Peripheral leukocyte profile in people with temporal lobe epilepsy reflects the associated proinflammatory state.

INTRODUCTION: Markers of low-grade peripheral inflammation have been reported amongst people with epilepsy. The mechanisms underlying this phenomenon are unknown. We attempted to characterize peripheral immune cells and their activation status in people with temporal lobe epilepsy (TLE) and healthy controls. METHODS AND RESULTS: Twenty people with TLE and 19 controls were recruited, and peripheral blood lymphocyte and monocyte subsets evaluated ex vivo by multi-color flow cytometry. People with TLE had higher expression of HLA-DR, CD69, CTLA-4, CD25, IL-23R, IFN-γ, TNF and IL-17 in CD4(+) lymphocytes than controls. Granzyme A, CTLA-4, IL-23R and IL-17 expression was also elevated in CD8(+) T cells from people with TLE. Frequency of HLA-DR in CD19(+) B cells and regulatory T cells CD4(+)CD25(+)Foxp3(+) producing IL-10 was higher in TLE when compared with controls. A negative correlation between CD4(+) expressing co-stimulatory molecules (CD69, CD25 and CTLA-4) with age at onset of seizures was found. The frequency of CD4(+)CD25(+)Foxp3(+) cells was also positively correlated with age at onset of seizures. CONCLUSION: Immune cells of people with TLE show an activation profile, mainly in effector T cells, in line with the low-grade peripheral inflammation.

Interleukin-1ß plasma levels are associated with depression in temporal lobe epilepsy.

Inflammatory mediators such as cytokines are likely to contribute to the pathophysiology of epilepsy. Proinflammatory cytokines are also associated with mood disorders, such as major depression. As people with temporal lobe epilepsy (TLE) are at an increased risk of mood disorders, we attempted to evaluate peripheral levels of IL-1ß in people with TLE with depression and people with TLE without depression and in healthy controls. In a cross-sectional study, we compared three groups: 21 people with TLE without depression (TLE D-), 18 people with TLE with depression (TLE D+), and 31 controls without depression. A structured clinical interview (MINI-Plus) was used to diagnose current depression, and the Hamilton Depression Rating Scale (HAM-D) was used to quantify depressive symptoms. Plasma levels of IL-1ß were significantly higher in people with TLE with depression than in controls (p=0.004) or people with TLE without depression (p=0.006). Interleukin-1beta levels positively correlated with HAM-D scores (Spearman's rho=0.381, p=0.017) in people with TLE. Higher levels of IL-1ß in TLE seem to be associated with depression.

Screening for depression in people with epilepsy: comparative study among neurological disorders depression inventory for epilepsy (NDDI-E), hospital anxiety and depression scale depression subscale (HADS-D), and Beck depression inventory (BDI).

PURPOSE: We aimed to assess and compare the psychometric properties of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Hospital Anxiety and Depression Scale Depression Subscale (HADS-D), and Beck Depression Inventory (BDI) as screening instruments for depression and suicidality in people with epilepsy. METHODS: One hundred twenty-six people (54% women) diagnosed with epilepsy were recruited and evaluated on their sociodemographic and clinical features. Depression and suicide risk were assessed with a structured psychiatric interview, the Mini International Neuropsychiatric Interview (MINI-Plus), and the performance of NDDI-E, HADS-D, and BDI was evaluated. RESULTS: The sensitivity and specificity of BDI for the diagnosis of depression was around 90%; HADS-D and NDDI-E have sensitivity higher than 80%, and specificity was greater than 75%. For identifying suicide risk, the NDDI-E sensitivity was 92.9%, and HADS-D sensitivity was 85.7%, and a reasonable specificity (68%) was observed for both instruments. All instruments showed a negative predictive value of over 90%. Comparisons of the areas under the ROC curve for these instruments were not significantly different regarding depression or moderate/severe risk of suicide. CONCLUSION: All three instruments evaluated have clinical utility in the screening of depression in people with epilepsy. Both NDDI-E and HADS-D are brief efficient screening instruments to identify depression in people with epilepsy. The BDI is a more robust instrument, but it takes longer to apply, which hampers its use by busy clinicians and by people with cognitive impairment.