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Nogueira, Mateus H.; Yasuda, Clarissa L.; Coan, Ana C.; Kanner, Andres M.; Cendes, Fernando

Concurrent mood and anxiety disorders are associated with pharmacoresistant seizures in patients with MTLE

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  • Media type: E-Article
  • Title: Concurrent mood and anxiety disorders are associated with pharmacoresistant seizures in patients with MTLE
  • Contributor: Nogueira, Mateus H.; Yasuda, Clarissa L.; Coan, Ana C.; Kanner, Andres M.; Cendes, Fernando
  • imprint: Wiley, 2017
  • Published in: Epilepsia
  • Language: English
  • DOI: 10.1111/epi.13781
  • ISSN: 0013-9580; 1528-1167
  • Origination:
  • Footnote:
  • Description: <jats:title>Summary</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>To investigate whether mood disorders (<jats:styled-content style="fixed-case">MD</jats:styled-content>) and anxiety disorders (<jats:styled-content style="fixed-case">AD</jats:styled-content>) are associated with seizure control in patients with mesial temporal lobe epilepsy (<jats:styled-content style="fixed-case">MTLE</jats:styled-content>). We compared patients without any current psychiatric disorder, patients with current <jats:styled-content style="fixed-case">MD</jats:styled-content> and/or <jats:styled-content style="fixed-case">AD</jats:styled-content>, patients with subsyndromic depression episodes (<jats:styled-content style="fixed-case">SSDE</jats:styled-content>) and anxiety episodes (<jats:styled-content style="fixed-case">SSAE</jats:styled-content>), and patients with family psychiatric history.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In a cross‐sectional study, we included 144 consecutive patients with <jats:styled-content style="fixed-case">MTLE</jats:styled-content> (82 pharmacoresistant and 62 treatment‐responsive patients). Every patient underwent a psychiatric evaluation including the Structured Clinical Interview for <jats:styled-content style="fixed-case">DSM</jats:styled-content>‐<jats:styled-content style="fixed-case">IV</jats:styled-content> (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) Axis I (<jats:styled-content style="fixed-case">SCID</jats:styled-content>‐I), Beck Depression Inventory (<jats:styled-content style="fixed-case">BDI</jats:styled-content>), Beck Anxiety Inventory (<jats:styled-content style="fixed-case">BAI</jats:styled-content>), Neurological Disorders Depression Inventory for Epilepsy (<jats:styled-content style="fixed-case">NDDI</jats:styled-content>‐E), and Interictal Dysphoric Disorder Inventory (<jats:styled-content style="fixed-case">IDDI</jats:styled-content>). Patients were divided into four groups: PsychNeg (G1, n = 61), current <jats:styled-content style="fixed-case">SSDE</jats:styled-content> and <jats:styled-content style="fixed-case">SSAE</jats:styled-content> (G2, n = 26), Current <jats:styled-content style="fixed-case">MD</jats:styled-content> or <jats:styled-content style="fixed-case">AD</jats:styled-content> (G3, n = 25), and current mixed <jats:styled-content style="fixed-case">MD</jats:styled-content>/<jats:styled-content style="fixed-case">AD</jats:styled-content> (G4, n = 32).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among patients with pharmacoresistant <jats:styled-content style="fixed-case">MTLE</jats:styled-content>, 68.3% (56/82) experienced symptoms of depression and/or anxiety (G2, G3, and G4) (<jats:styled-content style="fixed-case">odds ratio [OR]</jats:styled-content> 2.8, 95% <jats:styled-content style="fixed-case">confidence interval [CI]</jats:styled-content> 1.41–5.53, p &lt; 0.01). Patients with mixed <jats:styled-content style="fixed-case">MD</jats:styled-content>/<jats:styled-content style="fixed-case">AD</jats:styled-content> (G4, n = 24/32) were more likely to have pharmacoresistant <jats:styled-content style="fixed-case">MTLE</jats:styled-content> (<jats:styled-content style="fixed-case">OR</jats:styled-content> 4.04, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.57–10.42, p &lt; 0.01) than psychiatric asymptomatic patients (G1, n = 26/61), and their seizure frequency was significantly higher (p &lt; 0.01). Positive family psychiatric history was more frequent in pharmacoresistant patients (n = 27/82, <jats:styled-content style="fixed-case">OR</jats:styled-content> 2.28, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.02–5.05, p = 0.04). Finally, 31.6% of patients with <jats:styled-content style="fixed-case">MD</jats:styled-content> and or <jats:styled-content style="fixed-case">AD</jats:styled-content> were not receiving psychiatric treatment.</jats:p></jats:sec><jats:sec><jats:title>Significance</jats:title><jats:p>Identification of comorbid <jats:styled-content style="fixed-case">MD</jats:styled-content>/<jats:styled-content style="fixed-case">AD</jats:styled-content> and of family psychiatric history is of the essence in patients with <jats:styled-content style="fixed-case">MTLE,</jats:styled-content> as they appear to be associated with worse seizure control.</jats:p></jats:sec>
  • Access State: Open Access