Stress regulation in drug-resistant epilepsy.

The prevalence of psychological distress, especially depressive and anxiety disorders, is higher in epilepsy than in other chronic health conditions. These comorbid conditions contribute even more than epileptic seizures themselves to impaired quality of life in patients with epilepsy (PWE). The link between these comorbidities and epilepsy appears to have a neurobiological basis, which is at least partly mediated by stress through psychological and pathophysiological pathways. The impact of stress in PWE is also particularly important because it is the most frequently reported seizure trigger. It is therefore crucial for clinicians to take stress-related conditions and psychiatric comorbidities into account when managing PWE and to propose clinical support to enhance self-control of stress. Screening tools have been specially designed and validated in PWE for depressive disorders and anxiety disorders (e.g. NDDI-E, GAD-7). Other instruments are useful for measuring stress-related variables (e.g. SRRS, PSS, SCS, MHLCS, DSR-15, ERP-R, QOLIE-31) in order to help characterize the individual "stress profile" and thus orientate patients towards the most appropriate treatment. Management includes both pharmacological treatment and nonpharmacological methods for enhancing self-management of stress (e.g. mindfulness-based therapies, yoga, cognitive-behavioral therapies, biofeedback), which may not only protect against psychiatric comorbidities but also reduce seizure frequency.

Self-control of epileptic seizures by nonpharmacological strategies.

Despite the unpredictability of epileptic seizures, many patients report that they can anticipate seizure occurrence. Using certain alert symptoms (i.e., auras, prodromes, precipitant factors), patients can adopt behaviors to avoid injury during and after the seizure or may implement spontaneous cognitive and emotional strategies to try to control the seizure itself. From the patient's view point, potential means of enhancing seizure prediction and developing seizure control supports are seen as very important issues, especially when the epilepsy is drug-resistant. In this review, we first describe how some patients anticipate their seizures and whether this is effective in terms of seizure prediction. Secondly, we examine how these anticipatory elements might help patients to prevent or control their seizures and how the patient's neuropsychological profile, specifically parameters of perceived self-control (PSC) and locus of control (LOC), might impact these strategies and quality of life (QOL). Thirdly, we review the external supports that can help patients to better predict seizures. Finally, we look at nonpharmacological means of increasing perceived self-control and achieving potential reduction of seizure frequency (i.e., stress-based and arousal-based strategies). In the past few years, various approaches for detection and control of seizures have gained greater interest, but more research is needed to confirm a positive effect on seizure frequency as well as on QOL.

Cognitive and metabolic correlates of emotional vulnerability in patients with temporal lobe epilepsy.

BACKGROUND: Recent investigations have suggested that the occurrence of epileptic seizures is not completely random. In particular, various types of psychological changes or life events may act as triggering factors. OBJECTIVE: To identify a possible link between self-perception of the impact of affective precipitants, cognitive responses modulated by aversive information and brain metabolic modifications in patients with temporal lobe epilepsy (TLE). METHODS: The extent to which seizures were elicited or not by emotional precipitants was estimated using a self-reported scale, allowing distinction of two groups: 'Emo-TLE' group (patients reporting to have seizures triggered by emotional events) and 'Other-TLE' group, which were compared with healthy individuals ('control' group). Attentional biases were investigated using the probe detection paradigm, using negative and neutral stimuli. Interictal brain metabolism was studied using FDG-PET, and comparison was made between controls, Emo-TLE and Other-TLE groups. RESULTS: Patients with emotional vulnerability (Emo-TLE) disclosed specific attentional biases towards negative stimuli compared with the Other-TLE and control groups. Patients with Emo-TLE also exhibited specific hypometabolism in the anterior temporal lobe, including amygdala and hippocampus. The degree of attentional biases correlated with decreased metabolism in these regions. CONCLUSIONS: This investigation shows that the impact of affective events is the result of self-perception and also that it might be determined by specific cognitive and brain metabolic modifications in TLE.

How do cognition, emotion, and epileptogenesis meet? A study of emotional cognitive bias in temporal lobe epilepsy.

Emotional distress is one of the most frequently reported seizure precipitants in epilepsy, but little is known about its causes and processes. Interestingly, it is now accepted that emotional distress, such as anxiety, may be accompanied by evolutionary adaptation, or abnormal attentional vigilance toward threatening stimuli. The goal of this research was to study the link between emotional seizure precipitants and pathological attention-related biases toward threat in temporal lobe epilepsy (TLE). To this aim, patients were asked to report the extent to which seizures were elicited or not by emotional precipitants, allowing distinction of two groups: "Emo-TLE" group and "Other-TLE" group. Attentional biases were investigated by comparing patients' emotional Stroop and dot detection paradigms with those of healthy individuals (control group). We found that the Emo-TLE group was characterized by attentional bias toward threatening stimuli compared with neutral stimuli and compared with the other two groups. We thus hypothesize that attentional biases related to threat in patients with TLE may sustain emotional vulnerability and seizure occurrence.

Subjective and physiological response to emotions in temporal lobe epilepsy and psychogenic non-epileptic seizures.

BACKGROUND: Temporal lobe epilepsy (TLE) and psychogenic non-epileptic seizures (PNES) are conditions frequently associated with dysfunction in emotional regulation leading to increased risk of affective disorders. This study investigates emotional processing with an objective measure of emotional reactivity in patients with TLE and patients with PNES. METHODS: 34 patients with TLE and 14 patients with PNES were evaluated on skin conductance responses (SCR) to emotions induced by short films and compared to 34 healthy controls. An attention and a suppression condition were performed while viewing the films. RESULTS: The both groups of patients disclosed lower SCR to emotions compared to controls, mainly in suppression condition. While TLE patients had lower SCR in attention condition than controls for fear, sadness and happiness, PNES had lower SCR only for happiness. In suppression condition, both had lower SCR than controls except for peacefulness in both groups and sadness in PNES. Subjective evaluations revealed that both patient's groups scored a higher intensity for sadness than controls in attention and lower for in fear and disgust in suppression only in TLE. LIMITATIONS: The sample size in the PNES group and the lack of a control group with similar levels of mood symptoms limited the interpretation of our results. CONCLUSION: As no correlation were found between SCR to emotions and scores of affective disorders, this pattern of responses might be underpinned by specific pathophysiological and cognitive mechanisms related to TLE and to PNES. Thus, therapeutic approaches targeting emotional autonomic responses can be of interest in the management of these conditions.

A case-control study of skin conductance biofeedback on seizure frequency and emotion regulation in drug-resistant temporal lobe epilepsy.

This study investigates the physiological basis of effects of skin conductance biofeedback on anxiety disorders, depressive disorders and stress in drug-resistant temporal lobe epilepsy (TLE). This method presents an interest in seizure reduction and improvement in psychiatric comorbidities frequently associated with TLE. Our goal was to better understand the impact of biofeedback on seizure control and on emotional regulation. Fifteen patients with TLE were treated with 12 skin conductance biofeedback sessions and compared with 15 control TLE patients on a waiting list. They were evaluated in terms of seizure frequency, clinical evaluations of anxiety and depression and skin conductance responses (SCR) to five emotions: fear, disgust, sadness, happiness and peacefulness induced by short films. Biofeedback training significantly reduced seizure frequency with a mean reduction of -47.42% in the biofeedback group, while the control group did not differ at the two time measures. A significant improvement was found for depression and trait-anxiety in the biofeedback group but not in the control group. There were no differences on SCR on any emotion after biofeedback treatment. A correlation was found between mean change in SCR over the biofeedback treatment and the reduction of seizure frequency, but not between SCR changes and scores on psychiatric comorbidities. These results show independent effect of biofeedback on mood and seizure control. Improvements in anxiety and depressive symptoms were not related to SCR, whereas improved seizure control was, suggesting differential mechanisms underlying these two phenomena.

Nonequivalence of computerized and paper-and-pencil versions of Trail Making Test.

A computerized version of the Trail Making Test, an adaptation of the classical paper-and-pencil form, was compared with the paper-and-pencil form. The testee must connect targets on the screen with the cursor using the mouse instead of a sheet of paper and a pen. The participants were 68 healthy adolescents and young adults. The comparison of scores on the two versions showed that they cannot be considered equivalent; the difference between the two parts of the test (Parts A and B) was greater in the paper-and-pencil version; correlations between the two versions of Part A and of Part B were significant, but too low to consider the two versions parallel. Both versions were accepted by participants. As expected, mean scores were different in Parts A and B in both versions and magnitude of differences was large.

Does early training improve driving skills of young novice French drivers?

The aim of this research was to study drivers' performances and divided attention depending on their initial training. The performances of young novice drivers who received early training, traditionally trained drivers and more experienced drivers were compared during a dual task consisting of a simulated car-following task and a number' parity judgment task. It was expected that, due to their limited driving experience, the young novice drivers would have more difficulty in adequately distributing their attention between the two tasks. Poorer performances by novice drivers than experienced drivers were therefore expected. The results indicate that traditionally trained drivers had more difficulties in speed regulation and maintaining their position in the lane than drivers with early training and experienced drivers. Performance impairment linked to driving inexperience was also found in the secondary task. The results were interpreted regarding the attentional resources involved in driving with a secondary task and supported the positive effects of French early training.

I can read it in your eyes: what eye movements tell us about visuo-attentional processes in developmental dyslexia.

Most studies today agree about the link between visual-attention and oculomotor control during reading: attention seems to affect saccadic programming, that is, the position where the eyes land in a word. Moreover, recent studies show that visuo-attentional processes are strictly linked to normal and impaired reading. In particular, a large body of research has found evidence of defective visuo-attentional processes in dyslexics. What do eye movements tell us about visuo-attentional deficits in developmental dyslexia? The purpose of this paper is to explore the link between oculomotor control and dyslexia, taking into account its heterogeneous manifestation and comorbidity. Clinical perspectives in the use of the eye-movements approach to better explore and understand reading impairments are discussed.