Faculty Bibliography

Psychiatric and cognitive disorders in persons with epilepsy (PWE) are often overlooked or undertreated. Studies have shown that they occur in all types of epilepsy, but they are especially prominent when epilepsy is severe and multiple antiepileptic drugs are used. In particular, the clinician should be vigilant about the coexistence of depression with epilepsy. The depression must be properly treated to improve quality of life and also to prevent the mood disorder from interfering with epilepsy treatment.Mortality in PWE is overall twice that in the general population, but most of the increased mortality is due to major conditions with which the epilepsy is associated. The clinician should be aware that some PWE have increased risk for suicide. The phenomenon of sudden unexplained death in epilepsy occurs at the highest rate in persons with uncontrolled seizures, especially generalized convulsive seizures. For now, optimizing seizure control appears to be the best way to reduce the risk for this still mysterious and catastrophic event.

Little is known about psychiatric aspects of pediatric demyelinating conditions. A total of 23 youths (6-17 years) with demyelinating conditions underwent semistructured psychiatric interviews using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version. Adolescents and parents completed the Child Symptom Inventory-4 and the Youth's Inventory-4. Fears and conceptions of their neurological problems were elicited. In all, 48% (n = 11) met criteria for current psychiatric diagnoses, including 27% (n = 3) with depressive disorders and 64% (n = 7) with anxiety disorders. Fears and conceptions of the illness were severe and diverse. Depressive and anxiety disorders are common in pediatric demyelinating disease. Clinicians should therefore screen for psychiatric comorbidity symptoms as part of the routine evaluation of such patients

This retrospective study examined whether psychiatric conditions are directly related to epilepsy or, rather, are associated with underlying central nervous system (CNS) disorders linked to subsequent epilepsy. We examined data from a sample of older veterans (>65 years) receiving care from the Veterans Health Administration during fiscal year 2000. We compared individuals with new-onset epilepsy and individuals without epilepsy to examine the extent to which psychiatric disorders were associated with new-onset epilepsy; this analysis controlled for demographic and premorbid neurological risk factors previously associated with new-onset epilepsy. Premorbid psychiatric conditions occurred at higher rates in the epilepsy versus nonepilepsy groups, foremost including depression (17% vs 12%), anxiety (12% vs 8%), psychosis (12% vs 5%), and substance abuse (8% vs 4%). However, in the final model, only psychosis (OR=1.4, CI 1.2-1.6) was significantly associated with epilepsy when controlling for neurological disorders and psychiatric conditions (e.g., stroke, dementia, brain tumor, head injury).

Few studies have examined the issues that are specific to the older person with epilepsy, a population of increasing prominence in epilepsy management. Our understanding of the impact of epilepsy in the older person is based predominantly on what is inferred from studies of younger adults. Consequently, there is relatively little documented about the impact of epilepsy on the everyday lives of older people. In this article, we focus on adherence and its consequences for the physical, social, and psychological well-being of the older person. A number of strategies are proposed to improve adherence, including patient education through better communication between physician and patient; simplification of the medical regime; and use of extended-release formulations. This issue highlights that to ameliorate the impact of epilepsy for the older person with epilepsy, a greater understanding is required so that appropriate interventions can be tailored.

PURPOSE/OBJECTIVE:To assess anger/hostility during treatment with lamotrigine adjunctive therapy versus levetiracetam adjunctive therapy in patients with partial seizures. METHODS:This randomized, double-blind, parallel-group study in adults with partial seizures included an 8-week escalation phase, during which adjunctive lamotrigine (n = 132) or adjunctive levetiracetam (n = 136) was titrated to a target dose, and a 12-week, double-blind maintenance phase, during which dosages of study medication and concomitant antiepileptic drugs were maintained. The primary endpoint was change from baseline to the end of the maintenance phase (week 20) in the Anger-Hostility subscale score of the Profile of Mood States (POMS). RESULTS:Improvement with lamotrigine relative to levetiracetam was observed for mean +/- SD (standard deviation) change from baseline to the end of the maintenance phase (week 20) on the Anger-Hostility subscale (lamotrigine -2.0 +/- 8.2, levetiracetam -0.3 +/- 8.4; p = 0.024) (the primary endpoint); the Anger-Hostility subscale on weeks 5, 6, 7, 8, 9, 11, 12, 14, 16, 18, and 19; and the Total Mood Disturbance score on weeks 6, 7, 8, 9, 11, 12, 17, 19, and 20. Improvement (p < 0.05) with lamotrigine relative to levetiracetam was also observed on the POMS subscales Depression-Dejection, Vigor-Activity, Fatigue-Inertia, and Confusion-Bewilderment. No difference in seizure frequency was observed between groups. The most common adverse events with both medications were headache and dizziness. DISCUSSION/CONCLUSIONS:Adjunctive lamotrigine significantly improved Anger-Hostility subscale scores relative to adjunctive levetiracetam in patients with partial seizures at the end of 20 weeks. This difference was consistently observed throughout the treatment period. Similar improvement with lamotrigine versus levetiracetam was observed for other mood symptoms.