Pathophysiology of mood disorders in temporal lobe epilepsy

Objective: There is accumulating evidence that the limbic system is pathologically involved in cases of psychiatric comorbidities in temporal lobe epilepsy (TLE) patients. Our objective was to develop a conceptual framework describing how neuropathological, neurochemical and electrophysiological aspects might contribute to the development of psychiatric symptoms in TLE and the putative neurobiological mechanisms that cause mood disorders in this patient subgroup. Methods: In this review, clinical, experimental and neuropathological findings, as well as neurochemical features of the limbic system were examined together to enhance our understanding of the association between TLE and psychiatric comorbidities. Finally, the value of animal models in epilepsy and mood disorders was discussed. Conclusions: TLE and psychiatric symptoms coexist more frequently than chance would predict. Alterations and neurotransmission disturbance among critical anatomical networks, and impaired or aberrant plastic changes might predispose patients with TLE to mood disorders. Clinical and experimental studies of the effects of seizures on behavior and electrophysiological patterns may offer a model of how limbic seizures increase the vulnerability of TLE patients to precipitants of psychiatric symptoms.

Interictal hyposexuality in male patients with epilepsy

The purpose of this study was to compare the serum levels of androgens between hyposexual and non-hyposexual patients with epilepsy. Adult male patients with epilepsy were investigated. Serum levels of testosterone (T) and free-T, estradiol, and sex hormone binding globulin (SHBG) were measured and the free androgen index (FAI) was calculated. While there were no differences between hyposexual and non-hyposexual patients in the serum levels of T, free-T, and estradiol, or to the FAI, the serum levels of SHBG were significantly higher in hyposexual patients than in non-hyposexual patients. Thus, the effects of increased SHBG upon serum levels of testosterone biologically active in patients with epilepsy and hyposexuality were not detected by the methods used in this study. Four (44%) of nine hyposexual patients who were re-evaluated after two years follow-up improved sexual performance. Thus, clinical treatment that results in good seizure control may improve sexual performance in some patients with epilepsy.

Ictal technetium-99 m ethyl cysteinate dimer single-photon emission tomographic findings in epileptic patients with polymicrogyria syndromes: A Subtraction of ictal-interictal SPECT coregistered to MRI study

Purpose To describe the ictal technetium-99 m-ECD SPECT findings in polymicrogyria syndromes (PMG) during epileptic seizures. Methods We investigated 17 patients with PMG syndromes during presurgical workup, which included long-term video-electroencephalographic (EEG) monitoring, neurological and psychiatry assessments, invasive EEG, and the subtraction of ictal-interictal SPECT coregistered to magnetic resonance imaging (MRI) (SISCOM). Results The analysis of the PMG cortex, using SISCOM, revealed intense hyperperfusion in the polymicrogyric lesion during epileptic seizures in all patients. Interestingly, other localizing investigations showed heterogeneous findings. Twelve patients underwent epilepsy surgery, three achieved seizure-freedom, five have worthwhile improvement, and four patients remained unchanged. Conclusions Our study strongly suggests the involvement of PMG in seizure generation or early propagation. Both conventional ictal single-photon emission computed tomography (SPECT) and SISCOM appeared as the single contributive exam to suggest the localization of the epileptogenic zone. Despite the limited number of resective epilepsy surgery in our study (n=9), we found a strong prognostic role of SISCOM in predicting surgical outcome. This result may be of great value on surgical decision-making of whether or not the whole or part of the PMG lesion should be surgically resected.

Interictal hyperemia correlates with epileptogenicity in polymicrogyric cortex

Objective: To investigate pathophysiological factors underlying the presence of interictal hyper-perfusion within the limits of the polymicrogyric (PMG) cortex in epileptic patients. Methods: Retrospective observational study on interictal perfusion by Single Photon Emission Computed Tomography (SPECT) in 16 patients with PMG and its correlations with a number of clinical and neurophysiological variables. Patients underwent video-EEG monitoring, neurological and psychiatric assessments, invasive EEG, and the interictal SPECT coregistered to Magnetic Resonance Imaging (MRI). Results: Patients with interictal hyperperfusion within the PMG cortex had a significantly higher spike rate on interictal EEG than patients with normal perfusion. Interictal hyperperfusion was not correlated to sex, age at epilepsy onset, age at evaluation, number of seizures per month, presence of initial precipitating insult (IPI), abnormal neurological examination, EEG findings, ictal serniology, and seizure outcome. The high interictal spike rate did not correlate to a high frequency of seizures per month. Conclusions: Our work provides further evidences for an intrinsic epileptogenesis of the PMG cortex during the interictal state, which accounts for the major rote of PMG tissue in seizure generation. These results might help to increase our understanding about epileptogenesis related to the PMG cortex, providing new toots for more tailored epilepsy surgery in PMG patients. (c) 2008 Elsevier B.V. All rights reserved.

ANXIETY, DYSPHORIA, AND DEPRESSION SYMPTOMS IN MOTHERS OF PRETERM INFANTS

To compare presence and severity of clinical symptoms of anxiety, dysphoria, and depression in mothers of preterm and of full-term infants and to observe changes in symptoms of mothers of preterm infants during hospitalization of the infants and after discharge, 50 mothers of preterm infants and 25 mothers of full-term infants completed the State-Trait Anxiety Inventory and the Beck Depression Inventory. The mothers with preterm infants had significantly higher clinical symptoms of State Anxiety during hospitalization than the group with full-term infants, but the clinical symptoms of anxiety in mothers of preterm infants decreased significantly after discharge. The health staff in a neonatal intensive care unit should not only be aware of infants` clinical status but also of the mothers` emotional state.

Emotional cue exposure for alcohol abuse: Development of a new treatment procedure to train moderation drinking in the context of dysphoria

Negative mood states are credited to exacerbate excessive drinking among problem drinkers. We developed an emotional cue exposure treatment procedure and applied it to three problem drinkers who have a history of drinking excessively under stressful emotional states. All three preferred a controlled drinking goal and received an average of seven sessions of treatment. Treatment comprised of providing alcohol (priming doses), followed by negative mood induction and response prevention of further drinking. Reductions were observed in the quantity and frequency of drinking, the Beck Depression Inventory, the Severity of Alcohol Dependence Questionnaire (Form C) and the Impaired Control Questionnaire scores. Increments were observed in self-efficacy to face different difficult situations. These gains were maintained at the 6-month follow-up. Providing alcohol to problem drinkers in treatment, followed by negative mood induction and response prevention, is clinically feasible and may benefit clients who drink under a variety of stressful mood states. Copyright (C) 2001 John Wiley & Sons, Ltd.

Electroencefalograma Interictal. Sensibilidade e Especificidade no Diagnóstico de Epilepsia

O electroencefalograma (EEG) é um método não invasivo, económico e acessível, universalmente utilizado na investigação da epilepsia. Realizámos uma revisão dos principais trabalhos sobre a prevalência de actividade epileptiforme em EEGs de doentes epilépticos e não epilépticos, com o objectivo de tirar conclusões sobre a sensibilidade e especificidade deste exame no diagnóstico de epilepsia. Concluímos que o primeiro EEG tem uma sensibilidade global de 50-55% podendo atingir os 92% com a repetição do exame e recurso a registos de sono e técnicas de activação. A especificidade atinge os 96%, sendo afectada por múltiplos factores.

Interictal Spike EEG Source Analysis in Hypothalamic Hamartoma Epilepsy

Objective: The epilepsy associated with the hypothalamic hamartomas constitutes a syndrome with peculiar seizures, usually refractory to medical therapy, mild cognitive delay, behavioural problems and multifocal spike activity in the scalp electroencephalogram (EEG). The cortical origin of spikes has been widely assumed but not specifically demonstrated. Methods: We present results of a source analysis of interictal spikes from 4 patients (age 2–25 years) with epilepsy and hypothalamic hamartoma, using EEG scalp recordings (32 electrodes) and realistic boundary element models constructed from volumetric magnetic resonance imaging (MRIs). Multifocal spike activity was the most common finding, distributed mainly over the frontal and temporal lobes. A spike classification based on scalp topography was done and averaging within each class performed to improve the signal to noise ratio. Single moving dipole models were used, as well as the Rap-MUSIC algorithm. Results: All spikes with good signal to noise ratio were best explained by initial deep sources in the neighbourhood of the hamartoma, with late sources located in the cortex. Not a single patient could have his spike activity explained by a combination of cortical sources. Conclusions: Overall, the results demonstrate a consistent origin of spike activity in the subcortical region in the neighbourhood of the hamartoma, with late spread to cortical areas.

The BOLD Effect of Interictal Spike Activity in Childhood Occipital Lobe Epilepsy

Occipital lobe epilepsy (OLE) presents in childhood with different manifestations, age of onset and EEG features that form distinct syndromes. The ictal clinical symptoms are difficult to correlate with onset in particular areas in the occipital lobes, and the EEG recordings have not been able to overcome this limitation. The mapping of epileptogenic cortical regions in OLE remains therefore an important goal in our understanding of these syndromes.

Effects of amygdala-hippocampal stimulation on interictal epileptic discharges.

Deep brain stimulation (DBS) of different nuclei is being evaluated as a treatment for epilepsy. While encouraging results have been reported, the effects of changes in stimulation parameters have been poorly studied. Here the effects of changes of pulse waveform in high frequency DBS (130Hz) of the amygdala-hippocampal complex (AH) are presented. These effects were studied on interictal epileptic discharge rates (IEDRs). AH-DBS was implemented with biphasic versus pseudo monophasic charge balanced pulses, in two groups of patients: six with temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (HS) and six with non lesional (NLES) temporal epilepsy. In patients with HS, IEDRs were significantly reduced with AH-DBS applied with biphasic pulses in comparison with monophasic pulse. IEDRs were significantly reduced in only two patients with NLES independently to stimulus waveform. Comparison to long-term seizure outcome suggests that IEDRs could be used as a neurophysiological marker of chronic AH-DBS and they suggest that the waveform of the electrical stimuli can play a major role in DBS. We concluded that biphasic stimuli are more efficient than pseudo monophasic pulses in AH-DBS in patients with HS. In patients with NLES epilepsy, other parameters relevant for efficacy of DBS remain to be determined.

Diagnosing Gender: Transitivity Analysis on the Diagnostic Category of Gender Dysphoria in DSM-5

Tässä tutkielmassa analysoidaan teoksessa ’Diagnostic and Statistical Manual of Men-tal Disorders, Fifth Edition’ (DSM-5) ja tarkemmin sen kappaleessa ’Gender Dysphoria’ käytettyä kieltä. DSM-5 on mielenterveydenalan ammattilaisille suunnattu luokittelu virallisesti tunnustetuista mielenterveyden häiriöistä ja se sisältää myös oireiden kuvai-luun perustuvat ohjeet näiden mielenterveyshäiriöiden diagnosoimiseksi. ’Gender dys-phoria’ (vapaasti suomennettuna sukupuolidysforia) on lääketieteellinen termi, joka viittaa biologisesta sukupuolesta eriävän sukupuoli-identiteetin aiheuttamaan henki-seen pahoinvointiin. Sukupuoli-identiteetin ja mielenterveysongelman yhdistäminen sisältää ideologisiin arvoihin pohjautuvia perusteluja ja tässä tutkielmassa analysoi-daan ’Gender Dysphoria’ – kappaleen ideologista sisältöä kriittisestä näkökulmasta. Tutkimuksen tarkastellaan ’Gender Dysphoria’ – kappaleessa käytetyn kielen ideologi-sia heijastumia ja niiden sosiaalisia vaikutuksia kolmen tutkimuskysymyksen avulla: 1) Kuinka diagnosoitu henkilö esitetään tekstissä? 2) Kuinka tekstissä rakennetaan kuvaa sukupuolidysforiasta mielenterveyshäiriönä? 3) Miten analyysin tulokset saattavat vai-kuttaa käsitykseen sukupuolen yhteydestä mielenterveyteen ja sukupuolidysforian diagnosoimiseen. Analyysissä käytetään metodina M. A. K. Hallidayn transitiivisuusteo-riaa ja tulosten sosiaalisia vaikutuksia analysoidaan Norman Faircloughn diskurssiana-lyysimallin avulla. Transitiivisuusanalyysin avulla tarkastellaan kirjoittajien tekemiä va-lintoja kielenkäytön suhteen, jotka Hallidayn teorian mukaan heijastavat kirjoittajien henkilökohtaisia kokemuksia ympäröivästä maailmasta. Tutkimus paljasti, että sukupuolidysforia esitetään mielenterveysongelmana erotta-malla se yksilöstä erilliseksi toimijaksi, joka suorittaa erilaisia prosesseja yksilön sisällä. Yksilöistä erityisesti lapset esitetään tekstissä voimakkaasti perinteisiin sukupuoliroo-leihin pohjautuvan ideologian valossa, joka heijastuu oireiden kuvailuun. Analyysi osoittaa myös logiikkaongelmia lasten oireiden kuvailussa, jotka johtavat ristiriitoihin oireiden ja mielenterveysongelman yhteydessä ja kumoavat perusteet, joiden pohjalta lapset diagnosoidaan. Tutkimuksen lopussa ehdotetaan, että sukupuolidysforiaan liit-tyvien diagnoosiohjeiden ja – kriteerien perusteita muokataan yleisesti sukupuoli-identiteetin itsemääräämisoikeuteen pohjautuvaksi ja lasten osalta tekstiin sisällytet-täisiin mahdollisia tieteellisiä perusteluja, jotka kumoaisivat diagnoosiohjeiden nyky-muodossaan sisältämät ristiriidat ja perustelisivat lasten diagnosoinnin oikeellisuuden

fNIRS-EEG study of focal interictal epileptiform discharges

Functional near-infrared spectroscopy (fNIRS) acquired with electroencephalography (EEG) is a relatively new non-invasive neuroimaging technique with potential for long term monitoring of the epileptic brain. Simultaneous EEG-fNIRS recording allows the spatio-temporal reconstruction of the hemodynamic response in terms of the concentration changes in oxy-hemoglobin (HbO) and deoxy-hemoglobin (HbR) associated with recorded epileptic events such as interictal epileptic discharges (IEDs) or seizures. While most previous studies investigating fNIRS in epilepsy had limitations due to restricted spatial coverage and small sample sizes, this work includes a sufficiently large number of channels to provide an extensive bilateral coverage of the surface of the brain for a sample size of 40 patients with focal epilepsies. Topographic maps of significant activations due to each IED type were generated in four different views (dorsal, frontal, left and right) and were compared with the epileptic focus previously identified by an epileptologist. After excluding 5 patients due to the absence of IEDs and 6 more with mesial temporal foci too deep for fNIRS, we report that significant HbR (respectively HbO) concentration changes corresponding to IEDs were observed in 62% (resp. 38%) of patients with neocortical epilepsies. This HbR/HbO response was most significant in the epileptic focus region among all the activations in 28%/21% of patients.

Analysis of generalized interictal discharges using quantitative EEG

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A critical and descriptive approach to interictal behavior with the Neurobehavior Inventory (NBI)

Purpose: The purpose of this study was to test the psychometric properties of the Neurobehavior Inventory (NBI) in a group of temporal lobe epilepsy (TLE) patients from a tertiary care center, correlating its scores with the presence of psychiatric symptoms. Methods: Clinical and sociodemographic data from ninety-six TLE outpatients were collected, and a neuropsychiatric evaluation was performed with the following instruments: Mini-Mental State Examination (MMSE), structured psychiatric interview (MINI-PLUS), Neurobehavior Inventory (NBI), and Hamilton Depression Rating Scale (HAM-D). Results: Some traits evaluated by the NBI showed adequate internal consistency (mean inter-item correlation between 0.2 and 0.4) and were frequent, such as religiosity (74%) and repetitiveness (60.4%). Principal component analysis showed three factors, named here as emotions (Factor 1), hyposexuality (Factor 2), and unusual ideas (Factor 3). Depressive symptoms on HAM-D showed a strong association with emotions and hyposexuality factors. When patients with left TLE and right TLE were compared, the former exhibited more sadness (p=0.017), and the latter, a greater tendency toward sense of personal destiny (p=0.028). Conclusion: Depression influences NBI scoring, mainly emotionality and hyposexuality traits. Neurobehavior Inventory subscales can be better interpreted with an appropriate evaluation of comorbid mood and anxiety disorders. Compromise in left temporal mesial structures is associated with increased tendency toward sad affect, whereas right temporal pathology is associated with increased beliefs in personal destiny. (C) 2012 Elsevier Inc. All rights reserved.