Mood and anxiety disorders in mesial temporal lobe epilepsy: a clinical, laboratory and morphological perspective

Author(s)

Mateus Henrique Nogueira

• Document type: Doctoral Thesis
• Press: Campinas, SP.
• Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Ciências Médicas
• Defense date: 2016-09-02

Examining board members

Fernando Cendes; Luiz Eduardo Betting; Veriano Alexandre Junior; Cláudia Vianna Maurer Morelli; Enrico Ghizoni

• Advisor: Fernando Cendes

Abstract

Introduction: The association between mesial temporal lobe epilepsy (MTLE) and psychiatric disorders is complex, and despite its high prevalence, still remains poorly understood. This relationship involves multifactorial common neurobiological mechanisms, the effect of antiepileptic drugs (AEDs), subjective experiences, vulnerability and social impact of epilepsy. Objective: To evaluate the prevalence of mood disorders (MD), anxiety disorders (AD) and subsyndromic forms of psychiatric symptoms in patients with MTLE, and to verify a possible relationship among the occurrence of these psychiatric comorbidities with an inflammatory response and morphological changes in the brain. Methods: We evaluated 194 patients with MTLE, being included in the study 160 patients and 67 controls. The steps and analysis of the study were divided in three parts: psychological evaluation, blood collection and quantification of cytokines and BDNF, and acquisition and analysis of magnetic resonance imaging (MRI). The psychological evaluation was performed using the semi structured Interview for DSM-IV - Axis I Disorders (SCID-I), the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and the Interictal Dysphoric Inventory (IDDI). The quantification of cytokines and BDNF was performed using a multiplex immunoassay. The cytokines analyzed were IL-1?, IL-6, IL-8, IL-12, TNF-? (pro-inflammatory) and IL-4, IL-10, IL-13 (anti-inflammatory). The MRI analysis was performed with FreeSurfer and Diffusion Tensor Image (DTI). Results: The main results observed were a high prevalence of symptoms (51.9%) and psychiatric disorders in MTLE, associations in relation to drug resistance in the epilepsy and the co-occurrence (odds ratio = 2.36, 95% CI 1, 24 to 4.48, p <0.01) of mood disorders (MD) and anxiety (AD), and psychiatric family history (odds ratio = 2.37, 95% CI 1.11 to 5.06, p <0 02). The lack of psychological and / or psychiatric treatment was observed in 43.4% of patients with psychiatric symptoms. We did not observe significant results in the analysis of cytokines, BDNF and DTI images. The group of patients with MD showed reductions in cortical thickness compared to patients without psychiatric disorders in the lateral temporal lobe (p=0.04), mid-frontal left rostral region (p=0.04) and temporal right middle (p=0.04). Conclusion: The co-occurrence of MD and AD and a psychiatric family history were associated with drug-resistance in patients with MTLE. Despite the high prevalence of psychiatric disorders in epilepsy, these comorbidities are still underdiagnosed in patients with epilepsy. Morphological changes in the temporal and frontal areas seem to relate to the occurrence of MD in MTLE. Keywords: mesial temporal lobe epilepsy, psychiatric disorders, cytokines, inflammation, MRI, brain morphological changes (AU)

• FAPESP's process: 11/21818-6 - Mood disorders and anxiety in epilepsy: a clinical perspective, laboratory and morphological
• Grantee: Mateus Henrique Nogueira
• Support Opportunities: Scholarships in Brazil - Doctorate