Behavior In Epilepsy Research Articles

Tools and techniques for classifying behaviours in canine epilepsy.

Idiopathic epilepsy is the most common neurological disease in dogs. Similar to humans, dogs with epilepsy often experience behavioural comorbidities such as increased fear, anxiety, and aggression, as reported by their caregivers. Investigations of behaviour in canine epilepsy have yet to untangle interictal and pre and postictal behaviours, prodromal changes, and seizure-precipitating factors. Under-recognition of absence and focal seizures further complicates these assessments. These complex behavioural presentations in combination with caring for an epileptic animal have a significant negative impact on the dog's and caregiver's quality of life. Despite the growing recognition of behavioural comorbidities and their impact on quality of life in dogs with epilepsy, few objective research methods for classifying and quantifying canine behaviour exist. This narrative review examines the strengths, limitations, and granularity of three tools used in the investigation of canine behaviour and epilepsy; questionnaires, electroencephalography, and actigraphy. It suggests that a prospective combination of these three tools has the potential to offer improvements to the objective classification and quantification of canine behaviour in epilepsy.

Self-injury as a predominant challenging behavior in epilepsy: A study in a residential facility for profoundly disabled patients

BackgroundThe association between challenging behavior (CB) and epilepsy in people with intellectual disability (ID) remains largely controversial. AimTo clarify the correlation between CB and epilepsy, we investigated the clinical characteristics of CB in both people with and without epilepsy among individuals with ID hospitalized in our residential facility. Methods and proceduresA total of 63 individuals with CB was retrospectively investigated using the Behavior Problems Inventory, and the following items were collected from the medical records: sex, age, hospitalization period, etiology and risk factors, level of ID, type of CB, administration of psychotropic drugs, presence or absence of epilepsy and clinical features of epilepsy. Outcomes and resultsAlmost all individuals with CB showed profound ID. There was no significant difference in the rate of CB between people with and without epilepsy. A type analysis of CB revealed that self-injurious behavior was observed more frequently in epilepsy cases (66.7 %) than in cases without epilepsy (36.4 %) (p = 0.015), and self-injurious behavior was the predominant clinical form in people with epilepsy among the three subgroups of CB (self-injurious, aggressive and self-injurious and aggressive behavior). Conclusions and implicationsThe high incidence of self-injurious behavior in epilepsy with profound disabilities may imply the presence of common pathological basis of self-injurious behavior and epilepsy.

Anti-seizure medications and risk of suicide: Re-addressing the issue.

Although suicidal behaviour in epilepsy is a complex phenomenon, evidence suggests that suicide rates are higher amongst individuals with epilepsy than the general population. Yet, it has been a decade since the Food and Drug Administration (FDA) has passed a warning with anti-seizure medications (ASMs) and risk of suicide, the scientific community is still far from a final answer to this association. Since the available data are not methodologically strong enough to support or reject the claimed increased risk of suicide using ASMs, the dilemma continues. Through this perspective, authors sought to list certain important issues that the past studies often over-looked, which play a vital role in determining the true relationship between the use of ASMs and the risk of suicide.

Self-injurious behavior in epilepsy

Self-injurious behavior (SIB) can be described as an act involving self-inflicted destruction of tissue, right away or over a period of time. Patients with epilepsy have to deal with an often chronic and unpredictable disorder leading to adversity in many psychosocial variables such as employment, stigma, and overall quality of life. The above factors contribute toward SIB in these patients. Behavioral problems occurring in people with epilepsy can range from aggressiveness, mood fluctuations to SIB. We report a 23-year-old male, married, educated up to 10th standard, referred from neurology department for psychiatric evaluation. The patient had gone to neurologist with the chief complaints of generalized tonic–clonic convulsions and was hospitalized for breakthrough seizure. There was a history of indulging in episodes of self-SIB since the past 8 months. He responded satisfactorily to adjustment of antiepileptic medication along with fluoxetine and low-dose risperidone. Early identification of such behavior in epilepsy patients should be done so that a holistic management is undertaken leading to better functioning and improved quality of life.

The problem of aggressive behavior in epilepsy: clinical and neurobiological aspects

Aggressive behavior is observed in a significant number of patients with epilepsy. The aggressive behavior is associated with structural and functional changes in the amygdala, orbitofrontal cortex and striatum. From the clinical point of view, aggressive behavior more often is not related to the seizure, and develops as part of borderline psychiatric disorder. Another potential cause of aggressive behavior is postictal psychotic disorder. Pre- and intraictal aggressive behavior is rarely observed. Anticonvulsants may influence differently on aggression. Antidepressants, neuroleptics, normotimics and psychotherapy are used in correction of aggression.

Managing aggression in epilepsy

Behavioural changes associated with epilepsy can be challenging for patients and clinicians. Evidence suggests an association between aggression and epilepsy that involves various neurophysiological and neurochemical disturbances. Anti-epileptics have variable effects on behaviour and cognition that need consideration. Early detection and careful consideration of history, symptomatology and possible common comorbid psychiatric disorders is essential. Appropriate investigations should be considered to aid diagnosis, including electroencephalogram (EEG), video EEG telemetry and brain imaging. Optimising treatment of epilepsy, treatment of psychiatric comorbidities and behavioural management can have a major positive effect on patients' recovery and well-being.Learning Objectives• Understand the epidemiology of aggression in epilepsy• Comprehend the link between anti-epileptics and aggression, including the important role of pharmacodynamics• Be aware of the pharmacological treatments available for managing aggressive behaviour in epilepsy

Reprint of: The new approach to classification: Rethinking cognition and behavior in epilepsy.

There has been considerable debate surrounding the benefits and drawbacks of the new approach to classifying the epilepsies released by the ILAE Commission on Classification and Terminology (2005-2009). This new approach has significant implications for the way we conceptualize and assess cognition and behavior in epilepsy; however, as yet, there has been limited discussion of these issues in the field. The purpose of this Targeted Review is to spark this discussion by encouraging researchers and clinicians to think about the changes that the new approach may bring. These may include (i) reframing the way we think about the comorbidities of epilepsy, (ii) more precisely characterizing the cognitive and behavioral phenotypes of electroclinical syndromes, (iii) more carefully mapping the longitudinal trajectory of cognitive and behavioral features relative to the timing of seizures, and (iv) considering the links between cognitive, behavioral, and neurological phenotypes in the new classification scheme. It is hoped that such changes will aid translation of the advances in cognitive and behavioral neuroscience into routine clinical practice by providing purer markers of disease and more targeted treatments. A Special Issue canvassing such issues will be forthcoming that will consider current knowledge of the cognitive and behavioral features of the epilepsies from the view of the new classification scheme.

Reprint of: The new approach to epilepsy classification: Cognition and behavior in adult epilepsy syndromes.

The revised terminology and concepts for the organization of seizures and epilepsy proposed by the ILAE Commission on Classification and Terminology in 2010 allows for a number of new opportunities in the study of cognition and behavior in adults. This review examines the literature that has looked for behavioral and cognitive correlates of the newly recognized genetic epilepsies in adults. While some studies report clear cognitive phenotypes associated with specific genetic mutations in adults with epilepsy, others report remarkable clinical heterogeneity. In the second part of this review, we discuss some of the factors that may influence the findings in this literature. Cognitive function is the product of both genetic and environmental influences. Neuropsychological phenotypes under direct genetic influence may be wider and more subtle than specific deficits within discreet cognitive domains and may be reflected in broader, multidimensional measures of cognitive function than those tapped by scores on standardized tests of function. Future studies must be carefully designed to reflect these factors. It is also imperative that studies with negative findings are assigned as much value as those with positive results and published accordingly. This article is part of a Special Issue titled "The new approach to classification: Rethinking cognition and behavior in epilepsy".

Psychiatric comorbidities in epilepsy: Should they be considered in the classification of epileptic disorders?

The prevalence of psychiatric comorbidities is relatively high in people with epilepsy (PWE), as one in three patients will have experienced a psychiatric disorder in the course of their life. The new definition of epilepsy recognizes these comorbidities as part of the seizure disorder, which need to be recognized and treated together with the actual epileptic seizures. Psychiatric comorbidities have a complex relation with epilepsy, being associated with a negative course of the seizure disorder, worse tolerance of pharmacotherapy with AEDs, development of iatrogenic psychiatric complications from pharmacologic and surgical treatments, and increased mortality risks. Given their negative impact at several levels of the lives of PWE, should psychiatric comorbidities be included in a classification of the epilepsies? This question is addressed in this article. This article is part of a Special Issue entitled "The new approach to classification: Rethinking cognition and behavior in epilepsy".

The new approach to epilepsy classification: Cognition and behavior in adult epilepsy syndromes.

The revised terminology and concepts for the organization of seizures and epilepsy proposed by the ILAE Commission on Classification and Terminology in 2010 allows for a number of new opportunities in the study of cognition and behavior in adults. This review examines the literature that has looked for behavioral and cognitive correlates of the newly recognized genetic epilepsies in adults. While some studies report clear cognitive phenotypes associated with specific genetic mutations in adults with epilepsy, others report remarkable clinical heterogeneity. In the second part of this review, we discuss some of the factors that may influence the findings in this literature. Cognitive function is the product of both genetic and environmental influences. Neuropsychological phenotypes under direct genetic influence may be wider and more subtle than specific deficits within discreet cognitive domains and may be reflected in broader, multidimensional measures of cognitive function than those tapped by scores on standardized tests of function. Future studies must be carefully designed to reflect these factors. It is also imperative that studies with negative findings are assigned as much value as those with positive results and published accordingly. This article is part of a Special Issue titled "The new approach to classification: Rethinking cognition and behavior in epilepsy.

The new approach to classification of focal epilepsies: Epileptic discharge and disconnectivity in relation to cognition.

The new classification of epilepsy stratifies the disease into an acute level, based on seizures, and an overarching chronic level of epileptic syndromes (Berg et al., 2010). In this new approach, seizures are considered either to originate and evolve in unilateral networks or to rapidly encompass both hemispheres. This concept extends the former vision of focal and generalized epilepsies to a genuine pathology of underlying networks. These key aspects of the new classification can be linked to the concept of cognitive curtailing in focal epilepsy. The present review will discuss the conceptual implications for acute and chronic cognitive deficits with special emphasis on transient and structural disconnectivity. Acute transient disruption of brain function is the hallmark of focal seizures. Beyond seizures, however, interictal epileptic discharges (IEDs) are increasingly recognized to interfere with physiological brain circuitry. Both concomitant EEG and high-precision neuropsychological testing are necessary to detect these subtle effects, which may concern task-specific or default-mode networks. More recent data suggest that longstanding IEDs may affect brain maturation and eventually be considered as a biomarker of pathological wiring. This brings us to the overarching level of chronic cognitive and behavioral comorbidity. We will discuss alterations in structural connectivity measured with diffusion-weighted imaging and tractography. Among focal epilepsies, much of our current insights are derived from temporal lobe epilepsy and its impact on neuropsychological and psychiatric functioning. Structural disconnectivity is maximal in the temporal lobe but also concerns widespread language circuitry. Eventually, pathological wiring may contribute to the clinical picture of cognitive dysfunction. We conclude with the extrapolation of these concepts to current research topics and to the necessity of establishing individual patient profiles of network pathology with EEG, high-precision neuropsychological testing, and state-of-the-art neuroimaging. This article is part of a Special Issue entitled "The new approach to classification: Rethinking cognition and behavior in epilepsy".

Two distinct symptom-based phenotypes of depression in epilepsy yield specific clinical and etiological insights.

Depression is common but underdiagnosed in epilepsy. A quarter of patients meet criteria for a depressive disorder, yet few receive active treatment. We hypothesize that the presentation of depression is less recognizable in epilepsy because the symptoms are heterogeneous and often incorrectly attributed to the secondary effects of seizures or medication. Extending the ILAE's new phenomenological approach to classification of the epilepsies to include psychiatric comorbidity, we use data-driven profiling of the symptoms of depression to perform a preliminary investigation of whether there is a distinctive symptom-based phenotype of depression in epilepsy that could facilitate its recognition in the neurology clinic. The psychiatric and neuropsychological functioning of 91 patients with focal epilepsy was compared with that of 77 healthy controls (N=168). Cluster analysis of current depressive symptoms identified three clusters: one comprising nondepressed patients and two symptom-based phenotypes of depression. The 'Cognitive' phenotype (base rate=17%) was characterized by symptoms taking the form of self-critical cognitions and dysphoria and was accompanied by pervasive memory deficits. The 'Somatic' phenotype (7%) was characterized by vegetative depressive symptoms and anhedonia and was accompanied by greater anxiety. It is hoped that identification of the features of these two phenotypes will ultimately facilitate improved detection and diagnosis of depression in patients with epilepsy and thereby lead to appropriate and timely treatment, to the benefit of patient wellbeing and the potential efficacy of treatment of the seizure disorder. This article is part of a Special Issue entitled "The new approach to classification: Rethinking cognition and behavior in epilepsy".

Rethinking cognition and behavior in the new classification for childhood epilepsy: Examples from frontal lobe and temporal lobe epilepsies.

The new approach to classification of the epilepsies emphasizes the role of dysfunction in networks in defining types of epilepsies. This paper reviews the structural and neuropsychological deficits in two types of childhood epilepsy: frontal lobe and temporal lobe epilepsy. The evidence for and against a pattern of specificity of deficits in executive function and memory associated with these two types of epilepsies is presented. The evidence varies with the methodologies used in the studies, but direct comparison of the two types of epilepsies does not suggest a clear-cut mapping of function onto structure. These findings are discussed in light of the concept of network dysfunction. The evidence supports the conceptualization of epilepsy as a network disease. Implications for future work in the neuropsychology of pediatric epilepsy are suggested. This article is part of a Special Issue entitled "The new approach to classification: Rethinking cognition and behavior in epilepsy".

Cognition, behavior, and the ILAE Classification of the Epilepsies: A view from Africa.

Recent ILAE revisions to the definition and classification of the epilepsies have highlighted cognitive-behavioral comorbidities (CBCs). Integrating a CBC dimension within a formal classification scheme would more fully account for the burden of epilepsy. This would be technically challenging, because we use fundamentally different methods to conceptualize, define, and diagnose CBCs that require additional expertise. In low resource settings such as sub-Saharan Africa (SSA), CBC burden is high. Existing classification systems are inevitably simplified in practice, because complex classifications require training and technologies that rarely exist in these settings. This makes low-resource settings a good place to develop simple methods to integrate CBCs into existing classifications so that they ultimately will communicate the full burden of epilepsy. This article is part of a Special Issue entitled "The new approach to classification: Rethinking cognition and behavior in epilepsy".

Graph theory and cognition: A complementary avenue for examining neuropsychological status in epilepsy.

The recent revision of the classification of the epilepsies released by the ILAE Commission on Classification and Terminology (2005-2009) has been a major development in the field. Papers in this section of the special issue explore the relevance of other techniques to examine, categorize, and classify cognitive and behavioral comorbidities in epilepsy. In this review, we investigate the applicability of graph theory to understand the impact of epilepsy on cognition compared with controls and, then, the patterns of cognitive development in normally developing children which would set the stage for prospective comparisons of children with epilepsy and controls. The overall goal is to examine the potential utility of this analytic tool and approach to conceptualize the cognitive comorbidities in epilepsy. Given that the major cognitive domains representing cognitive function are interdependent, the associations between neuropsychological abilities underlying these domains can be referred to as a cognitive network. Therefore, the architecture of this cognitive network can be quantified and assessed using graph theory methods, rendering a novel approach to the characterization of cognitive status. We first provide fundamental information about graph theory procedures, followed by application of these techniques to cross-sectional analysis of neuropsychological data in children with epilepsy compared with that of controls, concluding with prospective analysis of neuropsychological development in younger and older healthy controls. This article is part of a Special Issue entitled "The new approach to classification: Rethinking cognition and behavior in epilepsy".

The implications of the new approach to classification: Adults with an intellectual disability.

The new ILAE classification offers the potential for clarity and improved translation of the understanding of the nature of epilepsy in people with an intellectual disability. This is particularly true in the use of the term genetic epilepsy and the removal of the term cryptogenic. However, the definition of the "dyscognitive" nature of seizures needs greater definition in those with coexistent cognitive impairment. This is of particular importance when ameliorating risk associated with impaired consciousness. This article is part of a Special Issue entitled "The new approach to classification: Rethinking cognition and behavior in epilepsy".

New classification efforts in epilepsy: Opportunities for clinical neurosciences.

Classification is truly a scientific endeavor. In recent years, the use of the term in clinical epilepsy has diverged from the purpose of the intellectual process of classification in the sciences. As genetics and molecular biology come into their own, scientific classification may finally come to epilepsy and begin to shed light on the many aspects of brain disorders that are characterized by seizures but which are truly multifaceted disorders and deserve more comprehensive, multidisciplinary approaches than they have received previously. This article is part of a Special Issue entitled "The new approach to classification: Rethinking cognition and behavior in epilepsy".

Semiological study of ictal affective behaviour in epilepsy and mental retardation limited to females (EFMR)

Epilepsy and mental retardation limited to females (EFMR) is a genetic disorder that affects females but spares transmitting males. The condition is caused by protocadherin 19 mutations and is characterised by seizures beginning at around 1 year of age, frequently associated with cognitive regression at seizure onset or later. Seizures can be generalised or focal, exacerbated by febrile illnesses, and grouped in clusters. This report shows the first video-EEG recording of EFMR, in a 7-year-old female presenting peculiar ictal features. [Published with video sequences].

Compromised function in the Nav1.2 Dravet syndrome mutation R1312T

Ion channels, specifically voltage-gated sodium channels (Navs), are common culprits in inheritable seizure disorders. Some Nav isoforms are particularly susceptible, while others are only weakly associated with neuronal hyperexcitability. Representative of the latter group is Nav1.2 (gene name SCN2A): despite its abundance in the brain, Nav1.2-related epilepsy is rare and only few studies have been conducted as to the pathophysiological basis of Nav1.2 in neuronal hyperexcitability. We here present a detailed functional analysis of Nav1.2 mutant, R1312T, which was originally found in a child with Dravet syndrome (formerly known as severe myoclonic epilepsy of infancy or SMEI). Whole-cell voltage clamp analysis revealed clearly compromised function: the mutant channels fast- and slow-inactivated at markedly more negative potentials and recovered from fast inactivation more slowly, which resulted in a use-dependent current reduction to less than 50% of wildtype levels. We also noted a small hyperpolarizing shift in the voltage dependence of activation. Our findings expand the spectrum of abnormal Nav channel behavior in epilepsy and raise the question as to how loss-of-function in a sodium channel predominantly expressed in excitatory neurons can lead to hyperexcitability.

Psychiatric comorbidity and suicidal behavior in epilepsy: A community‐based case–control study

To provide information about psychiatric comorbidity and suicidal behavior in people with epilepsy compared to those without epilepsy from a community sample in Brazil. An attempt was made to evaluate all 174 subjects with epilepsy (cases) identified in a previous survey. For every case identified, an individual without epilepsy (control) matched by sex and age was selected in the same neighborhood. A structured interview with validated psychiatric scales was performed. One hundred and fifty-three cases and 154 controls were enrolled in the study. People with epilepsy had anxiety more frequently [39.4% vs. 23.8%, odds ratio (OR) 2.1, 95% confidence interval (CI) 1.2-3.5; p = 0.006], depression (24.4% vs. 14.7%, OR 1.9, 95% CI 1.01-3.5; p = 0.04), and anger (55.6% vs. 39.7%, OR 1.9, 95% CI 1.2-3.1; p = 0.008). They also reported more suicidal thoughts [36.7% vs. 23.8%, OR 1.8, 95% CI 1.1-3.1; p = 0.02), plans (18.2% vs. 3.3%, OR 2.0, 95% CI 1.0-4.0; p = 0.04), and attempts (12.1% vs. 5.3%, OR 2.4, 95% CI 1.1-3.2, p = 0.04) during life than controls. These findings call attention to psychiatric comorbidity and suicidal behavior associated with epilepsy. Suicide risk assessment, mental evaluation, and treatment may improve quality of life in epilepsy and ultimately prevent suicide.