Psychosis in epilepsy patients and other chronic medically ill patients and the role of cerebral pathology in the onset of psychosis: A clinical epidemiological study

BACKGROUND: In a 3-year epidemiological survey (N=2623) prevalence of psychosis in epilepsy patients as compared with other chronic medically ill patients is assessed. AIM: To explore the role of cerebral pathology as compared to the role of chronic burden of disease in the onset of psychosis. METHOD: One thousand seven hundred fifty two patients with chronic medical disorders admitted to an Academic Hospital and 901 patients with epilepsy admitted to a tertiary care epilepsy clinic were assessed by CIDI, MINI and clinical psychiatric interview in a two stage screening survey. Medical files were searched for MRI scans about cerebral pathology. Poisson regression analysis was performed to estimate the relative risk for psychosis in both groups. RESULTS: In total, 52 patients with prevalent psychosis were found: 49 (5.4%) in the epilepsy clinic and 3 (0.17%) in the Academic Hospital. Age range (18-88), mean age (42) and gender distribution (equal) were similar in both samples. RR is 8.37 (2.74, 25.52). In 16 of the 49 epilepsy patients, cerebral pathology existed with mainly temporal and frontal localisation and of childhood-onset vascular or infectious origin. CONCLUSIONS: This finding suggests that in the onset of psychosis in epilepsy patients, the role of cerebral pathology, especially localized left temporal and frontal, is of strong etiological importance. The following epilepsy endophenotypes should be explored as factors in vulnerability for psychosis as well: frequent and severe epileptic activity; and psychotic reactions to certain AEDs, such as Topiramate and Lamotrigine. Burden of disease does not seem to play an important role.     

Factors associated with epilepsy in children with periventricular leukomalacia

Children with cerebral palsy associated with periventricular leukomalacia frequently develop unprovoked epileptic seizures. This article reports an analysis of risk factors for epilepsy in children with radiologically confirmed periventricular leukomalacia. This cohort was screened for epilepsy and for an array of clinical and demographic factors. Of 154 subjects with radiologically confirmed periventricular leukomalacia, 40 (26.0%) had epilepsy. In the epileptic group, radiologic pathology other than periventricular leukomalacia was uncommon. Significant associations were found between epilepsy and cerebral palsy patterns other than spastic diparesis, mental handicap, cortical visual impairment, neonatal seizures, and severe periventricular leukomalacia. Only the presence of neonatal seizures was significantly associated with epilepsy once other risk factors were controlled in the regression model. Some previous studies have shown an association between neonatal seizures and later epilepsy for cerebral palsy in general. This is the first report of such an association for a single predominant type of cerebral pathology.     

Psychiatric Disorders in Epilepsy: Clinical Aspects

Increased levels of psychiatric morbidity are associated with epilepsy in adults and children. The relationship between type of epilepsy, seizure focus, and nature of psychiatric disturbance remains controversial and varies across studies. Behavioral disturbances associated with epilepsy may be related to the seizure discharge itself, interictal discharges, adverse psychosocial consequences of chronic epilepsy, underlying CNS pathology, or antiepileptic drugs. Such symptoms could also coexist with epilepsy without there being a causal relationship between the two. The major psychiatric conditions associated with epilepsy are psychosis, personality disorders, depression, and anxiety. The clinical aspects of these disorders as they relate to epilepsy are reviewed.     

Comparison of the psychosocial effects of epilepsy and narcolepsy/cataplexy: a controlled study

A questionnaire survey compared the psychosocial effects of epilepsy in 60 patients without major organic pathology (selected cases with temporal lobe epilepsy or primary generalized epilepsy) with those of matched (duration of illness, sex) patients with narcolepsy/cataplexy and with those of age- and sex-matched controls. Comparing epileptic patients with controls, we confirmed the well-documented marked deleterious effects of epilepsy upon work, education, occupational and household accidents, recreation, personality, interpersonal relations, and other parameters. Comparisons of epileptic and narcoleptic patients, however, showed that, in general, persons with narcolepsy are even more psychosocially impaired. The narcoleptic patients showed greater frequencies of disease-attributed reduced performance at work, poorer driving records, higher accident rates from smoking, greater problems in planning recreation, and other significant differences. Rather dissimilar profiles of psychosocial impairment were found to characterize the two conditions, and these were largely understandable as a function of their symptoms. The only areas in which epileptic patients showed greater problems than those with narcolepsy were in educational achievement and in ability to maintain a driving license. Most of the intergroup differences remained significant even for smaller groups matched also for age. The somewhat greater psychosocial impact of narcolepsy appears to be due to the continuous excessive daytime sleepiness that persists between the diagnostic attacks, whereas persons with epilepsy are relatively alert between seizures.     

Psychosocial adjustment of people with epilepsy in Hong Kong

PURPOSE: In light of the issues associated with the psychosocial adjustment of people with epilepsy that have been widely reported, this study examined these issues within a Chinese cultural context. METHODS: Fifty patients with epilepsy completed The Washington Psychosocial Inventory, the Coping Inventory for Stressful Situations, and a questionnaire that assessed their psychosocial difficulties and coping styles. Multiple regression procedure was used to examine the strength of various medical and social factors in predicting the psychosocial adjustment problems of these participants. RESULTS: Social factors, such as self-perception and coping strategies, were more powerful predictors of psychosocial adjustment in people with epilepsy than the medical factors associated with epilepsy. CONCLUSIONS: These findings showed that psychosocial maladjustment is a significant issue for people with epilepsy in Hong Kong. The emerging importance of social factors as predictors of psychosocial adjustment in epilepsy, as compared with medical factors, highlights the need for developing tailored counseling therapy and social support groups for people with epilepsy.     

Surgery for temporal lobe epilepsy after cerebral malaria

The most common indication for epilepsy surgery is temporal lobe epilepsy (TLE) which usually is divided into two categories, mesial and lateral TLE. The commonest pathology underlying mesial temporal lobe epilepsy (MTLE) is mesial temporal sclerosis (MTS); we report on a 50-year-old male patient, who contracted cerebral malaria and developed MTLE shortly thereafter. Magnetic resonance imaging (MRI) showed MTS. Surgical treatment was an anteromedial temporal lobe resection with amygdalohippocampectomy. The patient is seizure free, 36 months after surgical treatment. This is the first report describing MTLE-onset subsequent to cerebral malaria and discussing the potential pathophysiological relationship between cerebral malaria and MTS.     

脑动静脉畸形患者癫痫间发作的相关因素分析

目的 探讨脑动静脉畸形并发癫痫间发作的相关危险因素以及癫痫间的合理预防措施。方法 回顾性分析286例脑动静脉畸形患者的临床及脑动静脉畸形基线资料。根据是否合并癫痫间发作分为癫痫间组和对照组。分析脑动静脉畸形患者并发癫痫间发作的危险因素,观察癫痫间组92例患者的发作类型及发作频率以及药物治疗反应情况。结果 癫痫间组与对照组畸形血管团的位置、畸形血管团直径、静脉引流方向等因素比较差异明显(P<0.05); 非条件多因素Logistic回归分析显示对脑动静脉畸形患者癫痫间发作有显著影响的因素为畸形团直径大于3 cm和由浅静脉或者浅深静脉共同引流(P<0.05)。经过抗癫痫间药物治疗,癫痫间组有69例患者癫痫间发作得到了完全控制,余患者发作频率均有不同程度减低。结论 畸形团直径大于3cm和由浅静脉或者浅深静脉共同引流是脑动静脉畸形患者并发癫痫间的危险因素; 脑动静脉畸形合并的癫痫间发作是一个相对良性过程,抗癫痫间药物对多数癫痫间患者治疗有效。     

Update on the epidemiology and prognosis of pediatric epilepsy

Epilepsy is among the most common serious neurologic disorders in childhood. Epidemiologic studies over the past few decades have greatly increased current knowledge of the incidence and prognosis of seizures. Newer epidemiologic studies have used population- or community-based cohorts, and careful attention has been given to etiology and specific epilepsy syndromes, the two most important factors affecting prognosis. Risk of epilepsy is highest in patients with an associated serious neurologic abnormality, such as mental retardation or cerebral palsy. More than two thirds of patients with childhood-onset epilepsy ultimately achieve remission. Of those attaining remission on medications, approximately 70% remain seizure free when medications are discontinued. Mortality is increased in patients with epilepsy, but the increased mortality risk in childhood-onset epilepsy is primarily seen in patients with neurologic abnormalities or intractable epilepsy. Although long-term seizure outcomes are generally favorable, childhood-onset epilepsy is associated with adverse long-term psychosocial outcomes, even in patients attaining remission. This review summarizes recent data on the epidemiology and prognosis of pediatric epilepsy.     

Epilepsy and primary cerebral tumours

Although the association of epilepsy with cerebral tumours is well recognized, the reported incidence of seizures and relationship to tumour pathology varies significantly. This study assessed retrospectively the incidence of seizures, relationship to tumour pathology, natural history of epilepsy and prognostic significance of presentation with a seizure in 120 consecutive adults with histologically proven primary cerebral hemisphere tumours including meningiomas. 52% had a seizure and most were at presentation. Seizures were more common with anaplastic astrocytoma (AA) (18 23 ) than glioblastoma multiforme (21 56 ) (p = 0.001) and seizure occurrence was associated with cortical invasion. 52% of meningioma patients had a seizure. Seizures recurred in 34%, more frequently with glioma (19 of 46) than meningioma (1 of 15) (p < 0.05). Patients with AA presenting with a seizure had a longer survival (28 months) than patients without seizure (8 months) (p = 0.05 one sided). In conclusion, seizures are a common complication of cerebral tumours, usually at presentation and correlate with tumour pathology. A seizure at presentation in AA correlates with longer survival.     

Interhemispheric differences in photosensitive epilepsy. II. Intermittent photic stimulation

Of a consecutive series of 138 photosensitive epileptic patients 57 showed a unilateral preponderance of asymmetrical discharges on IPS, significant in each individual at the 5% level. There was no association between asymmetry of IPS-induced discharges and clinical evidence of cerebral pathology (partial or secondary generalized epilepsy, neurological deficit, left handedness, etc.). It is concluded that these results, together with our previous findings of asymmetrical pattern sensitivity suggest that the cortical hyperexcitability postulated in primary cortico-reticular epilepsy is not uniformly distributed.     

Visual and computer-assisted assessment of the EEG in epilepsy of late onset.

A study was made of 275 patients presenting with suspected epilepsy after the age of 20 years. In 122 it was concluded that the attacks were non-epileptic. In 60 others cerebral pathology was found. If the EEG was visibly abnormal the risk of cerebral pathology was 8 times greater than when the record was normal. The EEGs were also assessed by an automatic pattern recognition technique, which classified them as abnormal by reference to a control population of 300 volunteers. 90% of EEGs from patients with pathology were classified as abnormal and, conversely, 86% of patients with abnormal records (as assessed by the automatic analysis) had pathology.     

Predictors of neuropsychological impairment in seizure-free epilepsy patients

Persons with epilepsy are at increased risk of cognitive deficits as a result of various factors like etiology, structural brain lesions, seizure frequency, seizure type, age at onset of epilepsy, hereditary factors, psychosocial factors, and possible adverse effects of antiepileptic drugs (AEDs). Despite the fact that the majority of epilepsy patients are seizure-free, previous studies on the relationship between epilepsy-related variables and cognitive function have mainly been conducted on patients with persisting seizures. In this study 158 adults with epilepsy on AED monotherapy and without epileptic seizures for at least 2 years were investigated with a neuropsychological test battery in addition to a neurological examination, MRI and EEG. The major findings were that the group had education and employment status similar to the population mean and neuropsychological function in the normal range. In the patient group without idiopathic generalized epilepsy known cerebral etiology was found to be a highly significant predictor of neuropsychological deficit. For patients with idiopathic generalized epilepsy, early seizure debut at < or =18 years was a powerful predictor of neuropsychological impairment.     

Childhood absence epilepsy with clinically apparent genetic and acquired burdens: a diagnostic consideration

Both genetic and acquired factors play important roles in the development of childhood absence epilepsy. This article describes a girl with mental retardation, probably due to a perinatal complication, who had typical absence seizures with characteristic electroencephalographic findings of childhood absence epilepsy, including normal background activity. This patient was subsequently found to have a strong genetic predisposition, which was suggested by the fact that childhood absence epilepsy also developed in her younger brother. Except for the mental subnormality, the electroclinical features of this patient satisfied the diagnostic criteria for childhood absence epilepsy. This case raises the question about diagnostic consideration of childhood absence epilepsy in association with cerebral pathology for genetically predisposed individuals.     

The relationship of regional frontal hypometabolism to executive function: a resting fluorodeoxyglucose PET study of patients with epilepsy and healthy controls

Executive dysfunction is common in patients with frontal lobe damage and may depend on the location of pathology within the frontal lobes. However, it is unclear how specific brain regions contribute to different aspects of executive functioning. Eighteen patients with frontal lobe epilepsy, 10 patients with juvenile myoclonic epilepsy, and 14 controls completed a series of tests that measure a broad range of executive functions. Resting fluorodeoxyglucose positron emission tomography scans were collected and regional cerebral rates of glucose uptake values were regressed on test scores. Results revealed that frontal lobe metabolic values were strong predictors of executive functioning in patients with epilepsy, but not in healthy controls. However, nonfrontal regions also contributed unique variance on several measures, suggesting that (1) a network of frontal and nonfrontal regions subserve many executive functions and (2) resting hypometabolism can be a useful predictor of executive dysfunction in patients with epilepsy.     

Behavioural adjustment in seizure-free epilepsy patients on monotherapy

PURPOSE: Risk of depression, anxiety, and reduced quality of life is elevated in epilepsy patients, due to a range of factors including aetiology, structural brain lesions, seizure worry, epilepsy surgery, hereditary factors, psychosocial factors, and possible adverse effects of antiepileptic drugs (AEDs). Studies on the relationships between epilepsy-related variables and behavioural adjustment have been mainly conducted on patients with persisting seizures, whereas the present study investigated behavioural function in epilepsy patients seizure-free for more than 2 years on monotherapy. METHODS: Adults with epilepsy on AED monotherapy and without epileptic seizures for at least 2 years (n=126) were assessed with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), in addition to MRI and EEG. RESULTS: Group analysis found mean MMPI-2 scores on all the clinical and content scales to be within the normal range. Abnormally elevated scores on scales measuring aspects of depression, health-related concerns, low self-esteem, negative treatment indicators, and physical complaints were recorded in a higher proportion of patients than would normally be expected. Multiple regression analysis showed that MRI pathology was a significant predictor for an abnormally poor score on the low self-esteem scale, and that epilepsy onset 相似文献   

Psychosocial Adaptation to Epilepsy: The Role of Coping Strategies

This article begins by reviewing the literature on the concept of psychosocial adaptation to impairment among persons with epilepsy. Particular attention is devoted to those roots reasoned to lie at the base of psychosocial problems manifested by people with epilepsy. The research literature on coping with epilepsy is then reviewed in two areas: (a) general coping styles and their relationship to psychosocial adaptation, and (b) specific coping strategies and their association with adaptation to epilepsy. Next, clinical implications of these findings are briefly outlined. The article concludes with a discussion of research limitations identified in the conceptualization and measurement of coping, followed by suggestions for future research on coping and adaptation to epilepsy.     

Epilepsy: Quality of Life and Cost of Care

The primary goal of epilepsy management is to enable the patient to lead a lifestyle as free from the medical and psychosocial complications of seizures as possible. This approach benefits a patient's quality of life as well as his or her family and society (particularly from a cost-of-care perspective). Though treatment with antiepileptic drugs is the primary therapy for epilepsy, physical and psychosocial issues must also be addressed. The indirect costs of epilepsy are related to the patient's ability to function. Since quality of life in epilepsy patients is improved with successful management, the indirect (and possibly the total) costs of epilepsy may decrease as the medical and psychosocial aspects of the disease are successfully managed.     

The impact of affectivity dispositions, self-efficacy and locus of control on psychosocial adjustment in patients with epilepsy

The main hypothesis of this study was that negative and positive affectivity, self-efficacy and health-related locus of control are important for psychosocial adjustment in patients with epilepsy. These dimensions are rarely examined directly in relation to the psychosocial adjustment in these patients. Correlations between measures of these constructs and measures of psychosocial adjustment in epilepsy were investigated. One hundred and one patients answered the Washington psychosocial seizure inventory (WPSI), the positive and negative affect schedule (PANAS-X), the multidimensional health locus of control scales (MHLC), the generalized self-efficacy scale and a scale measuring self-efficacy in epilepsy. Reliability analyses, correlational analyses and multiple stepwise regression analyses were performed. Negative affectivity (NA), positive affectivity (PA) and generalized self-efficacy showed high correlations with the WPSI scales emotional adjustment, overall psychosocial adjustment and quality of life. The epilepsy self-efficacy measures showed high, but lower correlations with the same WPSI scales. The MHLC scales showed low correlations with the WPSI scales. Multiple regression analyses showed that PA, NA and measures of self-efficacy explained more than 50% of the variances on emotional adjustment, overall psychosocial functioning and quality of life. In conclusion, positive and negative affectivity and self-efficacy are important predictors of perceived emotional adjustment, psychosocial adjustment and quality of life in patients with epilepsy. NA is the best predictor, but PA and self-efficacy measures give unique predictions independent of NA.     

卒中后癫痫临床分析

目的：探讨脑卒中后癫痫的临床特点及发病机制。方法：对2100例脑卒中病例中192例继发癫痫的临床资料进行回顾性分析。结果：卒中后癫痫的姓率为9．1％。早期癫痫发作6．04％,晚期癫痫发作3．09％,卒中后癫痫的发生率与病灶部位（皮质／皮质下）差异有显著性（P＜0．01）,与卒中类型差异不明显（P＞0．05）。结论脑水肿是早期癫痫发作的重要致痫,我期发作癫痫是因胶质疤痕等因素形成癫痫灶所致,建立议对晚期发作癫痫进行严格系统的有效治疗。     

Craniosynostosis as a risk factor

Craniosynostosis is a little known organic factor in sociopathy. This factor should be among those taken into consideration in selecting patients to undergo craniotomy. Among 22 000 skulls of neuropsychiatric patients, there were 100 with premature coronal synostosis, compared with 57 with dolichocephaly. Thirty-seven of the 100 patients with coronal synostosis exhibited disorders of social adaptation; frontal cortex functions are assumed to be involved. There were 34 cases of mental deficiency, 21 case of psychosis, 13 of cerebral vascular disease, 10 cases of epilepsy, 4 of acrocephalosyndactyly, 3 of decompensation by slight craniocerebral trauma, and 1 case of ependymoma of the IV ventricle. Dolichocephalic patients exhibited a stronger tendency towards depressivc states and cerebral vascular disease. The risks of cosmetic impairment and resulting psychosocial problems are discussed; especially in girls with oxy- and scaphocephaly craniofacial correction, is indicated, as it is also in patients with Saethre-Chotzen syndrome. In cases of premature synostosis of the coronal suture or synostosis of several sutures for carrying out a craniotomy, it is advisable to employ a combination of orbito-frontosphenoidal osteotomy for extension of the anterior cranial fossa. Craniosynostosis is a risk factor which, depending on the individual case and the sex and age of the patient, can impair central nervous functions, social adaption, and the blood supply of the brain.