeon Song
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Seung Bong Hong
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Korea.
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Abstract
PURPOSE OF REVIEW Depression and anxiety substantially contribute to interictal disability in patients with epilepsy (PWE). This review summarizes current studies that shed light on mechanisms of comorbidity. RECENT FINDINGS Mounting epidemiological data implicate shared risk factors for anxiety/depression and seizure propensity, but these remain largely elusive and probably vary by epilepsy type. Within PWE, these symptoms appear to be associated with unique genetic, neuropathological, and connectivity profiles. Temporal lobe epilepsy has received enormous emphasis particularly in preclinical studies of comorbidity, where candidate neurobiological mechanisms underlying bidirectionality have been tested without psychopharmacological confounds. Depression and anxiety in epilepsy reflect dysfunction within broadly distributed limbic networks that may be the cause or consequence of epileptogenesis. In refractory epilepsy, seizures and/or certain anticonvulsants may distort central emotional homeostatic mechanisms that perpetually raise seizure risk. Developing future safe and effective combined anticonvulsant-antidepressant treatments will require a detailed understanding of anatomical and molecular nodes that pleiotropically enhance seizure risk and negatively alter emotionality.
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Affiliation(s)
- Vaishnav Krishnan
- Departments of Neurology, Neuroscience and Psychiatry & Behavioral Sciences, Baylor Comprehensive Epilepsy Center, Baylor College of Medicine, One Baylor Plaza St., MS: NB302, Houston, TX, 77030, USA.
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Kim SJ, Kim HJ, Jeon JY, Kim HW, Lee SA. Clinical factors associated with suicide risk independent of depression in persons with epilepsy. Seizure 2020; 80:86-91. [PMID: 32544659 DOI: 10.1016/j.seizure.2020.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE We determined whether factors related to epilepsy are associated with a risk of suicide independent of depression in persons with epilepsy. METHOD This cross-sectional study included adults with epilepsy. Suicidality and depression were assessed with the Mini International Neuropsychiatric Interview (MINI). Patients were divided into two age groups (≤ 40 vs. > 40 years). Presence of suicide risk was defined as a MINI suicidality score ≥ 1. A stepwise logistic regression analysis was conducted. RESULTS A total of 212 participants were recruited (52.4 % men). Suicide risk and depression were noted in 31.6 % and 22.2 % of participants, respectively. An antiepileptic drug load ≥ 1 (odds ratio [OR], 4.093-4.152) was significantly associated with a risk of suicide, independent of depression (OR, 5.794), and a past or family history of psychiatric disorders (OR, 2.677). When stratified by age, pregabalin usage (OR, 13.403) in the younger group and high seizure frequency (≥ 1 per month) (OR, 5.748) in the older group were associated with a risk of suicide independent of current depression. CONCLUSION The risk of suicide in persons with epilepsy may be associated with epilepsy-related factors such as a high antiepileptic drug load, frequent seizures, and use of pregabalin, independent of depression. Such risk factors may vary depending on the age of the patient.
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Affiliation(s)
- Soo Jeong Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyo Jae Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Ye Jeon
- Department of Neurology, Kyungpook National University Chilgok Hospital, Kyungpook National University, Chilgok, Republic of Korea
| | - Hyun-Woo Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University, Yangsan, Republic of Korea
| | - Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Chang BS, Krishnan V, Dulla CG, Jette N, Marsh ED, Dacks PA, Whittemore V, Poduri A. Epilepsy Benchmarks Area I: Understanding the Causes of the Epilepsies and Epilepsy-Related Neurologic, Psychiatric, and Somatic Conditions. Epilepsy Curr 2020; 20:5S-13S. [PMID: 31965828 PMCID: PMC7031801 DOI: 10.1177/1535759719895280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The 2014 NINDS Benchmarks for Epilepsy Research included area I: Understand the causes of the epilepsies and epilepsy-related neurologic, psychiatric, and somatic conditions. In preparation for the 2020 Curing Epilepsies Conference, where the Benchmarks will be revised, this review will cover scientific progress toward that Benchmark, with emphasize on studies since 2016.
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Affiliation(s)
- Bernard S Chang
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Vaishnav Krishnan
- Departments of Neurology, Neuroscience and Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Chris G Dulla
- Department of Neuroscience, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, USA
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mt. Sinai, New York, NY, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - Eric D Marsh
- Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Vicky Whittemore
- Division of Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MA, USA
| | - Annapurna Poduri
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Liu X, Chen H, Zheng X. Effects of seizure frequency, depression and generalized anxiety on suicidal tendency in people with epilepsy. Epilepsy Res 2020; 160:106265. [PMID: 31981793 DOI: 10.1016/j.eplepsyres.2020.106265] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/30/2019] [Accepted: 01/01/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The highest risk of suicide was identified among patients diagnosed with both epilepsy and comorbid psychiatric disease. The most common comorbid psychiatric conditions of epilepsy are anxiety and depression. This study examines whether and how seizure frequency, depression and generalized anxiety interact to influence suicidal tendency. METHODS A consecutive cohort of PWE was recruited from the First Affiliated Hospital of Chongqing Medical University. Each patient completed the Neurological Disorders Depression Inventory for Epilepsy scale[NDDI-E], the Generalized Anxiety Disorder-7 (GAD-7), and the suicidality module of Mini-International Neuropsychiatric Interview(MINI) v.5.0.0. Spearman's correlation and moderated mediation analysis were used to examine the associations among seizure frequency, depression, generalized anxiety and suicidal tendency. RESULTS Seizure frequency was positively associated with suicidal tendency. Depression severity partially mediated the relationship between seizure frequency and suicidal tendency. The indirect effect of seizure frequency on suicidal tendency was positive, and accounted for 50.2 % of the total effect of seizure frequency on suicidal tendency. The indirect effect of seizure frequency on suicidal tendency through depression severity was positively moderated by generalized anxiety severity. CONCLUSIONS Reducing seizure frequency may be the basis of suicide prevention in PWE. At the same time, the effect of seizure frequency on suicidal tendency can be partially explained by the mediation of depression severity, and the magnitude of the indirect effect of seizure frequency on suicidal tendency was contingent upon generalized anxiety severity. In addition to depression severity, generalized anxiety severity also exerts an important effect on suicidal tendency in PWE.
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Affiliation(s)
- Xing Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Yixueyuan Rd. Yuzhong District, 400016, Chongqing, China
| | - Hongnian Chen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Yixueyuan Rd. Yuzhong District, 400016, Chongqing, China
| | - Xiao Zheng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, NO.1 Yixueyuan Rd. Yuzhong District, 400016, Chongqing, China.
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Risk factors for suicidal tendency in adult patients with epilepsy in China. Epilepsy Behav 2019; 97:118-122. [PMID: 31234043 DOI: 10.1016/j.yebeh.2019.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/01/2019] [Accepted: 06/02/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The major cause of premature mortality in people with epilepsy (PWE) is suicide. Actual data on the risk of suicidal tendency in adult PWE in China are scarce. In our study, associations between possible risk factors and suicidal tendency in adult PWE in China were investigated. METHODS People with epilepsy (n = 251) were recruited, and their demographic and clinical characteristics were evaluated. Suicide risk was examined using the suicidality module (SM) of the Mini International Neuropsychiatric Interview (MINI) Plus Chinese Version 5.0.0. RESULTS Suicidal tendency was present in 36 (14.3%) of the 251 PWE. On the basis of the results of univariate analyses, family relationship (P < 0.001), age at epilepsy onset (P = 0.037), seizure-free period (P = 0.041), seizures/month (P = 0.015), depressive disorders (P < 0.001), and number of antiepileptic drugs (AEDs) (P = 0.017) were associated with suicidal tendency. Multivariate analysis revealed that moderate or poor family relationships (odds ratio (OR): 6.468, 95% confidence interval (CI): 2.418-17.300) and depressive disorders (OR: 3.548, 95% CI: 1.575-7.995) were associated with high odds of suicidal tendency. CONCLUSION Suicidal tendency is common among adult PWE. This study reveals that family relationships and depressive disorders are independent risk factors for suicidal tendency among adult PWE. Therefore, while maintaining treatment of epilepsy, more attention should be directed to the social support and mental state of PWE to prevent suicide.
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Li Q, Zhu LN, Wang HJ, Lin X, Xu D, Chen D, Zhang Y, Liu L. Validation of the Neurological Disorders Depression Inventory for Epilepsy (NDDIE) as a rapid suicidality screening tool in Chinese people with epilepsy. Epilepsy Behav 2019; 94:216-221. [PMID: 30974350 DOI: 10.1016/j.yebeh.2019.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/17/2019] [Accepted: 03/17/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The objective of this study was to validate the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy (NDDIE) as a suicidality screening tool in Chinese people with epilepsy (PWE). METHODS A consecutive cohort of PWE was recruited from West China Hospital and 363 Hospital. Each patient received a psychiatric evaluation with the Mini International Neuropsychiatric Interview (MINI) and the Chinese version of the NDDIE (C-NDDIE). Demographic and clinical characteristics were collected. Receiver operating characteristic (ROC) curve analysis was conducted. The best possible cutoff was identified with the highest Youden index. Specificity, sensitivity, positive, and negative predictive values were calculated. RESULTS Among a total of 355 participants, 41 (11.5%) had a moderate to high suicide risk according to the Suicidality Module (SM) of the MINI. Receiver operating characteristic (ROC) curve analysis showed that item 4 ("I'd be better off dead") of the NDDIE had an area under the curve (AUC) of 0.930 (95% confidence interval [CI] = 0.884-0.977), a sensitivity of 80.5%, a specificity of 94.9%, a positive predictive value (PPV) of 68.0%, a negative predictive value (NPV) of 97.7%, and the largest Youden index of 0.754 for a cutoff score of >2. CONCLUSION Item 4 of the NDDIE is a valuable tool for screening suicidality in Chinese PWE.
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Affiliation(s)
- Qian Li
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China; Department of Neurology, 363 Hospital, Daosangshu Road 108#, Chengdu, Sichuan 610041, China
| | - Li-Na Zhu
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China
| | - Hai-Jiao Wang
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China
| | - Xu Lin
- Department of Neurology, 363 Hospital, Daosangshu Road 108#, Chengdu, Sichuan 610041, China
| | - Da Xu
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China
| | - Deng Chen
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China
| | - Yu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China.
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Raju Sagiraju HK, Wang CP, Amuan ME, Van Cott AC, Altalib HH, Pugh MJV. Antiepileptic drugs and suicide-related behavior: Is it the drug or comorbidity? Neurol Clin Pract 2018; 8:331-339. [PMID: 30140585 DOI: 10.1212/cpj.0000000000000489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/11/2018] [Indexed: 11/15/2022]
Abstract
Background We sought to compare trends of suicide-related behavior (SRB) before and after initiation of antiepileptic drug (AED) therapy among AED users (with and without epilepsy) to that of individuals without AED use controlling for sociodemographic characteristics and mental health comorbidity. Methods We used national Veterans Health Administration (VHA) data for post-9/11 veterans who received VHA care (2013-2014) without prior AED use. We conducted generalized estimation equation (GEE) analyses, stratified by epilepsy status and type of AED received, to assess the trend of SRB prevalence the year prior to and after the index date (date of first AED prescription/date of first health care encounter for non-AED users) controlling for sociodemographic factors and mental health comorbidity. Results The GEE analysis showed significant curvilinear trends of SRB prevalence over the 24-month study period among the AED users, indicating that the probability of SRB diagnoses increased over time with a peak before the index month and decreased thereafter. Similar patterns were observed among non-AED users, but significantly lower odds for SRB. Among AED users, there were no significant differences by epilepsy status; however, higher SRB prevalence and differential SRB trajectory measures were observed among those who received AEDs with mood-stabilizing action. Conclusions The peak of SRB prior to and rapid reduction in SRB after initiation of AED, and the finding that individuals eventually prescribed a mood-stabilizing AED (vs other AED or levetiracetam) had higher odds of SRB, suggests a strong possibility that the relationship of AED and SRB is one of residual confounding.
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Affiliation(s)
- Hari K Raju Sagiraju
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Chen-Pin Wang
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Megan E Amuan
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Anne C Van Cott
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Hamada H Altalib
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
| | - Mary Jo V Pugh
- South Texas Veterans Health Care System (HKRS, C-PW), San Antonio; Division of General and Hospital Medicine (HKRS) and Department of Epidemiology & Biostatistics (C-PW), University of Texas Health Science Center at San Antonio; Center for Healthcare Organization and Implementation Research (MEA), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; VA Pittsburgh Health Care System (ACVC); Department of Neurology (ACVC), University of Pittsburgh, PA; VA Connecticut Health Care System (HHA), West Haven; Department of Neurology & Psychiatry (HHA), Yale School of Medicine, New Haven, CT; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (MJVP), VA Salt Lake City Health Care System; and Division of Epidemiology (MJVP), University of Utah Health Science Center
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Mula M. Do anti-epileptic drugs increase suicide in epilepsy? 10 years after the FDA alert. Expert Rev Neurother 2018; 18:177-178. [DOI: 10.1080/14737175.2018.1427067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education, St George’s University of London and Atkinson Morley Regional Neuroscience Centre, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
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Turning down the volume: Astrocyte volume change in the generation and termination of epileptic seizures. Neurobiol Dis 2017; 104:24-32. [PMID: 28438505 DOI: 10.1016/j.nbd.2017.04.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 12/20/2022] Open
Abstract
Approximately 1% of the global population suffers from epilepsy, a class of disorders characterized by recurrent and unpredictable seizures. Of these cases roughly one-third are refractory to current antiepileptic drugs, which typically target neuronal excitability directly. The events leading to seizure generation and epileptogenesis remain largely unknown, hindering development of new treatments. Some recent experimental models of epilepsy have provided compelling evidence that glial cells, especially astrocytes, could be central to seizure development. One of the proposed mechanisms for astrocyte involvement in seizures is astrocyte swelling, which may promote pathological neuronal firing and synchrony through reduction of the extracellular space and elevated glutamate concentrations. In this review, we discuss the common conditions under which astrocytes swell, the resultant effects on neural excitability, and how seizure development may ultimately be influenced by these effects.
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