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Depression screening tools in persons with epilepsy: A systematic review of validated tools

Epilepsia - Sun, 01/08/2017 - 03:45
Summary Objective

Depression affects approximately 25% of epilepsy patients. However, the optimal tool to screen for depression in epilepsy has not been definitively established. The purpose of this study was to systematically review the literature on the validity of depression-screening tools in epilepsy.

Methods

MEDLINE, EMBASE, and PsycINFO were searched until April 4, 2016 with no restriction on dates. Abstract, full-text review and data abstraction were conducted in duplicate. We included studies that evaluated the validity of depression-screening tools and reported measures of diagnostic accuracy (e.g., sensitivity, specificity, and negative and positive predictive values) in epilepsy. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies Version 2. Medians and ranges for estimates of diagnostic accuracy were calculated when appropriate.

Results

A total of 16,070 abstracts were screened, and 38 articles met eligibility criteria. Sixteen screening tools were validated in 13 languages. The most commonly validated screening tool was the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) (n = 26). The Mini International Neuropsychiatric Interview (MINI) (n = 19) was the most common reference standard used. At the most common cutpoint of >15 (n = 12 studies), the NDDI-E had a median sensitivity of 80.5% (range 64.0–100.0) and specificity of 86.2 (range 81.0–95.6). Meta-analyses were not possible due to variability in cutpoints assessed, reference standards used, and lack of confidence intervals reported.

Significance

A number of studies validated depression screening tools; however, estimates of diagnostic accuracy were inconsistently reported. The validity of scales in practice may have been overestimated, as cutpoints were often selected post hoc based on the study sample. The NDDI-E, which performed well, was the most commonly validated screening tool, is free to the public, and is validated in multiple languages and is easy to administer, although selection of the best tool may vary depending on the setting and available resources.

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ADHD Drug Could Improve Brain Function in People with Epilepsy

Epilepsy Research - Thu, 01/05/2017 - 11:02

Methylphenidate (MPH), a drug used for the treatment of attention deficit and hyperactivity disorder (ADHD), could improve cognitive problems in people with epilepsy, according to a study published in the scientific journal Neurology.

This suggestion is based on the results of a clinical trial that included 35 adults with epilepsy aged between 20 and 62 years, who had long-standing cognitive complaints, including poor attention and memory. The trial compared the effect of MPH, given in divided doses one week apart, with an identical looking dummy pill. Neither the participants nor the doctors knew who was getting the drug and who was getting the dummy until the trial had ended.

A total of 31 participants completed the trial, of whom 24 had focal epilepsy, six had generalised epilepsy and one had unclassified epilepsy. The average duration of epilepsy among the participants was 12.5 years with an average frequency of 2.8 seizures per month.

The research was led by Dr Kimford Meador, from Stanford University Medical Center in California, and evaluated cognitive function using three different tests. These were the Medical College of Georgia Paragraph Memory Test, the Conners Continuous Performance Test, which assesses attention and vigilance, and the Symbol-Digit Modalities Test, which measures general brain dysfunction. Seizure frequency and adverse effects of MPH were also monitored.

Overall, MPH treatment resulted in a significant improvement in cognitive performance. No change in seizure frequency was observed in any of the participants and only three people withdrew from the trial due to adverse effects. These included “fogginess” in thinking ability, anxiety and agitation, and tachycardia (fast heart rate while at rest).

The authors concluded that MPH may be effective in improving cognitive deficits in people with epilepsy, but they advised that additional studies are needed to confirm this finding.

Author: Dr Özge Özkaya

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Gene Associated with Bipolar Disorder also Linked to Epilepsy

Epilepsy Research - Thu, 01/05/2017 - 05:36

A gene called ANK3, which is associated with bipolar disorder (formerly known as manic depression) could also be linked to epilepsy, according to a study published in the scientific journal Molecular Psychology.

This new finding means that ANK3 could be targeted and opens new potential avenues for the treatment of epilepsy.

Research led by Dr Edward Cooper, at Baylor College of Medicine in Houston, Texas, has shown that reduced expression of one variant of the ANK3 gene causes an imbalance between nerve cell excitation and inhibition.

The team found that a protein encoded by a variant of the ANK3 gene, which is reduced in people with bipolar disorder, is selectively lost from inhibitory neurons, or neurons that block firing, meaning that the excitation/inhibition balance is shifted towards excessive excitation.

In a press release from Baylor, Dr Cooper said: “We found that reduced expression of one type of ANK3 removes a brake on the output of brain neurons, leading to excesses in firing in circuits for emotions, memory and epilepsy”.

In order to test the effect of this imbalance, researchers created a mouse model lacking the inhibitory form of the ANK3 gene. They found that the animals had frequent epileptic seizures and a high risk of sudden death.

“This showed us that imbalance in ANK3 function can result not only in excessive circuit sensitivity and output leading to bipolar disorder, but also severe epilepsy,” Dr Cooper said.

Dr Cooper and his team discovered, around ten years ago, that ANK3 interacts with two other genes that are mutated in some people with epilepsy. Soon after, genetic testing on a large number of psychiatric patients across the world revealed that ANK3 is linked to bipolar disorder but the connection with epilepsy remained unclear. Through this work the connection between ANK3 and epilepsy has been unravelled for the first time.

Author: Dr Özge Özkaya

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Continuous EEG Recording Could Help Doctors Identify People Most at Risk of Developing Seizures

Epilepsy Research - Tue, 01/03/2017 - 09:02

Continuous electroencephalographic (EEG) monitoring and a detailed interpretation of the data obtained from such monitoring could help doctors classify patients according to their risk of having seizures, according to a study published in the medical journal JAMA Neurology. This knowledge could help them make better clinical decisions such as treating those at higher risk of seizures with more aggressive treatment approaches.

In order to identify the specific characteristics of periodic and rhythmic EEG patterns they may be associated with an increased risk of seizures, Dr Andres Rodriguez Ruiz, of Emory University School of Medicine, and colleagues, reviewed EEG recordings from 4772 critically ill adults. The recordings were taken at Brigham and Women’s Hospital, Yale University Hospital, and Emory University Hospital between February 2013 and September 2015 and corresponded to 5742 sessions averaging 12 hours each. Epileptic seizures occurred during 719 sessions and in 530 of these (74%) periodic/rhythmic patterns were also recorded. 

The researchers analysed the EEGs in detail looking for different patterns of electrical activity called lateralized periodic discharges (LPDs), lateralized rhythmic delta activity (LRDA), generalized periodic discharges (GPDs), bilateral periodic independent discharges (BIPDs), and generalized rhythmic delta activity (GRDA).

The results showed that more LPDs and GPDs were associated with an increased risk of developing seizures. LPDs had the highest association with seizures regardless of their frequency, while LRDAs and GPDs were associated with seizures in a frequency-dependent manner. Finally, the researchers found that patients who had GRDA patterns were not any more likely to have seizures than those with no rhythmic/periodic patterns of activity recorded on the EEG.

According to the authors, “These findings highlight the importance of detailed electroencephalographic interpretation” to group patients according to their risk of developing seizures “and clinical decision making”. They also point to the importance of using a standardized terminology to describe the specific patterns recorded during the EEG.

Continuous EEG monitoring is a powerful technique, which is increasingly being used to monitor brain activity in order to clearly diagnose and detect non-convulsive epileptic seizures with great sensitivity.

Author: Dr Özge Özkaya

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