Disorders In Epileptic Patients Research Articles

Unveiling the potential of perampanel and pregabalin in addressing pentylenetetrazole-induced electrographic alterations and neurobehavioral anomalies

Chemical kindling is broadly used experimental model to investigate novel treatments on the process of epileptogenesis and coexisting behavioral comorbidities. The current study aimed to investigate the low dose perampanel (PER) (0.125 and 0.5 mg/kg) and pregabalin (PG) (15 mg/kg) as standalone treatments and in combination on kindling-induced seizure progression with concurrent electroencephalographic alterations. Mice were subjected to pentylenetetrazole (PTZ)-induced kindling followed by neurobehavioral assessment for anxiety-like activity and cognitive deficit through behavioral experiments. The monotherapy with PER at 0.5 mg/kg and PG at 15 mg/kg delayed the kindling process but PRP+PG yielded pronounced benefits and hindered the development of seizures of higher severity. PER+PG combination relieved the animals from anxiety-like behavior in various employed anxiogenic tests. Furthermore, the kindling-associated cognitive deficit was protected by PER+PG combination as increased alteration behavior, discrimination index and latencies to enter the dark zone were noted in y-maze, object recognition and passive avoidance tests, respectively while shorter escape latencies were noted in water maze. The brain samples of kindled mice had elevated malondialdehyde and reduced catalase, superoxide dismutase and glutathione peroxidase enzymes while treatment with PER and PG combination shielded the mice from heightened kindling-associated oxidative stress. Overall, the findings of the present study illustrate that concurrent administration of PER and PG effectively hindered the process of epileptogenesis by protecting neuronal excitability and brain oxidative stress. The results predict the dominance of PER and PG combination over monotherapy which might serve as an effective novel combination to combat drug resistance and behavioral disorders in epileptic patients.

Assessing the prevalence of psychotic symptoms in epileptic patients at a tertiary clinic.

The International League against Epilepsy (ILAE) defines epilepsy as a brain disorder characterised by an enduring risk to generate seizures with neurobiological, cognitive, psychological and social consequences. Psychotic disorders in epilepsy are a serious psychiatric complication affecting the prognosis, morbidity and mortality of patients. There is a paucity in literature with regard to the prevalence of psychotic symptoms in epileptic patients in low- to middle-income countries. This study aimed to look at the prevalence of psychotic symptoms in epileptic patients at an outpatient clinic using the prodromal questionnaire 16 (PQ-16). The study was conducted at the epilepsy clinic at Charlotte Maxeke Academic Hospital (CMJAH), a tertiary hospital located in Johannesburg, South Africa. The PQ-16 was distributed to patients at the epilepsy clinic at CMJAH. The study consisted of 121 participants. The prevalence of patients found to be at high risk of psychosis (i.e., PQ-16 score > 6) was 61.2% (95% lower confidence interval (LCI): 0.53, upper confidence interval (UCI): 0.70). None of the demographic variables showed significant associations in the percentage of patients found to be at high risk. No association was found between any antiepileptic drug and high risk of psychosis. The high prevalence of psychotic like experiences found suggests it is imperative to screen for psychotic disorders in epileptic patients and if required to involve neuropsychiatrists in their management. This study highlights the importance of assessing psychotic symptoms in epileptic patients and the importance of a multidisciplinary approach in managing these complex patients.

Epidemiological profile of patients with epilepsy attended in an emergency in a psychiatric hospital in 2020

IntroductionAccording to the Global Burden of Disease study (WHO, 2010), epilepsy is ranked as the second most impacting neurological disorder worldwide, in terms of disability-adjusted life years, and is often associated with psychiatric comorbidities, stigma and high economic costs. This frequent association between epilepsy and mental disorders is a fact, however, they are often underdiagnosed and undertreated in patients with epilepsy, which further reduces the quality of life of this population and induces the demand for psychiatric emergency care.ObjectivesTo give the comorbid relevance between epilepsy and mental disorders, this study aims to identify the main psychiatric illnesses associated with patients with epilepsy treated at the emergency of a psychiatric hospital in 2020. In addition to establishing the clinical and epidemiological factors related to this association.MethodsAll patients diagnosed with epilepsy (G40), according to the International Classification of Diseases, who underwent emergency care at the HABM, São José do Rio Preto, São Paulo, in 2020. Epidemiological and clinical data were collected.ResultsThere were 7258 consultations, with only 27 as cid G40. 71.4% were male, 55% single and age between 42-49 years old. 47.6% indicated psychiatric comorbidities (cid F06). 23.8% patients with both disorders were attended by psychiatrist.ConclusionsThe concomitant occurrence of psychiatric disorders and epilepsy has significant relevance. However, it is known that the diagnosis of psychiatric disorders in epileptic patients is sometimes late, poorly conducted or even underdiagnosed. Therefore, knowing the profile of patients with epilepsy allows us to identify the factors associated with the concomitant of psychiatric disorders.DisclosureNo significant relationships.

Comorbidity of Psychiatric Disorders in Epileptic Patients A descriptive Study

Background: Epilepsy is a chronic disorder characterized by seizures, or paroxysmal brain dysfunction due to excessive neuronal discharge. Psychiatric and cognitive disturbances are relatively common in epilepsy, especially in refractory epilepsy. Aim of study: The aim of the study is to detect the psychiatric disorders and their frequency in epileptic patients. Patients and Methods: This descriptive study consisted of 104 patients with idiopathic epilepsy; 60 males and 44 female, aged between 17-68 years, who were attending either private clinics or the Psychiatric Unit at Azadi Teaching Hospital, Kirkuk, between December 2012 and January 2014. Diagnoses of comorbid psychiatric disorders were done according to Diagnostic and Statistical Manual of Mental Disorders. Results: The most frequent psychiatric disorders were anxiety disorders (59.64%) followed by sexual dysfunction in males (50%). Conclusion: This study reveals that those patients with epilepsy are at high risk of comorbidity of psychiatric disorders.

P13-T Epilepsy and sleep disorders: Coexistence in three patients

Background The relation of epilepsy and sleep disorders is well-known and complex and the coexistence of these two groups of pathologies is frequent. Sleep can favour the occurrence of epileptic seizures and it can also be the sole triggering factor for epileptic seizures in some types of epilepsies. On the other hand, its known that the occurrence of sleep disorders is more frequent in epileptic patients than in general population. These can be explained by a common pathophysiologic mechanism and can also be exacerbated by some antiepileptic drugs. The clinical diagnosis can be difficult, often underestimated the presence of sleep disorders in epileptic patients. Long-term Monitoring and Polysomnography are essentials exams to perform an adequate diagnosis and treatment in these patients. Material and methods/clinical cases We present three patients with epilepsy and sleep disorders. A 4 years old boy, with focal epilepsy and sleep related rhythmic movements (body rocking/body rolling). A 53 years old woman, with focal epilepsy and catathrenia. A 34 years old man, with cognitive delay and focal epilepsy, OSAS and NREM-related parasomnias (confusional arousals and sleepwalking). Results and conclusions The aim of this work is to highlight the frequent occurrence of sleep disorders in epileptic patients. An elevated suspicion of sleep disorders in epileptic patients is needed to perform an adequate diagnosis and treatment, in order to achieve a better seizures control, especially in refractory epilepsies.

Psychiatric Assessment in Patients with Mild Temporal Lobe Epilepsy.

Objectives The findings of previous studies focused on personality disorders in epileptic patients are difficult to interpret due to nonhomogeneous samples and noncomparable methods. Here, we aimed at studying the personality profile in patients with mild temporal lobe epilepsy (mTLE) with psychiatric comorbidity. Materials and Methods Thirty-five patients with mTLE (22 males, mean age 40.7 ± 12.1) underwent awake and sleep EEG, 3T brain MRI, and an extensive standardized diagnostic neuropsychiatric battery: Temperament and Character Inventory-Revised (TCI-R), Beck Depression Inventory-2, and State-Trait Anxiety Inventory. Drug history was collected in detail. Hierarchical Cluster Analysis was performed on TCI-R data, while all other clinical and psychological variables were compared across the resulting clusters. Results Scores of Harm Avoidance (HA), Reward Dependence (RD), Persistence (P), Cooperativeness (C), and Self-Transcendence (ST) allowed the identification of two clusters, describing different personality subtypes. Cluster 1 was characterized by an early onset, more severe anxiety traits, and combined drug therapy (antiepileptic drug and Benzodiazepine/Selective Serotonin Reuptake Inhibitors) compared to Cluster 2. Conclusions Our findings suggest that different personality traits may play a role in determining the clinical outcome in patients with mTLE. Specifically, lower scores of HA, RD, P, C, and ST were associated with worse clinical outcome. Thus, personality assessment could serve as an early indicator of greater disease severity, improving the management of mTLE.

The Most Common Treatable Neurometabolic Epilepsies in Children

Epilepsy is a common neurological disorder in childhood with prominent neurological manifestations, signs, and symptoms in inherited neurometabolic disorders. Accurate diagnosis of neurometabolic disorders in epileptic patients increases the possibility of a specific treatment to improve epilepsy. Therefore, early diagnosis is essential in potentially treatable epileptic disorders. Various seizure types occur in neurometabolic disorders, which are often refractory to antiepileptic drugs (without the treatment of the underlying neurometabolic disorders). Patients with underlying disorders have severe clinical presentations, such as refractory seizures. In addition, they do not respond to antiepileptic drugs in many cases. In the epileptic patients with developmental delay and/or regression, neurometabolic disorders should be considered in the presence of abnormal neurological examination and brain imaging with specific patterns. Some of these disorders are potentially treatable. Therefore, neurologists should determine the etiology of epilepsy, especially in pediatric patients, and the treatment should not be restricted to symptomatic therapy. The present study aimed to introduce some of the treatable causes of epilepsy in pediatric patients.

Interaction between clozapine and oxcarbazepine: a case report.

Combinations of psychoactive treatments are frequently used to treat impulsivity, aggressiveness, or anxiety in patients with resistant schizophrenia. Antipsychotics, as recommended by the French authorities [Haute Autorite de Sante, 2007], can be co-prescribed with antiepileptic agents in order to reduce impulsivity, to stabilize mood or to treat epilepsy. The prevalence of psychotic disorders in epileptic patients is significantly higher compared with the general population [Clancy et al. 2014]. Clozapine (CLZ; 8-chloro-11-(4-methyl-1-piperazinyl)-5H-dibenzo[b,e][1,4]-diazepine) is an atypical antipsychotic indicated for resistant schizophrenia or in cases of intolerance to the other antipsychotic agents. CLZ has a complex pharmacological profile because of its binding properties. It presents an antagonist action on serotoninergic and dopaminergic systems (5HT2A and D4) and, to a lesser extent, an antagonist activity on histaminergic (H1), cholinergic-like muscarinic (M3 and M1) and adrenergic (α1) systems [Stahl, 2015]. CLZ is recommended as third-line treatment because of the side effects in 25.2% of patients [Mustafa et al. 2015]. The coadministration of treatments may induce the modulation of the pharmacokinetics of CLZ via the enzyme inhibition or induction of cytochrome P450 (CYP450). CLZ is metabolized mainly in N-desmethylclozapine (NCLZ or norclozapine) and CLZ N-oxide by the isoenzymes of CYP450: CYP1A2, CYP3A4 and to a lesser extent by CYP2D6, CYP2C19 and CYP2C9 [Kennedy et al. 2013; Rouleau et al. 2008]. As documented, NCLZ is known to present anticholinergic and hypersalivation effects [de Leon et al. 2012]. Uridine 5′-diphospho-glucuronosyltransferase (UGT) catalyses glucuronidation reactions of NCLZ facilitating its elimination [Rouleau et al. 2008]. A correlation between plasma concentrations of CLZ, NCLZ and the occurrence of side effects have been previously reported [Llorca and Pere, 2004]. This led to an evaluation of the factors of variability in plasma concentration of CLZ and its active metabolites. Plasma levels are also indicative of the quality of compliance. The relative rate of CLZ/NCLZ is also useful to estimate the quality of the observance with CLZ [Couchman et al. 2010]. Oxcarbazepine (OXC; 10, 11-dihydro-10-oxo-5H-dibenzo[b, f]azepine-5-carboxamide) is developed from structural rearrangements of carbamazepine (CBZ) [Schmidt and Elger, 2004] in order to minimize the involvement of isoenzymes of CYP450 in OXC metabolism. This is a choice anti-epileptic treatment, anti-impulsive and mood stabilizer as with CBZ [Stahl, 2015]. OXC is indicated in the treatment of partial seizures with or without secondary generalization. After absorption, an important proportion of OXC undergoes rapid reduction in a pharmacologically active metabolite, monohydroxy derivative (MHD; 10, 11-dihydro-10-hydroxy-5H-dibenzo[f,b]azepine-5-carboxamide or licarbazepine) while a minority of MHD is oxidized in pharmacologically inactive dihydroxy derivative (DHD; carbamazepine-10,11-dihydro-10,11-dihydroxy) [Flesch, 2004]. In comparison with CBZ which is significantly inductive of CYP3A4 (about 46% higher than that of OXC), OXC is known to present a less pronounced dose-dependent effect [Andreasen et al. 2007]. The induction effect is more effective at high doses (900–1200 mg/day). In fact, OXC weakly induced CYP3A4 and UGT in vitro [Patsalos, 2013a,2013b], as documented by a decrease in plasma concentrations of oral contraceptives, felodipine, imatinib and lamotrigine. To our knowledge, there is no report of a putative interaction between CLZ and OXC. In this paper, we report the case of important variations of CLZ and NCLZ concentrations after OXC introduction. This raises the hypothesis of an interaction between CLZ and OXC in a schizophrenic patient for whom we performed a therapeutic drug monitoring of plasma concentration of CLZ and NCLZ, before, during and after treatment of OXC.

Troubles psychiatriques et facteurs associés chez une population de patients épileptiques à Fès, Maroc

The prevalence of psychiatric disorders in epileptic patients remains unclear. This study was conducted in order to determine the prevalence and nature of the psychiatric disorders and the associated factors in patients with idiopathic epilepsy. A cross-sectional study was conducted over a period of eighteen months in the psychiatric unit of the University Hospital Hassan II of Fez (Morocco). A questionnaire was completed by the included patients, which specified: the socio-demographic data, personal and family history, and the clinical features of epilepsy and its management. Psychiatric disorders were identified by the Mini International Neuropsychiatric Interview test (MINI). The severity of the depression and anxiety symptoms was investigated using the Beck Depression Inventory (BDI) and the Hamilton Rating Scale. Eighty-nine patients met the inclusion criteria. The average age of patients was 29.7±10.8years. Mood disorders were the leading psychiatric comorbidity: 32.6% among which 25.8% of major depressive episodes, 15.7% of dysthymia and 2.2% of hypomanic episodes. Anxiety disorders came second: 28.1% (among which 19.1% panic disorder, 13.5% agoraphobia, 12.4% generalized anxiety disorder, 10.1% social phobia and 4.5% post-traumatic stress disorder). Female gender, unemployment and poor compliance to antiepileptic drugs are all risk factors for the occurrence of psychiatric disorders in this population.

Analysis of reasons for low adherence to antiepileptic therapy in patients with symptomatic epilepsy

Objective: to study the major factors that influence treatment adherence. Patients and methods. One hundred patients aged 20 to 68 years (mean age 42.9±3.0 years for women and 43.3±5.0 years for men) diagnosed with a ≥3-year history of symptomatic epilepsy were screened. The minimal and maximal durations of the disease were 5 and 59 years, respectively (mean 20.8±3.9 years). Results and discussion. There was a female preponderance in the treatment adherence group. The patients who had secondary special education were unemployed, disabled, and single were in both comparison groups. These data are indicative of social stigmatization in epileptic patients. Patients with severe epilepsy on multiple drug therapy were prevalent. Neuropsychological testing revealed higher levels of anxiety and depression among those who were non-adherent to therapy. Conclusion. The sex, age, and social characteristics (education level, disability) of patients with epilepsy and its clinical picture, neurological symptoms and changes were ascertained by magnetic resonance imaging had no significant impact on therapy adherence. The factors influencing treatment adherence should include multiple drug therapy (co-administration of two or three drugs) and the high frequency of drug use, which is more frequently observed in patients with severe treatment-resistant epilepsy. Anxiety and depressive disorders in epileptic patients resulted in impaired compliance with anticonvulsant therapy.

Reboxetine and its influence on the action of classical antiepileptic drugs in the mouse maximal electroshock model

BackgroundOur previous studies revealed that different classes of antidepressant drugs differently affect seizure phenomena. Continuing our research in this field, in the present study we wanted to investigate the influence of acute and chronic treatment with reboxetine, a selective norepinephrine reuptake inhibitor, on the anticonvulsant action of classical antiepileptic drugs. MethodsExperiments were conducted in the model of electroconvulsive threshold and maximal electroshock in mice. Motor coordination was evaluated in the chimney test and long term memory in the step-through passive avoidance task. Brain concentrations of antiepileptic drugs were detected by fluorescence polarization immunoassay. ResultsAcute treatment with reboxetine (8–16mg/kg) significantly raised the electroconvulsive threshold. In contrast, chronic reboxetine (2–16mg/kg) did not affect this parameter. Single administration of the antidepressant applied at its subthreshold doses enhanced the action of valproate, carbamazepine and phenobarbital. The antielectroshock effect of phenytoin was also potentiated by acute reboxetine, but only at doses increasing the threshold. Repeated administration of reboxetine (8–12mg/kg) enhanced the anticonvulsant action of carbamazepine, but not that of three remaining antiepileptic drugs. Neither acute nor chronic reboxetine changed the brain concentrations of valproate, carbamazepine, phenytoin or phenobarbital. Therefore, all revealed interactions seem to be pharmacodynamic. In terms of undesired effects, acute/chronic reboxetine and its combinations with classical antiepileptic drugs did not significantly impair motor performance or long-term memory in mice. ConclusionsAs far as the obtained data can be extrapolated into clinical conditions, it seems that reboxetine may be safely used in the treatment of depressive disorders in epileptic patients.

Effect of sodium valproate on the sleep structures of epileptic patients.

The aims of the present study were to investigate the effect of sodium valproate (VPA) on the sleep structures of epileptic patients and the correlation of these effects with patient weight gain. A total of 60 epileptic patients were divided into three groups: E-AED I (VPA administration for a duration of <3 months), E-AED II (VPA administration for a duration of >3 months) and ECO (without VPA) groups, for polysomnography monitoring. When the E-AED II group was compared with the E-AED I and ECO groups, non-rapid eye movement sleep phase 1 was significantly prolonged (92.10±48.24, 29.50±10.61 and 23.94±13.27 min, respectively; P<0.01), rapid eye movement sleep was significantly shortened (70.82±17.69, 116.99±12.90 and 126.19±35.01 min, respectively; P<0.01), sleep efficiency was significantly reduced (89.39±2.55, 91.98±2.53 and 91.96±3.14%, respectively; P<0.01), the number of times of that the patients awoke was significantly increased (7.25±2.86, 2.55±1.42 and 2.40±1.39, respectively; P<0.01) and the number of REM phases throughout the night was significantly reduced (P<0.01). There were no significant differences for the various sleep parameters between the E-AED I and ECO groups. Therefore, VPA is capable of inducing sleep structure disorders in epileptic patients. In addition, these disorders begin 3 months following the administration of VPA, which indicates that these disorders may be associated with VPA-induced weight gain.

Correction of affective and cognitive disorders in epileptic patients and the value of lamotrigine

The paper characterizes an association of cognitive and affective disorders in epilepsy, which may be a cause of worse quality of life, social dysadaptation, and disability. In this connection, it is imperative to choose correct antiepileptic drugs (AEDs). Groups of AEDs with different modes of action are considered, among which, lamotrigine that is noted for its unique profile of not only antiepileptic, but also psychotropic properties is given much attention.

Épilepsies vitamino-sensibles

Inborn error of metabolism may produce a complex clinical picture in which epilepsy is only one of the various neurologic manifestations including developmental delay/regression, mental retardation, and movement disorders. However, metabolic epilepsies may dominate the clinical presentation. A specific diagnosis of metabolic disorders in epileptic patients may provide the possibility of specific treatments that can improve seizures. In a few metabolic diseases such as vitamin-responsive epilepsies, epilepsy responds to specific treatments based on supplementation of cofactors. Certain rare vitamin-responsive inborn errors of metabolism may present as early encephalopathy with anticonvulsant-resistant seizures. These include pyridoxine-dependent seizures, pyridoxal-phosphate-dependent seizures, folinic acid-responsive seizures, and biotinidase deficiency. This review discusses our current understanding of these vitamin-responsive epilepsies.

Epileptic seizure-induced structural and functional changes in rat femur and tibia bone tissues: a Fourier transform infrared imaging study

The disease- and drug-related bone disorders are rapidly increasing in the population. It is previously reported that anti-epileptic drugs (AEDs) may cause osteopenia, osteoporosis, and fractures in epilepsy patients. However, it cannot be determined whether the bone disorders in epileptic patients are due to AED therapy and/or to epilepsy and epileptic seizures. There is no study in the literature which investigates the sole effects of epilepsy and epileptic seizures on bone tissues. The current study provides the first report on determination of the possible effects of epilepsy and epileptic seizures on long bone tissues. Wistar Albino Glaxo/Rijswijk rats, which are accepted as genetic rat models for human absence epilepsy, were compared with the healthy Wistar rats to get information about the sole effects of epilepsy and epileptic seizures on bones. Cortical regions of tibia and femur bones were studied by Fourier transform infrared microspectroscopy (FTIRM). According to FTIRM parameters, variation on bone mineral and matrix composition, including decreased mineral content, decreased collagen cross-links, increased carbonate substitution, and larger crystals in epileptic group compared to the healthy one, show severe effects of epilepsy and seizures on bone tissues for the first time.

Association Between Epileptiform Discharges and the Sleep Cycle in 200 Epileptic Patients

ABSTRACTObjective: The poor sleep quality of epileptic patients may be partly due to the occurrence epileptiform discharges (EDs). We observed the number of interictal discharges in each sleep stage and explored the associations between EDs and sleep phases in epileptic patients. Methods: Two hundred epileptic patients and 182 healthy volunteers were enrolled in the current study. For all subjects, video electroencephalography (EEG) monitoring and 24-hr night polysomnography were conducted to detect EDs and analyze the sleep structures. Results: EDs were detected in 91% of epileptic patients with the most frequent cases from the temporal lobe. The EDs detected during waking, sleeping, or both waking and nonrapid eye movement (NREM) sleep stages 1–2 accounted for 7.1%, 19.2%, and 25.3% of the total patients, respectively. EDs were rare during NREM stages 3–4 with 1.1% of total patients mainly in the central–temporal lobe. The total sleep time and time spent in REM were similar between the epileptic patients and healthy volunteers. However, epileptic patients spent a significantly longer mean sleep time in NREM stages 1–2 (293.91 ±27.57 min vs. 223.17 ±15.28; p = .000) and less in NREM stages 3–4 (50.11 ± 12.12 min vs. 133.96 ±10.77; p = .000) than healthy volunteers. Furthermore, asymmetric sleep spindles and fragmentary sleep structure as well as high inversion frequency were found in 26.7% and 43.3% of epileptic patients, respectively. Conclusion: Combination of long-term video EEG with polysomnography is a useful method to analyze associations between EDs and the sleep–wake cycle. This strategy can also help identify the nature of sleep disorders in epileptic patients, which may improve the treatment efficacy.

Effect of lamotrigine and environmental enrichment on spatial memory and other behavioral functions in rats

Epileptic patients are at risk of experiencing cognitive deficits as a result of pharmacotherapy as well as etiology of epilepsy. Antiepileptic drugs increase inhibitory neurotransmission and reduce the responsiveness of neurons, and thereby may have a negative impact on memory. The enriched environment intensifies exploration of the new area behavior, which may have a positive impact on spatial memory in rats. Depression is among the most common affective disorders in epileptic patients, and using antidepressant drugs together with antiepileptics brings about the risk of interactions and intensifying side effects, The aim of the study was to assess the effects of lamotrigine (CAS 84057-84-1, LTG) (10 mg/kg i.p.), a new anticonvulsant with antidepresssant and neuroprotective properties, for memory and other behavioral functions in rats in standard and enriched environments (EE). LTG improved spatial memory upon repeated administration of the drug both in the rats housed in standard conditions and those housed in EE. Exposure to an enriched environmentsignificantly improved spatial learning. LTG showed antidepressant effect on the forced swimming test both in the rats housed in standard conditions and those housed in EE. In rats housed in EE the antidepressant effect occurred earlier. LTG had a low profile of adverse effects (activity meter, chimney test).

Alterations in serotonin receptors and transporter immunoreactivities in the hippocampus in the rat unilateral hypoxic-induced epilepsy model.

Unilateral hypoxic-ischemia results in the frequent occurrence of interictal spikes, and occasionally sustained ictal discharges accompanied by a reduction in paired-pulse inhibition within the non-lesioned dentate gyrus. To elucidate the roles of serotonin (5-hydroxytryptamine [5-HT]) in an epileptogenic insult, we investigated the changes in 5-HT receptors and serotonin transporter (5-HTT) immunoreactivities within the lesioned and contralateral hippocampus following unilateral hypoxic-ischemia. During epileptogenic periods following hypoxic-ischemia, both 5-HT(1A) and 5HT(1B) receptor immunoreactivities were decreased within the lesioned and the non-lesioned hippocampus. However, 5-HTT immunoreactivity was transiently increased within the hippocampus bilaterally. These findings indicate that alteration of the 5-HT system results in a "diaschisis" pattern, and may contribute to neuronal death and the development of emotional disorders in epileptic patients accompanied by psychological stress.

Prevalence of psychiatric comorbidities in temporal lobe epilepsy: the value of structured psychiatric interviews

Although many studies have demonstrated a high prevalence of psychiatric disorders in epileptic patients, most have used unstructured psychiatric interviews for diagnosis, which may lead to significant differences in results. Here we present a study evaluating the prevalence of major psychiatric comorbidities in a cohort of South Brazilian patients with temporal lobe epilepsy using a structured clinical interview. Neuropsychiatric symptoms were analyzed in 98 patients (39 men and 59 women) with temporal lobe epilepsy. Patient mean age was 43 years old, and mean duration of epilepsy was 25 years. Patients were diagnosed according to the ILAE Classification of Epileptic Syndromes using clinical, EEG, and neuroimaging criteria. All patients participated in the Structured Clinical Interview for DSM-IV (SCID). Fifty-three patients (54.1%) presented major psychiatric comorbidities. Mood disorders were observed in 42 patients (42.9%), the most common being neuropsychiatric disorders. Anxiety disorders were the second most frequent disorders, observed in 18 patients (18.4%). Psychotic disorders and substance abuse were each observed in six patients (6.1%). There were no clinical variables regarding epilepsy characteristics (age of onset, duration, response to antiepileptic drugs) and no MRI features associated with psychiatric disorders. A seven-fold increased risk of mood disorders was identified in patients with inter-ictal EEG abnormalities associated with the left hemisphere. Relative to previous reports, we identify a high prevalence of psychiatric disorders in TLE patients, although our data is similar to that observed in other studies which have used similar structured interviews in populations of epileptic patients attending tertiary centres. The wide variation in percentages is probably attributable to the different patient groups investigated and to the even greater variety of diagnostic methods. Structured psychiatric interviews may contribute to a better evaluation of the true prevalence of psychiatric comorbidities in temporal lobe epilepsy.

T09-P-06 Sexual dysfunction in patients with temporal lobe epilepsy

Objective the current study was carried out in order to find any possible relationships between seizure semiology, their frequency, antiepileptic drugs treatment and affective disorders and sexual disorders in epileptic patients. Design and methods Two groups of epileptic patients with (100 persons) and without (50) sexual disorders were compared in study. Munich Personality Test (MPT; SCL-90; Hamilton Depression Scale and National Hospital Scale for Severity of Seizures (NHS3) were used in study. Results Obtained results have shown that libido reduction and disharmonic sexual relationships were the most frequent complaints in epileptic patients and has occurred in 75% of patients. Patients with sexual dysfunctions were mostly characterized by temporal lobe epilepsy, concomitant depressive disorder, frequent complex partial seizures and long duration of epilepsy compared with epileptic patients without sexual disorders. Conclusion Sexual dysfunctions in patients with epilepsy seem to have interrelationship with temporal epilepsy with co-morbid depression and represents one facet of Geschwind-Gastout triad. Suggestion can be made that mesial temporal epilepsy is risk factor for possible sexual dysfunctions development. The therapy methods should be elaborated for improvement of quality of life in patients with temporal lobe epilepsy and sexual dysfunctions.