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Alemam S, Bokhari SA, Hasan SF, Al Ammour S, Hussein B, Elnoor M. A Case of Treatment-Resistant Schizophrenia With Mesial Temporal Sclerosis: A Case Report. Cureus 2023; 15:e49623. [PMID: 38161891 PMCID: PMC10755633 DOI: 10.7759/cureus.49623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Mesial temporal sclerosis (MTS) is one of the most common causes of treatment-resistant epilepsy, especially temporal lobe epilepsy (TLE). Various psychiatric symptoms are common with temporal lobe epilepsy. However, the least established symptoms were psychotic symptoms. Furthermore, treatment-resistant schizophrenia is a significant proportion of schizophrenia patients who have failed treatment with at least two different antipsychotics, resulting in poor outcomes and a significant negative impact on the patient's life. In our case report, psychotic symptoms and abnormal behaviors were explained by schizophrenia for more than 17 years in a 32-year-old female, while the diagnosis of temporal lobe epilepsy with mesial temporal sclerosis was missed, resulting in incomplete treatment, which led to a deterioration of her quality of life for years. This case aims to shed light on TLE rare manifestations and to discuss the proper investigations and treatment that might increase the quality of life of these patients. Underlining the necessity for more research in treatment-resistant schizophrenia, this unusual case underscores the importance of exploring the underlying biological, psychological, and social risk factors. It also emphasizes the need to focus additional attention on formulating proper investigation strategies for the susceptible patient population.
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Affiliation(s)
- Shokry Alemam
- Psychiatry, Al Amal Psychiatric Hospital, Dubai, ARE
| | | | - Safa F Hasan
- Psychiatry, Al Amal Psychiatric Hospital, Dubai, ARE
| | | | - Basma Hussein
- Psychiatry, Al Amal Psychiatric Hospital, Dubai, ARE
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Adachi N, Onuma T, Kato M, Sekimoto M, Okazaki M, Hara K, Ishii R, Ito M, Akanuma N, Fenwick P. Psychoses after an antiepileptic drug administration: Frequency, timing, and duration. Epilepsy Behav 2023; 140:109087. [PMID: 36702055 DOI: 10.1016/j.yebeh.2023.109087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To clarify the pathophysiology of psychoses after the new administration of antiepileptic drugs (AED), we analyzed the annual incidence, timing of development, and duration of episodes. METHODS Psychotic outcomes in the first 6-month period after an AED or non-AED administration in patients with focal epilepsy were exhaustively reviewed in eight Japanese neuropsychiatry institutions. In cases with psychotic episodes, the subtype of psychosis, timing of development, previous history of psychosis, and duration of the episode were evaluated. RESULTS Between 1981 and 2015, 5018 new drugs (4402 AED and 616 non-AED) were administered to 2067 patients with focal epilepsy. In the first 6-month period, 105 psychotic episodes occurred (81 interictal psychosis [IIP] and 24 postictal psychosis). Furthermore, 55 cases were first episodes and 50 were recurrent episodes. The frequency of psychoses is significantly higher after AED administration (n = 102) compared with non-AED administration (n = 3). Psychosis occurred most frequently in the initial 1-month period after new-AED administration and tended to decrease with increasing time. The estimated annual incidence of all psychoses after a new AED administration was 3.5% (2.0% for first-episode psychosis and 1.8% for first-episode IIP). Duration of psychoses (mean, 38.5 weeks) was equivalent to overall IIP. Duration of IIP did not shorten with discontinuation of newly administered AED. SIGNIFICANCE Patients with epilepsy exhibit psychosis more frequently after new AED administration than after non-AED administration. This study shows the pathophysiology of psychoses after AED administration with annual incidence, the timing of development, and the duration of PAP, which have rarely been reported.
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Affiliation(s)
- Naoto Adachi
- Adachi Mental Clinic, Sapporo, Japan; National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan.
| | - Teiichi Onuma
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
| | - Masaaki Kato
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
| | - Masanori Sekimoto
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
| | - Mitsutoshi Okazaki
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan
| | | | - Ryouhei Ishii
- Department of Psychiatry, University of Osaka Graduate School of Medicine, Osaka, Japan
| | - Masumi Ito
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Jozen Clinic, Sapporo, Japan
| | - Nozomi Akanuma
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter Fenwick
- South London and Maudsley NHS Foundation Trust, London, UK
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Naydenov C, Parashkevova-Simeonova B, Mancheva V. Social Relevance and Post-stroke Epilepsy Prevention. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Abstract: Stroke is an important cerebrovascular disease resulting in long-term disability and death. A rare consequence of stroke is structural epilepsy. Here we discuss the importance of post-stroke epilepsy prevention. We look into the occurrence of stroke and epilepsy in the general population, the risk factors and severity of those conditions and the significance of early seizure prevention after the stroke. We analyze published research papers and reviews dealing with this problem. In brief, there is a diagnostic problem leading to ineffective treatment. On one hand preventing seizures in patients with no history of epilepsy, treating them with medications with known side effects. On the other hand by not treating them, risk seizures and future repercussions for their health and wellbeing. Here we propose ways to select patients for treatment and refine the diagnostic considerations for early start of anti-seizure therapy.
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Hamed SA, Attiah FA. Psychosis in adults with epilepsy and its relationship to demographic, clinical and treatment variables. Neurol Res 2019; 41:959-966. [PMID: 31280704 DOI: 10.1080/01616412.2019.1638017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objectives: Psychiatric symptoms and disorders are commonly reported with epilepsy. This study aimed to determine the prevalence of interictal psychosis (IIP) in adults with epilepsy and its risk predictors. Methods: The study included 710 patients (mean age: 36.40 years; age at onset: 13.58 years; duration of epilepsy: 22.80 years). All underwent neurological and psychiatric interviewing, electroencephalography and brain imaging. Results: IIP was reported in 20.65%, of them 50% had temporal lobe epilepsy with impaired awareness and/or to bilateral tonic clonic, 42.47% had frontal lobe epilepsy with impaired awareness and/or to bilateral tonic clonic and 7.53% had generalized tonic-clonic seizures. Compared to patients without psychosis, patients with psychosis were older at age of examination, had earlier age at onset, frequent seizures, longer duration of epilepsy and long-term antiepileptic drugs therapy and many relatives with epilepsy. Nearly 76.71% had history of postictal psychosis (PIP). The mean age of onset of IIP was 30.45 years and its mean duration was 3.84 months. Approximately 22% of patients with IIP had family history of psychosis. Patients developed IIP 10 years or more after epilepsy onset. Multivariate logistic regression analyses showed that predictors for IIP were the age at onset and duration of epilepsy, number of seizures, family history of epilepsy or psychosis, history of PIP and different types of epilepsy. Conclusion: IIP is not infrequent with chronic epilepsy regardless to its type. These findings emphasize the importance of optimizing patients' treatment and early recognition and management of IIP. Abbreviations: IIP: interictal psychosis; PIP: post-ictal psychosis; TLE: temporal lobe epilepsy; FLE: frontal lobe epilepsy; GTC: generalized tonic clonic; AEDs: antiepileptic drugs; CBZ: carbamazepine; VPA: valproate; LEV: levetiracetam; APDs: antipsychotic drugs.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital , Assiut , Egypt
| | - Fadia Ahmed Attiah
- Department of Neurology and Psychiatry, Assiut University Hospital , Assiut , Egypt
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Scharfman HE, Kanner AM, Friedman A, Blümcke I, Crocker CE, Cendes F, Diaz-Arrastia R, Förstl H, Fenton AA, Grace AA, Palop J, Morrison J, Nehlig A, Prasad A, Wilcox KS, Jette N, Pohlmann-Eden B. Epilepsy as a Network Disorder (2): What can we learn from other network disorders such as dementia and schizophrenia, and what are the implications for translational research? Epilepsy Behav 2018; 78:302-312. [PMID: 29097123 PMCID: PMC5756681 DOI: 10.1016/j.yebeh.2017.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 12/18/2022]
Abstract
There is common agreement that many disorders of the central nervous system are 'complex', that is, there are many potential factors that influence the development of the disease, underlying mechanisms, and successful treatment. Most of these disorders, unfortunately, have no cure at the present time, and therapeutic strategies often have debilitating side effects. Interestingly, some of the 'complexities' of one disorder are found in another, and the similarities are often network defects. It seems likely that more discussions of these commonalities could advance our understanding and, therefore, have clinical implications or translational impact. With this in mind, the Fourth International Halifax Epilepsy Conference and Retreat was held as described in the prior paper, and this companion paper focuses on the second half of the meeting. Leaders in various subspecialties of epilepsy research were asked to address aging and dementia or psychosis in people with epilepsy (PWE). Commonalities between autism, depression, aging and dementia, psychosis, and epilepsy were the focus of the presentations and discussion. In the last session, additional experts commented on new conceptualization of translational epilepsy research efforts. Here, the presentations are reviewed, and salient points are highlighted.
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Affiliation(s)
- Helen E Scharfman
- Departments of Psychiatry, Neurosciences and Physiology, and the Neuroscience Institute, New York University Langone Medical Center, New York, NY 10016, USA.
| | - Andres M Kanner
- University of Miami, Miller School of Medicine, 1120 NW 14th Street, Room #1324, Miami, FL 33136, USA
| | - Alon Friedman
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; Department of Physiology and Cell Biology, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ingmar Blümcke
- Neuropathological Institute, University Hospitals Erlangen, Germany
| | - Candice E Crocker
- Nova Scotia Early Psychosis Program, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Fernando Cendes
- Department of Neurology, University of Campinas, 13083-888 Campinas, Sao Paulo, Brazil
| | - Ramon Diaz-Arrastia
- Centre for Neuroscience & Regenerative Medicine, Uniformed Services University of the Health Sciences, 12725 Twinbrook Parkway, Rockville, MD 20852, USA
| | - Hans Förstl
- Department of Psychiatry, University of Munich, Klinikum rechts der Isar, Ismaninger Strabe 22, D-81675 Munich, Germany
| | - André A Fenton
- Centre for Neural Science, New York University, 4 Washington Place, Room 809, New York, NY 10003, USA
| | - Anthony A Grace
- University of Pittsburgh, 456 Langley Hall, 4200 Fifth Avenue, Pittsburgh, PA 15269, USA
| | - Jorge Palop
- Department of Neurology, Gladstone Institute, 1650 Owens Street, San Francisco, CA 94158-2261, USA
| | - Jason Morrison
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Astrid Nehlig
- INSERM U 1129, Hôpital Necker, Paris, Faculty of Medicine, Strasbourg, France
| | - Asuri Prasad
- Department of Pediatrics, Children's Hospital of Western Ontario, London, ON, Canada
| | - Karen S Wilcox
- Department of Pharmacology & Toxicology, Anticonvulsant Drug Development Program, University of Utah, Salt Lake City, UT, USA
| | - Nathalie Jette
- Icahn School of Medicine at Mount Sinai, Department of Neurology, New York, NY, USA; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Bernd Pohlmann-Eden
- Brain Repair Center, Life Science Research Institute, Dalhousie University, Room 229, PO Box 15000, Halifax, NS B3H4R2, Canada.
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Abstract
Psychiatric comorbidities, including mood, anxiety, and psychotic disorders, are common in epilepsy, often occurring at rates 2-3-fold or higher than in the general population without epilepsy. This article discusses the epidemiology of psychiatric disorders in epilepsy, hypotheses regarding the pathogenesis of these comorbidities, and treatment implications. More specifically, it addresses: (1) How common are major depressive disorder, anxiety disorders, and psychotic disorders in epilepsy? (2) How does one screen for these psychiatric disorders in persons with epilepsy? (3) Why do psychiatric conditions occur in epilepsy? (4) Is the treatment of psychiatric comorbidity in epilepsy associated with seizures? The important topic of suicide and suicidal ideation in epilepsy, risk factors for their occurrence, and how to screen for these co-existent conditions is also discussed. Finally, gaps in knowledge regarding psychiatric conditions in epilepsy are briefly discussed.
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Affiliation(s)
- Colin B Josephson
- a Department of Clinical Neurosciences , Hotchkiss Brain Institute and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary , Calgary , AB , Canada
| | - Nathalie Jetté
- a Department of Clinical Neurosciences , Hotchkiss Brain Institute and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary , Calgary , AB , Canada
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Abstract
Psychosis of epilepsy (POE) is a term applied to a group of psychotic disorders with a distinct phenomenology in which potential etiopathogenic mechanisms are believed to be closely related to a seizure disorder. POE can present as interictal psychotic episodes, which may often differ semiologically from primary schizophrenic disorder. They may present as ictal or postictal psychotic episodes and may be the expression of an iatrogenic process to pharmacologic and/or surgical interventions.Epilepsy and POE have a complex and bidirectional relation, as not only are patients with epilepsy at greater risk of developing a psychotic disorder, but patients with a primary psychotic disorder are also at greater risk of developing epilepsy. The prevalence of POE is more than 7 times higher than the frequency of primary schizophreniform disorders in the general population. While POE has been associated with focal epilepsy of temporal and frontal lobe origin, its etiology and pathophysiology of POE have yet to be established.The treatment of all forms of POE, with the exception of ictal psychotic episodes, requires the use of antipsychotic drugs, preferably the atypical antipsychotic agents with a very low or negligible potential to lower the seizure threshold (eg, risperidone, apiprazole), starting at a low dose with stepwise increments.
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Hara K, Adachi N, Akanuma N, Ito M, Okazaki M, Kato M, Onuma T. Effects of antipsychotic drugs on the duration of interictal psychotic episodes in patients with epilepsy. Epilepsy Behav 2013; 27:342-5. [PMID: 23537620 DOI: 10.1016/j.yebeh.2013.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 02/19/2013] [Accepted: 02/24/2013] [Indexed: 11/26/2022]
Abstract
Treatment protocols for interictal psychosis (IIP) of patients with epilepsy have not yet been established. We aimed to clarify the effects of antipsychotic drugs (APDs) on duration of IIP episodes. We studied 393 IIP episodes in 200 patients with epilepsy in accordance with our empirical treatment protocol. The duration of all the episodes and APD treatments were reviewed. Antipsychotic drugs were used in 338 episodes and not used in 55 episodes (non-APD group). The APDs used in the treatment of IIP episodes were divided into the following three groups: first-generation APDs (FAPD, n=252), second-generation APDs (SAPD, n=44), and the combination of first- and second-generation APDs (CAPD, n=42). The non-APD group showed a significantly shorter episode duration than did the APD group (F=6.05, p=0.014). Among the 3 APD groups (FAPD, SAPD, and CAPD), there was a significant difference in duration of IIP episode (F=8.65, p=0.000). Whereas the duration of episodes was significantly longer in the CAPD group than in the other two groups, it was not significantly different between the FAPD and SAPD groups. Our findings further to clarify the nature of IIP and add further perspectives on treatment protocols for IIP.
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Adachi N, Kanemoto K, de Toffol B, Akanuma N, Oshima T, Mohan A, Sachdev P. Basic treatment principles for psychotic disorders in patients with epilepsy. Epilepsia 2013; 54 Suppl 1:19-33. [PMID: 23458463 DOI: 10.1111/epi.12102] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In patients with epilepsy, coexisting psychoses, either interictal (IIP) or postictal (PIP), are associated with serious disturbance in psychosocial function and well-being, and often require the care of a specialist. Unfortunately, evidence-based treatment systems for psychosis in patients with epilepsy have not yet been established. This article aims to propose concise and practical treatment procedures for IIP and PIP based on currently available data and international consensus statements, and primarily targeting nonpsychiatrist epileptologists who are often the first to be involved in the management of these complex patients. Accurate and early diagnosis of IIP and PIP and their staging in terms of acuity and severity form the essential first step in management. It is important to suspect the presence of psychosis whenever patients manifest unusual behavior. Knowledge of psychopathology and both individual and epilepsy-related vulnerabilities relevant to IIP and PIP facilitate early diagnosis. Treatment for IIP involves (1) obtaining consent to psychiatric treatment from the patient, whenever possible, (2) optimization of antiepileptic drugs, and (3) initiation of antipsychotic pharmacotherapy in line with symptom severity and severity of behavioral and functional disturbance. Basic psychosocial interventions will help reinforce adherence to treatment and should be made available. Due consideration must be given to patients' ability to provide informed consent to treatment in the short term, with the issue being revisited regularly over time. Given the often prolonged and recurrent nature of IIP, treatment frequently needs to be long-term. Treatment of PIP consists of two aspects, that is, acute protective measures and preventive procedures in repetitive episodes. Protective measures prioritize the management of risk in the early stages, and may involve sedation with or without the use of antipsychotic drugs, and the judicious application of local mental health legislation if appropriate. As for preventative procedures, optimizing seizure control by adjusting antiepileptic drugs or by surgical treatment is necessary.
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Prolonged preictal psychosis in refractory seizures: a report of three cases. Epilepsy Behav 2008; 13:252-5. [PMID: 18314397 DOI: 10.1016/j.yebeh.2007.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 10/22/2007] [Accepted: 11/19/2007] [Indexed: 11/23/2022]
Abstract
Seizures and psychosis coexist in a large number of patients with epilepsy, and a significant amount of research on their relationship has been published. There are several reports and reviews on postictal and interictal psychosis in patients with epilepsy. We describe three patients with refractory temporal lobe epilepsy, each of whom presented with a history of episodic psychosis that preceded almost all habitual seizures and, thus, served as a useful warning symptom. All three patients had intractable left complex partial seizures; two had right mesial temporal sclerosis, and the third had a gliotic area in the right frontotemporal region on MRI. This is the first report of psychosis preceding seizures. The literature on seizure anticipation, as well as on the complex relationship between seizures and psychosis, is also reviewed.
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Chapter 20 Psychiatric Comorbidities in Epilepsy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2008; 83:347-83. [DOI: 10.1016/s0074-7742(08)00020-2] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Tadokoro Y, Oshima T, Kanemoto K. Interictal psychoses in comparison with schizophrenia--a prospective study. Epilepsia 2007; 48:2345-51. [PMID: 17666070 DOI: 10.1111/j.1528-1167.2007.01230.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To prospectively investigate the incidence of interictal psychoses of epilepsy patients, and make a comparison between those with interictal psychoses and patients with schizophrenia in respect to their responses to antipsychotic drugs, as well as psychotic states. METHODS We undertook a two-part prospective investigation. In Part I, the psychotic episodes of 619 epilepsy patients were investigated, while 182 patients with psychotic syndromes were followed in Part II, of whom 59 were diagnosed with schizophrenia and 13 with epilepsy with interictal psychoses. The Positive and Negative Syndrome Scale was used for efficacy assessment. RESULTS The average annual incidence of interictal psychosis was 0.42% during the 56-month study period. A significant difference was found between patients with schizophrenia and epilepsy patients with interictal psychoses in respect to results on the negative subscale of the PANSS at the initial examination (mean scores of 18.1 and 13.2, respectively, p = 0.004). The response rates one year later for these groups were 27.1% and 53.8%, respectively, which showed a trend of better response to the antipsychotic medication by the epilepsy group (p = 0.098). Initial and maximum doses of antipsychotic drugs used for epilepsy patients with interictal psychoses were significantly lower than those used for patients with schizophrenia (p = 0.008 and p = 0.006, respectively). CONCLUSIONS Schizophrenia and epileptic psychosis showed different symptom profiles. On average, epilepsy patients with interictal psychoses achieved higher remission rates with lower doses of antipsychotic drugs as compared to patients with schizophrenia in the present 1-year follow-up study.
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Affiliation(s)
- Yukari Tadokoro
- Department of Psychiatry, School of Medicine, Aichi Medical University, Yazako, Nagakute-cho, Aichi-gun, Aichi-ken, Japan.
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Flügel D, Cercignani M, Symms MR, Koepp MJ, Foong J. A magnetization transfer imaging study in patients with temporal lobe epilepsy and interictal psychosis. Biol Psychiatry 2006; 59:560-7. [PMID: 16165106 DOI: 10.1016/j.biopsych.2005.07.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Revised: 07/05/2005] [Accepted: 07/12/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Findings from previous neuropathological and neuroimaging studies in patients with epilepsy and interictal psychosis have been inconclusive, and both focal and widespread brain abnormalities have been reported. Thus, further investigation with advanced in vivo magnetic resonance imaging (MRI) techniques, such as magnetization transfer imaging, capable of detecting more subtle brain abnormalities, is warranted. METHODS Twenty patients with temporal lobe epilepsy and interictal psychosis were compared with 20 nonpsychotic patients. Patients were matched with respect to conventional MRI findings. Each group comprised of 10 patients with hippocampal sclerosis (6 left, 4 right) and 10 patients without focal lesions on MRI. A voxel-based analysis was used for the group comparisons. RESULTS Voxel-based analysis revealed significant reductions of magnetization transfer ratio (an index of signal loss derived from magnetization transfer imaging) in the left superior and middle temporal gyri in the psychotic patients for the subgroup of patients with no focal lesions on MRI. There were no significant volumetric differences between the psychotic and nonpsychotic patients. CONCLUSIONS Focal cortical magnetization transfer ratio abnormalities in the left temporal lobe unrelated to volume changes can be demonstrated in some temporal lobe epilepsy patients with interictal psychosis. Our findings might reflect subtle neuropathological abnormalities that are undetected by conventional MRI.
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Affiliation(s)
- Dominique Flügel
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, London, United Kingdom
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Abstract
Several studies have assessed the prevalence of psychiatric disorders in epilepsy. They are characterized by considerable heterogeneity, because of differences in the population setting and type of study. A non-systematic review of the literature allows us to draw some useful, although not definite, conclusions. Six per cent of people with epilepsy in the general population appear to suffer from a psychiatric disorder, while this rises to 10-20% in populations with temporal lobe and/or refractory epilepsy. Mood disorders are the most common culprit (24-74%), particularly depression (30%), followed by anxiety disorders (10-25%), psychoses (2-7%) and personality disorders (1-2%). This comorbidity appears to be related to endogenous and exogenous (including iatrogenic) factors and to the severity and chronicity of epilepsy. Conditions such as schizophrenia-like psychosis of epilepsy and interictal dysphoric disorder are represented only in epilepsy. Adequate recognition and treatment of psychiatric conditions in epilepsy is essential for patient management because of their considerable burden in morbidity and quality of life.
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Affiliation(s)
- A Gaitatzis
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, and The National Hospital for Neurology and Neurosurgery, London, UK
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15
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Abstract
PURPOSE To review transcultural perspectives in the neuropsychiatry of epilepsy. METHODS Systematic literature searches of standard databases, cross-referencing, chapters, and opinion leader articles. RESULTS Articles from the Indian subcontinent, Africa, and Japan were identified and are reviewed herein. The spectrum of psychopathology in epilepsy is rather similar across cultures. However, psychopathology specific to epilepsy, the interictal behavioural syndrome of Geschwind, for example, has not been well studied outside the Western world. DISCUSSION There is a need for well-designed epidemiological studies of neuropsychiatric disorders in epilepsy. These should use harmonised protocols and outcome measures. Special attention should be paid to the impact of aetiology on psychiatric co-morbidity and disablement.
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Affiliation(s)
- Michael R Trimble
- Department of Behavioural Neurology, Institute of Neurology, London, United Kingdom.
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Matsuura M, Oana Y, Kato M, Kawana A, Kan R, Kubota H, Nakano T, Hara T, Horikawa N. A multicenter study on the prevalence of psychiatric disorders among new referrals for epilepsy in Japan. Epilepsia 2003; 44:107-14. [PMID: 12581237 DOI: 10.1046/j.1528-1157.2003.25202.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the prevalence rate and risk factors of psychiatric disorders among new referrals for epilepsy, a multicenter study was conducted by using the International League Against Epilepsy (ILAE) criteria for epilepsy and the ICD-10 criteria for psychiatric disorders. METHODS From April 2000 to March 2001, 398 patients with epilepsy, who were referred to nine neuropsychiatric outpatient clinics specialized for epilepsy in the Tokyo metropolitan area, were evaluated by using a newly developed five-axis classification scheme. RESULTS Forty-two percent of the subjects showed a psychiatric disorder. Twenty-four percent of the total showed psychiatric disorders, including neurotic disorders in 8%, psychotic disorders in 7%, and affective disorders in 1%. In addition, 23% of the total showed mental retardation, and 18% showed personality disorders. A logistic regression analysis revealed that the three risk factors for a psychiatric disorder were mental retardation, temporal lobe epilepsy (as opposed to other subtypes), and a high seizure frequency. CONCLUSIONS The presence of mental retardation was the primary risk factor for developing a psychiatric disorder, especially a schizophrenia-spectrum disorder. The type of epilepsy alone is not a strong predictor of psychiatric illness, and intractable temporal lobe epilepsy with a high seizure frequency is accountable for the link between the epilepsy and the psychiatric illness.
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Affiliation(s)
- Masato Matsuura
- Department of Neuropsychiatry, Surugadai Nihon University Hospital, Nihon University School of Medicine, Tokyo, Japan.
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Adachi N, Matsuura M, Hara T, Oana Y, Okubo Y, Kato M, Onuma T. Psychoses and epilepsy: are interictal and postictal psychoses distinct clinical entities? Epilepsia 2002; 43:1574-82. [PMID: 12460261 DOI: 10.1046/j.1528-1157.2002.22402.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate further the relevance of designating psychotic episodes as either postictal or interictal, we compared several biologic variables between epilepsy patients with and without psychosis. METHODS The study subjects comprised 282 patients with psychosis (36 with postictal psychosis, 224 with interictal psychosis, and 22 with both postictal and interictal psychoses, i.e., bimodal psychosis), and 658 epilepsy patients without psychosis. The clinical characteristics of these patients were reviewed retrospectively by experienced neuropsychiatrists. Factors predicting the development of each type of psychosis were determined by serial multivariate logistic regression analyses. RESULTS Factors that were comparable between postictal and interictal psychoses were intellectual function, family history of psychosis, epilepsy type, and the presence of complex partial seizures. In contrast, age at the onset of epilepsy and at the onset of psychosis and the presence of generalized tonic-clonic seizures differed for the three types of psychosis. Patients with bimodal psychosis showed characteristics associated with both postictal and interictal psychoses. CONCLUSIONS This study documented conditions, including both general factors and epilepsy-related factors, common to epilepsy patients with psychosis, regardless of chronologic distinctions. Certain epileptic processes appear to have equal influence on postictal and interictal psychoses. However, some differences between postictal and interictal psychoses suggest that these chronologic descriptors are valid. Our findings confirmed that psychosis associated with epilepsy should not be defined as a single, simple condition but rather as a complex condition with several possible subcategories.
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MESH Headings
- Adult
- Brain Damage, Chronic/classification
- Brain Damage, Chronic/diagnosis
- Brain Damage, Chronic/psychology
- Dominance, Cerebral/physiology
- Electroencephalography
- Epilepsy/classification
- Epilepsy/diagnosis
- Epilepsy/psychology
- Epilepsy, Complex Partial/classification
- Epilepsy, Complex Partial/diagnosis
- Epilepsy, Complex Partial/psychology
- Epilepsy, Tonic-Clonic/classification
- Epilepsy, Tonic-Clonic/diagnosis
- Epilepsy, Tonic-Clonic/psychology
- Female
- Humans
- Male
- Neurocognitive Disorders/classification
- Neurocognitive Disorders/diagnosis
- Neurocognitive Disorders/psychology
- Retrospective Studies
- Risk Factors
- Schizophrenia/classification
- Schizophrenia/diagnosis
- Schizophrenic Psychology
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Abstract
Psychiatric complications of epilepsy are multiple and result from the complex interaction between endogenous, genetic, therapeutic, and environmental factors. The relationship between epilepsy and psychiatric disorders may be much closer than previously appreciated. Recent studies have suggested the existence of a bi-directional relationship between depression and epilepsy, whereby patients with epilepsy have a higher risk than the general population of suffering from depression, not only after, but also before the onset of epilepsy. Furthermore, similar neurotransmitter changes have been identified in depression and epilepsy, suggesting the possibility that these two disorders share common pathogenic mechanisms. Although the clinical manifestations of psychiatric disorders in epilepsy are often indistinguishable from those of nonepileptic patients, certain types of depression and psychotic disorders may present with clinical characteristics that are particular to epilepsy patients. These include the psychosis of epilepsy, postictal psychotic disorders, alternative psychosis (or forced normalization), and certain forms of interictal depressive disorders.
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Affiliation(s)
- Andres M Kanner
- Department of Neurological Sciences, Rush-Presbyterian-St. Luke's Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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Adachi N, Onuma T, Hara T, Matsuura M, Okubo Y, Kato M, Oana Y. Frequency and age-related variables in interictal psychoses in localization-related epilepsies. Epilepsy Res 2002; 48:25-31. [PMID: 11823107 DOI: 10.1016/s0920-1211(01)00329-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Several studies have described that patients with temporal lobe epilepsy (TLE) develop psychoses more frequently than patients with extra-temporal localization-related epilepsy (LRE). However, few controlled studies have demonstrated an increased susceptibility to psychosis in TLE patients. As one of a series of multi-center studies on psychosis in epilepsy, we investigated whether the frequency of interictal psychosis differs between types of LRE. METHODS We reviewed some biological characteristics of 197 PE patients with interictal psychosis and of 456 LRE patients with no history of psychosis. Type of PE was determined as TLE, frontal lobe epilepsy, parietal lobe epilepsy, occipital lobe epilepsy, and multi-lobar epilepsy/undifferentiated lobar epilepsy by clinical symptoms, EEG findings, and neuroimaging. The frequency of psychosis for each type of LRE was compared. Ages at onset of epilepsy and psychosis and the time interval between onset of each were also analyzed. RESULTS There was no significant correlation between psychosis and epilepsy type (P=0.211). Age-related variables also failed to show any significant differences between LRE types (age at onset of epilepsy, P=0.369; age at onset of psychosis, P=0.852; the time interval, P=0.893). CONCLUSIONS Patients with LREs as well as with TLE are susceptible to interictal psychosis. The mean ages at onset of symptoms and the interval between onset of epilepsy and onset of psychosis that we observed suggest that patients with LREs, regardless of focus, may share similar processes in the development of psychiatric symptoms.
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Affiliation(s)
- Naoto Adachi
- Adachi Mental Clinic, Kitano 7-5-12, Kiyota, Sapporo 004-0867, Japan.
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Matsuura M, Trimble MR. Psychoses in epilepsy: a review of Japanese studies. Epilepsy Behav 2000; 1:315-26. [PMID: 12609162 DOI: 10.1006/ebeh.2000.0112] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2000] [Revised: 09/11/2000] [Accepted: 09/11/2000] [Indexed: 11/22/2022]
Affiliation(s)
- M Matsuura
- Department of Neuropsychiatry, Nihon University School of Medicine, 1-8-13 Surugadai, Kanda, Chiyoda-ku, Tokyo, 101-0062, Japan
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Adachi N, Onuma T, Nishiwaki S, Murauchi S, Akanuma N, Ishida S, Takei N. Inter-ictal and post-ictal psychoses in frontal lobe epilepsy: a retrospective comparison with psychoses in temporal lobe epilepsy. Seizure 2000; 9:328-35. [PMID: 10933987 DOI: 10.1053/seiz.2000.0413] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
There have been few studies of the psychopathology of patients with frontal lobe epilepsy (FLE). The majority of studies of both inter-ictal and post-ictal psychoses have strongly suggested the influence of temporal lobe disturbance on psychoses. Patients with organic brain damage or schizophrenia, however, sometimes show frontal lobe dysfunction. The purpose of this study was to better understand the effect, if any, of frontal lobe disturbance and seizure on psychopathology. Patients were divided into four groups based on epilepsy type and preceding seizures; 8 with FLE/inter-ictal psychosis, 3 with FLE/post-ictal psychosis, 29 with temporal lobe epilepsy (TLE)/inter-ictal psychosis, and 8 with TLE/post-ictal psychosis. Psychopathologic symptoms were retrospectively reviewed based on case notes, using a modified brief psychiatric rating scale (BPRS). Psychomotor excitement, hostility, suspiciousness, and hallucinatory behaviour were prominent features in all four groups. Six orthogonal factors were derived by factor analysis from the original data based on the 18 BPRS items. FLE patients with inter-ictal psychosis showed marked hebephrenic characteristics (i.e. emotional withdrawal and blunted effect). Our findings suggest that patients with FLE can exhibit various psychiatric symptoms. However, their psychotic symptoms, hebephrenic symptoms in particular, may often be overlooked.
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Affiliation(s)
- N Adachi
- National Centre Hospital for Mental, Nervous and Muscular Disorders, National Centre of Neurology and Psychiatry, Kodaira, Tokyo, Japan
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