Psychiatric Comorbidities In Epilepsy Research Articles

Knowledge and attitude about seizures among caregivers of patients with supratentorial craniotomy

Among the psychiatric co-morbidities in epilepsy, anxiety disorders are highly frequent and have profound influence on the quality of life of epilepsy patients. Moringa oleifera Lam. (Moringaceae) is used in traditional medicine to treat various ailments including anxiety and epilepsy. However, no scientific evidence exists to support its use. We studied antiepileptic and anxiolytic activities of aqueous extract of Moringa oleifera Lam. leaves (AEMO).Antiepileptic activity was evaluated using pentylenetetrazole (PTZ) induced seizure and maximum electroshock (MES) induced seizure test and anxiolytic activity was evaluated using elevated plus maze, light/dark box and hole board test.In present study, AEMO (250, 375 and 500 mg/kg, i.p.) demonstrated significant antiepileptic and anxiolytic effects. To study involvement of GABA in anxiolytic and antiepileptic activity of AEMO, we also evaluated effect of AEMO on Baclofen induced catatonia, a GABA mediated behavior, wherein AEMO significantly potentiated (preponed) baclofen induced catatonia, which is suggestive of its GABA mimetic action.Thus, it may be concluded that aqueous extract of M. oleifera possess anxiolytic and antiepileptic effects possibly mediated via of GABA mimetic action and these findings authenticate the traditional claims about use of Moringa oleifera in treatment of epilepsy and anxiety.

Botanicals for mood disorders with a focus on epilepsy

Mood disorders are among the major health problems that exist worldwide. They are highly prevalent in the general population and cause significant disturbance of life quality and social functioning of the affected persons. The two major classes of mood disorders are bipolar disorders and depression. The latter is assumed to be the most frequent psychiatric comorbidity in epilepsy. Studies published during the second half of the 20th century recognized that certain patients with epilepsy present a depressed mood. Synthesized pharmaceuticals have been in use for decades to treat both mood disorders and epilepsy, but despite their efficiency, their use is limited by numerous side effects. On the other hand, animal models have been developed to deeply study potential botanicals which have an effect on mood disorders. Studies to investigate the potential effects of medicinal plants acting on the nervous system and used to treat seizures and anxiety are increasingly growing. However, these studies discuss the two conditions separately without association. In this review, we present animal models of depression and investigative models (methods of assessing depression) of depression and anxiety in animals. Other classical test models for prediction of clinical antidepressant activity are presented. Finally, this review also highlights antidepressant activities of herbals focusing specially on depression-like behaviors associated with epilepsy. The pharmacological properties and active principles of cited medicinal plants are emphasized. This review, therefore, provides an overview of the work done on botanicals for mood disorders, potential mechanisms of action of botanicals, and the major compounds. This article is part of a Special Issue entitled "Botanicals for Epilepsy".

Frontolimbic brain networks predict depressive symptoms in temporal lobe epilepsy

Psychiatric co-morbidities in epilepsy are of great concern. The current study investigated the relative contribution of structural and functional connectivity (FC) between medial temporal (MT) and prefrontal regions in predicting levels of depressive symptoms in patients with temporal lobe epilepsy (TLE). Twenty-one patients with TLE [11 left TLE (LTLE); 10 right TLE (RTLE)] and 20 controls participated. Diffusion tensor imaging was performed to obtain fractional anisotropy (FA) of the uncinate fasciculus (UF), and mean diffusivity (MD) of the amygdala (AM) and hippocampus (HC). Functional MRI was performed to obtain FC strengths between the AM and HC and prefrontal regions of interest including anterior prefrontal (APF), orbitofrontal, and inferior frontal regions. Participants self-reported depression symptoms on the Beck Depression Inventory-II. Greater depressive symptoms were associated with stronger FC of ipsilateral HC-APF, lower FA of the bilateral UF, and higher MD of the ipsilateral HC in LTLE, and with lower FA of the contralateral UF in RTLE. Regression analyses indicated that FC of the ipsilateral HC-APF was the strongest contributor to depression in LTLE, explaining 68.7% of the variance in depression scores. Both functional and microstructural measures of frontolimbic dysfunction were associated with depressive symptoms. These connectivity variables may be moderating which patients present with depression symptoms. In particular, FC MRI may provide a more sensitive measure of depression-related dysfunction, at least in patients with LTLE. Employing sensitive measures of frontolimbic network dysfunction in TLE may help provide new insight into mood disorders in epilepsy that could eventually guide treatment planning.

Is it time to train neurologists in the management of mood and anxiety disorders?

Depression and anxiety disorders are the most frequent psychiatric comorbidities in people with epilepsy (PWE), with lifetime prevalence rates estimated to range between 30 and 35% in population-based studies [ [1] Tellez-Zenteno J.F. Patten S.B. Jetté N. Williams J. Wiebe S. Psychiatric comorbidity in epilepsy: a population-based analysis. Epilepsia. 2007; 48: 2336-2344 Crossref PubMed Scopus (762) Google Scholar ]. The need for their timely identification and treatment has been recognized for the last two decades. In fact, the National Institute of Neurological Disorders and Stroke (NINDS) has singled out psychiatric comorbid disorders as one of its benchmarks, while various aspects of mood and anxiety disorders in epilepsy have been the topic of major lectures and symposia at national and international scientific epilepsy congresses for the last ten years (e.g., American Epilepsy Society, European Epilepsy Congress, International Epilepsy Congress of the International League Against Epilepsy, Brain Mind and Epilepsy Congress). Yet, despite the wide recognition of the problems associated with these two conditions, they remain undiagnosed and untreated in a vast majority of these patients. Asato et al. address this problem head-on, as illustrated in their statement “again and again it is pointed out that the comorbidities continue to be under-recognized and undertreated and that patients with epilepsy have significant unmet mental health needs. Nonetheless, there is no indication that this disappointing state of affairs will change anytime” [ [2] Asato M.R. Caplan R. Hermann B.P. Epilepsy and comorbidities—what are we waiting for?. Epilepsy Behav. 2014; 31: 127-128 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar ].

Anxiety and Epilepsy: What Neurologists and Epileptologists Should Know

Although there has been increasing recognition of psychiatric comorbidity in epilepsy, most research and attention in this area has focused on depression. However, comorbid anxiety in epilepsy is highly prevalent, affecting more than 40 % of patients in some reports. Many important outcomes are significantly impacted by anxiety in epilepsy, including quality of life, mortality, and seizure status. Recent evidence from epidemiologic studies suggests a bidirectional association of anxiety and epilepsy, and there is mounting evidence for possible common pathophysiology underlying anxiety and epilepsy. Despite this importance, anxiety is under-recognized and undertreated in clinical practice. A variety of anxiety symptoms are seen in epilepsy, including symptoms exclusively before, during or after seizures (peri-ictal anxiety), symptoms resembling primary anxiety disorders, and anxiety directly related to epilepsy or its treatment. Key therapeutic approaches include pharmacotherapy or cognitive behavioral therapy for most forms of interictal anxiety and better seizure control for peri-ictal anxiety.

Study of psychiatric comorbidities in epilepsy by using the Mini International Neuropsychiatric Interview

BackgroundEpilepsy is a neurological condition affecting men and women of all age groups and is associated with psychiatric comorbid conditions. There is a paucity of published data available regarding psychiatric comorbid conditions in patients with epilepsy (PWEs) from developing countries. MethodsWe compared the psychiatric comorbid conditions in 80 PWEs, 80 patients with asthma (asthma control (AC) subjects), and 80 healthy controls (normal control (NC) subjects) using the Mini International Neuropsychiatric Interview (MINI) for the diagnosis of Axis I psychiatric disorders. ResultsPsychiatric comorbid conditions are more common in PWEs (32.50%) as compared with the AC (17.5%) and NC (7.5%) subjects. Longer duration of seizures, increased frequency of seizures, recent recurrence of seizures, anticonvulsant polypharmacy, poor compliance with medications, and family history of seizures were associated with increased psychiatric comorbidity. ConclusionPatients with epilepsy are more likely to have psychiatric comorbid disorders compared with the other patients with chronic illness or with the healthy controls. It is of immense clinical importance to identify the comorbid psychiatric disorders in PWEs as the treatment of these disorders apart from a good seizure control may significantly improve their quality of life.

Tryptophan hydroxylase 2 (TPH2) gene polymorphisms and psychiatric comorbidities in temporal lobe epilepsy

Psychiatric comorbidities are frequent in temporal lobe epilepsy (TLE). It is plausible that variance in serotonin-related genes is involved in the susceptibility of these associations. We report here the results on the association of tryptophan hydroxylase 2 (TPH2) gene polymorphisms with psychiatric comorbidities in TLE. A cohort study was conducted on 163 patients with TLE. We assessed the influence of the rs4570625 and rs17110747 polymorphisms in the TPH2 gene on psychiatric comorbidities in TLE. In patients with TLE, the presence of the T allele in the rs4570625 polymorphism was associated with psychotic disorders (OR=6.28; 95% CI=1.27–17.54; p=0.02), while the presence of the A allele in the rs17110747 polymorphism was associated with alcohol abuse (OR=20.33; 95% CI=1.60–258.46; p=0.02). Moreover, we identified male gender (OR=11.24; 95% CI=1.68–76.92; p=0.01) and family history of psychiatric disorder (OR=15.87; 95% CI=2.46–100; p=0.004) as factors also associated with alcohol abuse in TLE. Conversely, a family history of epilepsy was inversely associated with alcohol abuse (OR=0.03; 95% CI=0.001–0.60; p=0.02). Tryptophan hydroxylase 2 gene allele variants might be risk factors for psychiatric conditions in TLE. More specifically, we observed that the T allele in the rs4570625 polymorphism was associated with psychotic disorders, and the A allele in the rs17110747 TPH2 polymorphism was associated with alcohol abuse in patients with TLE. We believe that this study may open new research venues on the influence of the serotonergic system associated with psychiatric comorbidities in epilepsy.

Mental Illness Linked to Premature Death in Epilepsy Patients

Mental Illness Linked to Premature Death in Epilepsy Patients

Loss of Emotional Responsiveness Secondary to Left Amygdalohippocampectomy Performed for the Treatment of Complex, Drug-Resistant Partial Epilepsy

Loss of Emotional Responsiveness Secondary to Left Amygdalohippocampectomy Performed for the Treatment of Complex, Drug-Resistant Partial Epilepsy

Which symptoms are indicative of depression in epilepsy settings? An analysis of the diagnostic significance of somatic and non-somatic symptoms

BackgroundDepression is a common psychiatric co-morbidity in epilepsy. However, there have been no previous studies which have investigated the validity of individual symptoms for comorbid depression in epilepsy, in particular the diagnostic value of somatic and non-somatic symptoms. MethodsPatients with epilepsy diagnosed in a specialist epilepsy clinic were approached and completed several self-reported mood scales, prior to or immediately after their neurology outpatient consultations. Symptoms of depression were elicited using PHQ-9, BDI-II and HADS scales, comprising a total of 44 self report questions. 266 patients returned complete questionnaires of whom 18.0% met criteria for DSM-IV major depression according to the WHO Major Depression Inventory. ResultsAgainst DSM-IV major depressive disorder (MDD), both somatic and non-somatic symptoms were valuable. The top five most useful questions relating to a diagnosis of MDD in epilepsy were “Moving or speaking so slowly that other people could have noticed” “Little interest or pleasure in doing things” “Feeling down depressed or hopeless” “Trouble concentrating on things such as reading” and “Feeling tired or having little energy.” Four of these symptoms were rated as excellent initial screening questions for depression namely, “Moving or speaking so slowly that other people could have noticed” “Little interest or pleasure in doing things” “Feeling down depressed or hopeless” “Trouble concentrating on things such as reading.” The item “Moving or speaking so slowly that other people could have noticed” from the PHQ9 was endorsed in about 90% of depressed patients with epilepsy but only about 6% of non-depressed patients. ConclusionThese findings suggest that both somatic and non-somatic symptoms can be valuable when diagnosing depression in epilepsy and should be considered when designing scales for depression in epilepsy. Specific psychological symptoms and specific somatic symptoms are indicative of depression in epilepsy.

Changes in background electroencephalographic activity in patients with epilepsy and/without comorbid depression

PURPOSE: Depressive disorders are the most common interictal psychiatric comorbidity in epilepsy. Recent data highlights the possibility of a close bi-directional pathophysiological relationship between these two disorders. Early detection and treatment of interictal depressive disorder (DD) may significantly improve patients' quality of life. The aim of the present study was to compare recorded interictal electroencephalographic (EEG) data in patients with epilepsy with and without comorbid DD. MATERIAL AND METHODS: Forty patients with epilepsy were divided into two groups according to the presence/absence of comorbid DD. They were diagnosed by applying the International Classification of Diseases, Version 10 (ICD-10) diagnostic criteria. Evaluation on Hamilton Depression Rating Scale (HAM-D-17) supported the diagnosis. Nineteen-electrode electroencephalography (EEG) with spectral analysis of the power was recorded for each participant. Gender- and age-matched subjects comprised a control group. RESULTS: An increase in slow wave EEG activity in the frontal and temporal lobe as well as a decrease in sensory motor rhythm was found out in the group of patients with epilepsy and comorbid DD. No such findings were detected in the group of patients with epilepsy only. CONCLUSION: Atypical presentation of interictal DD is common in epilepsy. Comorbid depression remains unrecognized and untreated in a great proportion of patients. Detection of certain patterns of EEG changes may be useful as a screening tool for forwarding these patients to a further psychiatric evaluation. It can serve as a basis for applying alternative therapeutic methods such as the biofeedback method. Scripta Scientifica Medica 2013; 45(1): 48-51.

Treatment of anxiety disorders in epilepsy: An evidence‐based approach

During recent years growing attention has been paid to psychiatric comorbidities in epilepsy. However, anxiety disorders still remain underrecognized and undertreated. This is largely related to the lack of specific screening instruments and the frequent co-occurrence with mood disorders. Data on treatment are insufficient and clinical practice still relies heavily on individual experience. In this article we review evidence-based treatment strategies for primary major anxiety disorders and adapt them to the specific needs of patients with epilepsy. In panic disorder, a combined approach, namely serotonin-reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) is always indicated during the acute phase. Long-term maintenance treatment may include combined therapy or CBT alone depending on individual cases. For generalized anxiety disorders pregabalin has to be considered first choice for short-term and long-term treatment. In social anxiety disorder and posttraumatic stress disorder SSRIs, in particular sertraline and paroxetine, can be safely used. Obsessive-compulsive disorder represents a serious condition that needs to be approached in a psychiatric setting. CBT should be considered as the first choice in patients with epilepsy. If drug treatment is needed, epileptologists have to be aware that high-dose antidepressants are appropriate and that SSRIs, in particular sertraline, should be considered first choice. In these patients, careful clinical monitoring is indicated, in selected cases, for potential seizure precipitation and side effects due to pharmacodynamics interactions.

Influence of Depressive Mood on Quality of Life Ratings of Women with Epilepsy of Childbearing Age / Влияние Депрессивного Настроения На Оценку Качества Жизни У Женщин С Эпилепсией В Детеродном Возрасте

Depressive disorders are the most frequent psychiatric comorbidity in epilepsy. Depressive mood affects negatively quality of life (QOL) ratings, sometimes having greater impact than seizure-related variables. Women with epilepsy are a specific subgroup at risk of comorbid depression in consequence of certain biopsychosocial demands. The AIM of this study was to assess the relative contribution of mood, seizure-related and demographic variables on QOL scores in women with epilepsy of childbearing age. A psychiatric assessment was carried out of 65 women with epilepsy (aged 18-55, mean 37.23 +/- 11.83 yrs). Comorbid depressive disorder was diagnosed according to ICD-10 criteria. Its severity was evaluated on the Hamilton Depression Rating Scale (HAMD-17). A questionnaire for demographic and seizure-related variables was completed. Two self-assessment questionnaires were administered: the Seizure Severity Questionnaire (SSQ) and the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). The data were analysed using SPSS for Windows (version 17.0). Univariate correlation and multiple stepwise regression analyses were performed to explore the association between possible prognostic variables (independent variables) and QOLIE-31 overall and subscale scores (dependent variables). Analysis showed that demographic factors: employment and education; seizure-related factors: seizure severity, seizure frequency, antiepileptic drug therapy and comorbid depressive disorder were the variables significantly associated with QOLIE-31 overall score (p < 0.01). A three variable model accounted for 64.8% of the variance in QOLIE-31 overall score including seizure severity, comorbid depression and seizure frequency. Clinical factors are the strongest predictors of QOL of women with epilepsy in our study, seizure severity and comorbid depression being the main contributors. Paying attention to the psychological needs of women with epilepsy will have a positive effect on their QOL.

Serotonin gene polymorphisms and psychiatry comorbidities in temporal lobe epilepsy

Neuropsychiatric comorbidities are frequent in temporal lobe epilepsy (TLE). It is biologically plausible that alterations in serotonin-related genes may be involved in higher susceptibility to psychiatric disease in these individuals. Here we report results of an association study of serotonin gene polymorphisms and psychiatry comorbidities in TLE. Case-control study of 155 patients with temporal lobe epilepsy. We evaluate the influence of 5-HTTLPR and 5-HTTVNTR polymorphisms in the 5-HTT gene and the C-1019G polymorphism in the 5-HT1A gene in psychiatric comorbidities of TLE. After logistic regression, female sex (OR=2.34; 95% CI 1.06-5.17; p=0.035) and the presence of C allele of 5-HT1A C-1019G polymorphism (OR=2.77; 95% CI 1.01-7.63; p=0.048) remained independent risk factors for anxiety disorders in temporal lobe epilepsy. C allele of 5-HT1A C-1019G polymorphism might be an independent risk factor for anxiety disorders in temporal lobe epilepsy. We believe that other studies in this venue will shade some light on molecular mechanisms involved in psychiatric comorbidities in epilepsy.

P-534 - Influence of comorbid depressive disorder on quality of life ratings in epilepsy

The degree to which depressive disorders, as the most frequent psychiatric comorbidity in epilepsy, influence the quality of life (QOL) of the patients is a research issue of interest in recent years. Purpose of the study is to assess simultaneously the influence of some sociodemographic, seizure-related variables and comorbid depression in determining QOL of people with epilepsy (PWE). The study included 126 patients aged 18–60 with a determined diagnosis of idiopathic epilepsy. Comorbid depressive disorder was diagnosed according to ICD-10 diagnostic criteria followed by an evaluation on Hamilton Depression Rating Scale (HAMD-17). QOL was assessed by the Quality of Life in Epilepsy Inventory - 31(QOLIE-31). Seizure severity was measured by Seizure Severity Questionnaire (SSQ). Univariate and multivariate regression analyses were performed to explore the association between possible prognostic variables (independent variables) and QOLIE-31 overall and subscale scores (dependent variables). Following the univariate analysis gender, age, education and employment as sociodemographic factors and seizure severity, seizure frequency, duration of epilepsy and antiepileptic medication intake as seizure-related factors and comorbid depressive disorder were the variables strongly associated with QOLIE-31 scores. Multiple regressions examined the contribution of these independent variables to QOLIE-31 overall score and subscales’ scores. A three variable model accounted for 68.9% of the variance for QOLIE-31 overall score including seizure severity, comorbid depression and seizure frequency. Clinical factors are the strongest predictors of QOL of PWE in our study. Seizure severity and comorbid depression are found to be the main variables affecting QOLIE-31 scores.

Differential aberrant sprouting in temporal lobe epilepsy with psychiatric co-morbidities

Psychiatric co-morbidities in epilepsy are common in patients with temporal lobe epilepsy (TLE). Pathological alterations in TLE are well characterised; however, neuropathologic data are relatively scale regarding the association between psychiatric diseases and epilepsy. Our objective was to evaluate the clinical data of 46 adult TLE patients with and without psychiatric co-morbidities and to correlate the data with hippocampal neuronal density and mossy fiber sprouting. Accordingly, patients were grouped as follows: TLE patients without history of psychiatric disorder (TLE, n=16), TLE patients with interictal psychosis (TLE+P, n=14), and TLE patients with major depression (TLE+D, n=16). Hippocampi from autopsies served as non-epileptic controls (n=10). TLE+P exhibited significantly diminished mossy fiber sprouting and decreased neuronal density in the entorhinal cortex when compared with TLE. TLE+P showed significantly poorer results in verbal memory tasks. TLE+D exhibited significantly increased mossy fiber sprouting length when compared with TLE and TLE+P. Further, a higher proportion of TLE+D and TLE+P presented secondarily generalised seizures than did TLE. Our results indicate that TLE patients with psychiatric disorders have distinct features when compared with TLE patients without psychiatric co-morbidities and that these changes may be involved in either the manifestation or the maintenance of psychiatric co-morbidities in epilepsy.

Altered quality of life in epilepsy: significance of interictal depression

Depressive disorders, as the most common interictal psychiatric comorbidity in epilepsy, with prevalence rates of 10-60% of the patients, are an important issue in the management of people with epilepsy. AIM AND METHOD: We assessed the frequency, severity and the impact of comorbid depressive disorder on the quality of life (QOL) of people with epilepsy (PWE). The research was conducted on 106 patients with idiopathic epilepsy (41 males and 65 fe males), aged 18 to 60 years. There search protocol was applied interictally. Comorbid depressive disorder was diagnosed according to ICD-10 diagnostic criteria for affective and delusional disorders and supported by evaluation on Hamilton Depression Rating Scale (HAM-D-17). QOL was measured by Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Statistical analysis included analysis of variance, correlation analysis, t-tests analysis. RESULTS: Comorbid depressive disorder affected 30(28.3%) of all patients. Based on HAM-D-17 scores depression was defined as mild in 24(80%) patients, moderate in 5(17%) and severe in 1(3%) patient. There were significant between-group differences for the QOLIE-31 overall score and all scores on QOLIE-31 subscales which were lower for the patients with comorbid depressive disorder. A moderate correlation was found between the interictal depressive disorder and lower scores for QOLIE-31 overall score and overall quality of life, emotional well-being, energy/fatigue and social functioning subscales. CONCLUSIONS: Comorbid depressive disorder is relatively common in PWE resulting in significant reduction of QOL of the affected subjects. These data clearly high light the need to better appreciate its importance in the overall treatment plan of patients with epilepsy. Scripta Scientifica Medica 2011;V.43(1):47-50

DEPRESSIVE DISORDERS IN EPILEPSY

Depressive disorders are the most frequent psychiatric comorbidity in epilepsy but very often remain unrecognized and untreated. We examined 103 epileptic patients, aged 18-60 years, 40 males and 63 females, for the presence of interictal depressive disorder. All subjects underwent clinical psychiatric examination, including evaluation on Hamilton Depression Rating Scale (HAM-D17). A questionnaire for demographic and seizure-related variables was also completed. Concurrent depressive disorder (clinically presented according to ICD-10 diagnostic criteria) affected 28.3% of all evaluated patients. Based on HAM-D-17 scores depression was defined as mild 80% of all depressed patients, moderate 17% and severe 3%. Atypical presentation of interictal depressive disorder was frequent. Depression has a tremendous effect on one’s family, social and psychological functioning, even more than the actual seizure frequency and severity. Diagnostic difficulties come through the atypical mode of presentation of depressive disorders in epilepsy. Proper neuropsychiatric evaluation is essential for improving treatment and quality of life for patients with epilepsy.

Inventário de Depressão em Transtornos Neurológicos para a Epilepsia (IDTN-E): versão brasileira de um instrumento de rastreamento

INTRODUÇÃO: Depressão é a comorbidade psiquiátrica mais frequente na epilepsia, sendo sua identificação frequentemente negligenciada nos centros especializados. OBJETIVO: Avaliar o desempenho da versão brasileira do Inventário de Depressão em Transtornos Neurológicos para a Epilepsia (IDTN-E) em um grupo de pacientes atendidos em um serviço especializado. MÉTODOS: A versão brasileira do ITDN-E foi aplicada em um grupo de 142 pacientes com epilepsia. Foi utilizado o MINI-Plus como padrão ouro para o diagnóstico de episódio depressivo maior. Resultados: Quarenta pacientes (28,2%) apresentavam o diagnóstico de depressão no momento da avaliação. A análise da curva ROC indicou que o ponto de corte em 15 (&gt;15) para o IDTN-E representa dicotomização ótima entre deprimidos e não deprimidos (sensibilidade de 70,0%, especificidade de 87,3%, valor preditivo positivo de 68,3% e valor preditivo negativo de 88,1%). A utilização de pontos de corte inferiores pode eventualmente ser adotada para proporcionar uma maior sensibilidade ao instrumento. CONCLUSÃO: A versão brasileira do IDTN-E é um instrumento sensível e prático que pode auxiliar o rastreamento da depressão na epilepsia, diminuindo o seu subdiagnóstico.

Psychiatric Comorbidity in Epilepsy

Psychiatric Comorbidity in Epilepsy