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

Author(s)

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

• Document type: Journal article
• Source: Epilepsia; v. 58, n. 7, p. 1268-1276, JUL 2017.
• Web of Science Citations: 20

Abstract

ObjectiveTo investigate whether mood disorders (MD) and anxiety disorders (AD) are associated with seizure control in patients with mesial temporal lobe epilepsy (MTLE). We compared patients without any current psychiatric disorder, patients with current MD and/or AD, patients with subsyndromic depression episodes (SSDE) and anxiety episodes (SSAE), and patients with family psychiatric history. MethodsIn a cross-sectional study, we included 144 consecutive patients with MTLE (82 pharmacoresistant and 62 treatment-responsive patients). Every patient underwent a psychiatric evaluation including the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) Axis I (SCID-I), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and Interictal Dysphoric Disorder Inventory (IDDI). Patients were divided into four groups: PsychNeg (G1, n = 61), current SSDE and SSAE (G2, n = 26), Current MD or AD (G3, n = 25), and current mixed MD/AD (G4, n = 32). ResultsAmong patients with pharmacoresistant MTLE, 68.3% (56/82) experienced symptoms of depression and/or anxiety (G2, G3, and G4) (odds ratio {[}OR] 2.8, 95% confidence interval {[}CI] 1.41-5.53, p < 0.01). Patients with mixed MD/AD (G4, n = 24/32) were more likely to have pharmacoresistant MTLE (OR 4.04, 95% CI 1.57-10.42, p < 0.01) than psychiatric asymptomatic patients (G1, n = 26/61), and their seizure frequency was significantly higher (p < 0.01). Positive family psychiatric history was more frequent in pharmacoresistant patients (n = 27/82, OR 2.28, 95% CI 1.02-5.05, p = 0.04). Finally, 31.6% of patients with MD and or AD were not receiving psychiatric treatment. SignificanceIdentification of comorbid MD/AD and of family psychiatric history is of the essence in patients with MTLE, as they appear to be associated with worse seizure control. (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
• FAPESP's process: 14/08765-9 - Psychiatric disorders in epilepsy: a clinical, laboratory and morphological perspective
• Grantee: Mateus Henrique Nogueira
• Support Opportunities: Scholarships abroad - Research Internship - Doctorate