Abstract
Intracranial electroencephalographic (iEEG) recordings from patients with epilepsy provide distinct opportunities and novel data for the study of co-occurring psychiatric disorders. Comorbid psychiatric disorders are very common in drug-resistant epilepsy and their added complexity warrants careful consideration. In this review, we first discuss psychiatric comorbidities and symptoms in patients with epilepsy. We describe how epilepsy can potentially impact patient presentation and how these factors can be addressed in the experimental designs of studies focused on the electrophysiologic correlates of mood. Second, we review emerging technologies to integrate long-term iEEG recording with dense behavioral tracking in naturalistic environments. Third, we explore questions on how best to address the intersection between epilepsy and psychiatric comorbidities. Advances in ambulatory iEEG and long-term behavioral monitoring technologies will be instrumental in studying the intersection of seizures, epilepsy, psychiatric comorbidities, and their underlying circuitry.
Highlights
Serious mental illnesses resulting in substantial functional impairment affect over 13 million US adults (Substance Abuse and Mental Health Services Administration, 2020)
The most frequent indication for Intracranial electroencephalographic (iEEG) recordings with stereoelectroencephalographic electrodes or subdural strip and grid electrodes is seizure onset zone (SOZ) localization as part of presurgical evaluation for drug-resistant focal epilepsy. Given this unique access to invasive recordings, increased effort is being directed to the study of comorbid psychiatric symptoms in people with epilepsy (PWE)
Much of the literature on invasive electrophysiology in patients with psychiatric diagnoses has involved iEEG recordings at and near regions established for deep brain stimulation (DBS) treatment of obsessive-compulsive disorder (OCD) or targeted in clinical trials for major depressive disorder (MDD)
Summary
Serious mental illnesses resulting in substantial functional impairment affect over 13 million US adults (Substance Abuse and Mental Health Services Administration, 2020). Much of the literature on invasive electrophysiology in patients with psychiatric diagnoses (without epilepsy) has involved iEEG recordings at and near regions established for deep brain stimulation (DBS) treatment of OCD or targeted in clinical trials for MDD. In PWE with symptoms of depression, electrical stimulation of the lateral OFC was shown to acutely improve mood (Rao et al, 2018), demonstrating the utility of stimulation studies in PWE in the selection of DBS targets to treat primary psychiatric disorders These iEEG studies from PWE have laid the groundwork for more recent clinical trials of invasive monitoring in patients with the primary psychiatric diagnosis of MDD, without epilepsy (Scangos K. et al, 2020; Figee and Mayberg, 2021). Multifunctional research platforms that integrate these emerging devices with wireless stimulation control, peripheral biosensors, and environmental features as in virtual reality should further guide and inform the generation of clinical hardware (Topalovic et al, 2020)
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