Clinical relevance of interictal dysphoric disorder and its impact on quality of life in drug-resistant epilepsy.

OBJECTIVE: This study aims to assess the prevalence of Interictal Dysphoric Disorder (IDD) in drug-resistant epilepsy (DRE) and to describe its clinical and psychopathological profile, including personality, as well as its impact on quality of life (QOL). METHOD: A retrospective cross-sectional study from an Epilepsy Unit from January 2007 to December 2017. All patients were diagnosed with DRE. Patients underwent a battery of tests (HADS, SCL-90R, PDQ-4+, QOLIE-31) and a psychiatrist assessed the presence of Axis-I disorders and IDD. Statistical procedures were carried out using R-4.0.1 software. RESULTS: A total of 282 patients were included. A statistically significant association was found between IDD and mood and anxiety disorders (p < 0.001 and p < 0.05 respectively), and between IDD and higher scores in all HADS and SCL-90-R items compared to subjects without IDD (p < 0.001). A statistically significant association was also found between IDD and obsessive-compulsive, borderline and depressive personality disorder (p < 0.05). Scores in all QOLIE-31 items except for 'medication effects' were significantly lower in subjects with IDD compared with subjects without IDD (p < 0.001). CONCLUSIONS: In DRE, IDD subjects show differences in the psychopathological profile and QOL scores compared to subjects without a diagnosis of IDD. An early diagnosis of IDD could facilitate prompt interventions which might positively impact QOL.

Association between depressive and anxious symptoms with cognitive function and quality of life in drug-resistant epilepsy.

•Depressive/anxious disorders and cognitive impairment are frequent comorbidities in epilepsy and have a more deleterious effect in DRE.•Studies concerning the relationship between anxiety and depression and cognitive performance in DRE are scarce.•Higher scores in HADS are associated with lower QOLIE-31 scores and might be considered as predictors of QOL in DRE.•A relationship between anxious and depressive symptoms -measured with HADS and SCL-90R- and cognition might not exist.•There remains an unexplored study area regarding this relationship which requires more attention to improve the assessment of DRE.

[Peri-ictal SPECT in temporal lobe epilepsy: post-surgical evaluation]. / SPECT periictal en la epilepsia del lóbulo temporal: valoración tras cirugía.

INTRODUCTION: our aim was to evaluate the usefulness of peri-ictal SPECT in localising the epileptogenic region (ER) in candidates for temporal lobectomy to treat medically refractory complex partial seizures (CPS). Interictal and ictal SPECT, MRI and video-EEG results were compared and the positive predictive value (PPV) was calculated in those patients with good surgical outcome. MATERIALS AND METHODS: 37 patients who had a minimum of 3 years follow-up after surgery were studied retrospectively. Pre-surgical evaluation had included video-EEG monitoring, MRI and interictal and ictal SPECT. These results were compared to the surgically treated ER and successful outcome confirmed by post-surgical clinical follow-up. 29/37 patients remained seizure-free in the post-surgical follow-up. Interictal and peri-ictal SPECT were performed using 740 MBq of 99mTc-HMPAO. Peri-ictal SPECT was ictal in 25 patients and postictal in 12. RESULTS: ER concordance with video-EEG and peri-ictal SPECT was 86% (32/37 patients). It was 84% (31/37) for MRI and 54% (20/37 patients) for interictal SPECT. Peri-ictal SPECT localised the ER in 8/11 patients with discordant MRI and video-EEG results. Ictal SPECT localised the ER in the correct temporal lobe in 23/25 patients (92% concordance). In the 29 patients with a good surgical outcome, the PPV of video-EEG was 95% (27/29) and it was 90% (26/29) for both MRI and peri-ictal SPECT. CONCLUSIONS: peri-ictal brain SPECT is well able to localize ER in patients with temporal lobe epilepsy. Periictal SPECT concordance with ER was as good as video-EEG and MRI and its PPV was as good as that of MRI. We strongly recommend its use in the pre-surgical evaluation of temporal lobe epilepsy, especially when MRI and EEG are discordant.

[Neuropsychological aspects of obsessive compulsive disorder]. / Aspectos neuropsicológicos del trastorno obsesivocompulsivo.

INTRODUCTION AND OBJECTIVE: Neuropsychological performance in obsessive compulsive disorder (OCD) and its association with disfunctions in neuroanatomic structures and clinical symptoms of disorder has been reviewed. DEVELOPMENT: OCD symptoms and different aspects between children and adult psychopatology are presented. Briefly neurobiologic studies related with the etiology and patophisiology of OCD has been revised. This article summarizes some last studies about OCD cognitive functioning and its impairment. CONCLUSION: The more impaired cognitive functions in OCD are executive functions and visual abilities, specially non verbal memory. In addition, other studies have identified verbal memory deficits. These deficits are consistent with neurodevelopmental models, which hypothesizes that abnormalities of ventral prefrontal striatal and thalamic circuits may be involved in the etiology and patophisiology of OCD. The cognitive deficits could be functioning as a intermediate variable between neurobiological abnormalities and OCD symptoms. More studies are needed to analize the OCD cognitive impairment.

[Epilepsy surgery in a reference centre]. / Cirugía de la epilepsia en un centro de referencia.

INTRODUCTION: Patients with drug resistant epilepsy are potential candidates for surgery. The pre surgical study of these patients involves a multidisciplinary approach. PATIENTS AND METHODS: We included patients who had been submitted to EEG video monitoring in our centre (a tertiary university hospital) between April 1995 and May 2000. The evaluation protocol included magnetic resonance (MR) brain scan (according to a specific protocol), neuropsychological and psychiatric evaluation, and ictal/interictal SPECT, when possible. Patients who underwent surgery were followed up at regular intervals until at least two years after surgery. RESULTS: Of the 299 patients with EEG video monitoring, 87 had been submitted to surgery up to June 2000. Nine of these patients required invasive subdural studies or studies of the foramen ovale using electrodes. Of the patients who underwent surgery, 44.8% had sclerosis of the hippocampus in the MR and in 10% it was found to be normal. The results of pathological anatomy revealed: 49.3% with sclerosis of the hippocampus, 15.1% with benign tumours, 13.7% with gliosis, 4.1% heterotopias and 4.1% cavernomas. Just one patient has been submitted to surgery again because of badly controlled seizures. Eight patients have presented post surgical complications (four with permanent morbidity). Of the 73 patients who were followed up for at least a year, 83.6% are in Engel class I, 9.6% in class II, 2.7% in class III and 4.1% in class IV. Among patients who underwent a temporal resection, 88.7% were in class I and 0% in class IV. CONCLUSIONS: Epilepsy surgery, in selected patients, has a very low morbidity/mortality rate and the chances that seizures will disappear or greatly improve are high.

[Selective alteration of the declarative memory systems in patients treated with a high number of electroconvulsive therapy sessions]. / Alteracion selectiva de los sistemas declarativos de memoria en los pacientes tratados con un elevado numero de sesiones de terapia electroconvulsiva.

INTRODUCTION: The reversible electrochemical effects of electroconvulsive therapy (ECT) on specific areas of the brain enable the neuroanatomical bases of some cognitive functions to be studied. In research carried out on memory systems, a selective alteration of the declarative ones has been observed after treatment with ECT. Little work has been done to explore the differential alteration of the memory subsystems in patients with a high number of ECT sessions. AIM. To study the declarative and non declarative memory system in psychiatric patients submitted to maintenance ECT treatment, with a high number of previous ECT sessions. PATIENTS AND METHODS: 20 patients submitted to treatment with ECT (10 diagnosed as having depression and 10 with schizophrenia) and 20 controls, who were paired by age, sex and psychopathological diagnosis. For the evaluation of the declarative memory system, the Wechsler Memory Scale (WMS) logical memory test was used. The Hanoi Tower procedural test was employed to evaluate the non declarative system. RESULTS: Patients treated with ECT performed worse in the WMS logical memory test, but this was only significant in patients diagnosed as suffering from depression. No significant differences were observed in the Hanoi Tower test. CONCLUSIONS: A selective alteration of the declarative systems was observed in patients who had been treated with a high number of ECT sessions, while the non declarative memory systems remain unaffected.