Validation of diagnostic tests for depressive disorder in drug-resistant mesial temporal lobe epilepsy.

PURPOSE: This study aimed to evaluate the diagnostic accuracy of the Hamilton Rating Scale for Depression (HRSD), the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale (HADS), and the Hospital Anxiety and Depression Scale-Depression subscale (HADS-D) as diagnostic tests for depressive disorder in drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). METHODS: One hundred three patients with drug-resistant MTLE-HS were enrolled. All patients underwent a neurological examination, interictal and ictal video-electroencephalogram (V-EEG) analyses, and magnetic resonance imaging (MRI). Psychiatric interviews were based on DSM-IV-TR criteria and ILAE Commission of Psychobiology classification as a gold standard; HRSD, BDI, HADS, and HADS-D were used as psychometric diagnostic tests, and receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores. RESULTS: For all the scales, the areas under the curve (AUCs) were approximately 0.8, and they were able to identify depression in this sample. A threshold of ≥9 on the HRSD and a threshold of ≥8 on the HADS-D showed a sensitivity of 70% and specificity of 80%. A threshold of ≥19 on the BDI and HADS-D total showed a sensitivity of 55% and a specificity of approximately 90%. The instruments showed a negative predictive value of approximately 87% and a positive predictive value of approximately 65% for the BDI and HADS total and approximately 60% for the HRSD and HADS-D. CONCLUSIONS: HRSD≥9 and HADS-D≥8 had the best balance between sensitivity (approximately 70%) and specificity (approximately 80%). However, with these thresholds, these diagnostic tests do not appear useful in identifying depressive disorder in this population with epilepsy, and their specificity (approximately 80%) and PPV (approximately 55%) were lower than those of the other scales. We believe that the BDI and HADS total are valid diagnostic tests for depressive disorder in patients with MTLE-HS, as both scales showed acceptable (though not high) specificity and PPV for this type of study.

Predictors of quality of life in patients with refractory mesial temporal lobe epilepsy.

PURPOSE: The identification of variables associated with health-related quality of life (HRQoL) in patients with mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) would improve surgical decision-making and post-operatory follow-up in this group of patients. METHODS: We analyzed the independent association between the Quality of Life in Epilepsy Inventory-31 (QOLIE-31) of 81 consecutive patients with refractory MTLE-HS. The clinical, demographic, radiological and electrophysiological variables were analyzed by multiple linear regression analysis. KEY FINDINGS: Approximately 36% (adjusted R(2)=0.36; R coefficient=0.66) of the QOLIE-31 overall score variance was explained by the history of initial precipitant injury, family history of epilepsy, disease duration, age of epilepsy onset, seizure frequency and presence of psychiatric axis-II diagnosis. The variance of QOLIE-31 sub-scales was: seizure worry=7%; overall QOL=11%; emotional well-being=32%; energy/fatigue=38%; cognitive function=13%; medication effects=7%; social function=13% (R coefficient between 0.30 and 0.65). SIGNIFICANCE: The pre-surgical variables studied had relatively low prediction capacity for the overall QOLIE-31 score and its sub-scales in this set of Brazilian patients with refractory MTLE-HS.

Is self-report sleepiness associated with cognitive performance in temporal lobe epilepsy?

OBJECTIVES: Sleepiness and cognitive impairment are common symptoms observed in patients with epilepsy. We investigate whether self-reported sleepiness is associated with cognitive performance in patients with refractory mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). Seventy-one consecutive patients with MTLE-HS were evaluated with the Stanford Sleepiness Scale (SSS) before neuropsychological evaluation. Their mean SSS scores were compared with controls. Each cognitive test was compared between patients with (SSS ≥ 3) or without sleepiness (SSS < 3). Imbalances were controlled by regression analysis. Patients reported a significantly higher degree of sleepiness than controls (p < 0.0001). After multiple linear regression analysis, only one test (RAVLT total) remained associated with self-reported sleepiness. CONCLUSION: Self-reported sleepiness was significantly higher in MTLE-HS patients than controls, but did not affect their cognitive performance. If confirmed in other populations, our results may have implications for decision making about sleepiness screening in neuropsychological settings.

Is self-report sleepiness associated with cognitive performance in temporal lobe epilepsy? / A sonolência auto-relatada está associada ao desempenho cognitivo na epilepsia do lobo temporal?

ABSTRACT Sleepiness and cognitive impairment are common symptoms observed in patients with epilepsy. We investigate whether self-reported sleepiness is associated with cognitive performance in patients with refractory mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). Seventy-one consecutive patients with MTLE-HS were evaluated with the Stanford Sleepiness Scale (SSS) before neuropsychological evaluation. Their mean SSS scores were compared with controls. Each cognitive test was compared between patients with (SSS ≥ 3) or without sleepiness (SSS < 3). Imbalances were controlled by regression analysis. Patients reported a significantly higher degree of sleepiness than controls (p < 0.0001). After multiple linear regression analysis, only one test (RAVLT total) remained associated with self-reported sleepiness. Conclusion: Self-reported sleepiness was significantly higher in MTLE-HS patients than controls, but did not affect their cognitive performance. If confirmed in other populations, our results may have implications for decision making about sleepiness screening in neuropsychological settings.

RESUMO A sonolência e o comprometimento cognitivo são queixas comuns na epilepsia. Investigamos se a sonolência relatada pelo paciente está associada ao desempenho cognitivo na epilepsia do lobo temporal mesial refratária com esclerose do hipocampo (ELTM-EH). 71 pacientes com ELTM-EH foram avaliados pela Escala de Sonolência de Stanford (ESS) antes da avaliação neuropsicológica. A média na ESS foi comparada com a de controles. Cada teste foi comparado entre os pacientes com sonolência (ESS ≥ 3) ou sem sonolência (ESS <3). Diferenças foram controladas por regressão logística múltipla. Os pacientes relataram uma sonolência maior do que os controles (p <0,0001). Após a regressão, a sonolência relatada pelos pacientes mostrou-se associada a apenas um teste (RAVLT total). Os pacientes com ELTM-EH referem mais sonolência do que os controles, mas esta não foi associada com a cognição. Se confirmado em outras populações, nossos resultados implicarão na tomada de decisão sobre o impacto da sonolência no contexto neuropsicológico.

Cross-cultural translation of the INSPIRIT-R for Brazil and its applicability among epilepsy patients.

OBJECTIVE: To describe the cross-cultural adaptation of the INSPIRIT-R instrument for evaluation of religious and spiritual experiences into a Brazilian Portuguese version and its applicability among epileptic patients. METHOD: After the translation and back-translation phases, a multidisciplinary committee compared the back-translation with the original text in order to evaluate its content, comprehensibility, conceptual equivalence, cultural and contextual adjustment for Brazilian population. Lastly, the final version was tested on 50 long-term followed-up outpatients with a confirmed diagnosis of epilepsy in Florianópolis, SC, Brazil. RESULTS: The patients' mean age was 33.7 years (18-55) and 26 (52%) were women. They had attended school for a mean of 8.0 years (3-17) years. Most of them (80%) were Catholics and 82% had a confirmed diagnosis of temporal lobe epilepsy. In the final Portuguese version, questions 3, 7C and 7E required slight modifications, along with the layout of question 7. CONCLUSION: The Brazilian Portuguese version of the INSPIRIT-R instrument was easily understood by most of the patients, after minimal modifications.

Headache among mesial temporal lobe epilepsy patients: a case-control study.

Epilepsy and headache are two chronic disorders that are characterized by recurrent attacks, but the relationship between them is not completely understood. Using a structured questionnaire, we investigated the prevalence of headache during the previous year in a homogeneous group of 100 patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). The control group consisted of 100 age-matched individuals who were randomized from a nationwide Brazilian headache database. There was a significantly higher prevalence of headache (92%) among the MTLE-HS patients when compared with the controls (73%; p=0.001). Chronic daily headache (CDH) was significantly associated with MTLE-HS (OR 6.1, CI 95% 1.7-22, p=0.005). We did not find any association between the diagnosis of migraine or tension-type headache and MTLE-HS. This study showed that MTLE-HS increases the likelihood of a headache diagnosis. In addition, CDH was more prevalent among the MTLE-HS patients, which supports a common pathophysiological mechanism for epilepsy and headache.

Hippocampal sclerosis and ipsilateral headache among mesial temporal lobe epilepsy patients.

PURPOSE: To investigate the frequency and patterns of headache in a well-defined and homogeneous group of mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) patients. METHODS: One hundred consecutive MTLE-HS patients under comprehensive presurgical evaluation were evaluated from May 2009 to April 2010. A standardized questionnaire was applied according to the criteria of the International Headache Society (IHS). Headache diagnosis was based on the second edition of the International Classification of Headache Disorders (ICHD-II). RESULTS: Ninety-two patients (92%) had at least one headache episode during the previous 12 months. Migraine occurred in 51.9% of patients and tension-type headache (TTH) in 39.1%. Patients with migraine presented higher frequency (p=0.002) and severity of episodes (p<0.001), as well as lateralized pain (p=0.001) than individuals with TTH. MTLE-HS patients with unilateral HS and predominantly unilateral headache (irrespective of the type), presented pain ipsilateral to the HS (OR 8.5; CI 95%=2.1-35.1; p=0.003). CONCLUSIONS: Headache is a frequent clinical symptom of lateralizing value, which may share common pathophysiology with epileptogenesis among MTLE-HS patients.

A relação entre sono e epilepsia: uma revisão sobre o tema / The relationship between sleep and epilepsy: a review

A relação entre sono e epilepsia é mútua e complexa. O sono é um conhecido ativador de crises e paroxismos epileptiformes, como pode ser observado em algumas síndromes epilépticas em que há um nítido padrão de distribuição das crises relacionado ao ciclo sono-vigília. Além do mais, a epilepsia e seus tratamentos têm efeitos sobre o sono, alterando sua estrutura e provocando sua fragmentação. Pacientes com epilepsia possuem maior prevalência de sonolência diurna e de distúrbios do sono. Esses distúrbios resultam em piores índices de qualidade de vida quando comparados àqueles que não apresentam tais comorbidades. Dentre os distúrbios do sono que estão associados à epilepsia, o mais estudado é a síndrome da apneia e hipopneia obstrutiva do sono. O tratamento dessa síndrome melhora a sonolência excessiva diurna nos PCE além de melhorar o controle de crises nos pacientes resistentes às medicações antiepilépticas. O objetivo do presente artigo é revisar a interação entre o sono e epilepsia, destacando sua relação recíproca, além de abordar a prevalência e os efeitos do tratamento dos distúrbios do sono nos pacientes com epilepsia.

The relationship between sleep and epilepsy is mutual and complex. Epileptic discharges' activation during sleep is well known. In some epileptic syndromes, there is a close relationship between seizures and sleep-wake cycle. Moreover epilepsy and its treatments affect sleep, resulting in increased sleep fragmentation and disruption. The prevalence of sleep disorders and excessive daytime sleepiness is increased in patients with epilepsy (PWE), worsening their quality of life. Comorbidity between epilepsy and obstrutive apnea syndrome is the most studied and sleep apnea, when treated, improves daytime sleepiness and seizure control. This study aims to review the relationship between epilepsy and sleep, focusing on their reciprocal interaction, the prevalence of sleep disorders among PWE and the effect of their treatment on the epilepsy.

Aspectos neuropsicológicos da Esclerose Lateral Amiotrófica: relato de caso / Neuropsychological aspects of Amyotrophic Lateral Sclerosis: case report

A Esclerose Lateral Amiotrófica (ELA) é uma doença neurológica degenerativa e progressiva, com comprometimento dos neurônios motores, e consequente incapacidade na realização de atividades de vida diária do paciente, podendo apresentar distúrbios psicológicos (emocionais e cognitivos), repercutindo na dinâmica familiar e exigindo uma abordagem multidisciplinar. Relato de caso: Sujeito do sexo masculino, 55 anos, casado com filhos, comerciante, com 2º grau, procedente de Florianópolis, SC, com diagnóstico de ELA há 1 ano, com piora progressiva da doença, com acometimento da musculatura respiratória, atendido no Hospital Universitário ­ Universidade Federal de Santa Catarina (UFSC). A Avaliação Neuropsicológica utilizou subtestes da Escala de Inteligência de Wechsler para adultos e da Escala de Memória de Wechsler, tarefas de fluência verbal semântica e fonética, Inventário de Alterações Neuropsicológicas de Schlindwein-Zanini e Cruz (SZC), e a Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised. De modo geral, apresentou funções corticais preservadas, apresentando QI Estimado Médio; desempenho normal em orientação, memória operacional, atenção e flexibilidade mental, vocabulário, conhecimento de palavras, praxia construtiva e organização perceptual; sendo que em memória verbal recente e tardia mostrava performance um pouco pobre para o esperado, mas próximo a faixa de normalidade; discriminação visual classificada como médio inferior;e déficit em fluência verbal semântica (-2,6 dp) e fluência verbal fonética (-1,7 dp). No entanto, percebeu-se sintomatologia depressiva e prejuízo nas atividades de vida diária com redução da autonomia e funções motoras, além de crescente irritabilidade e baixa tolerância a frustração, que repercutem nas relações familiares do mesmo.

Amyotrophic Lateral Sclerosis (ALS) is a degenerative and gradual neurological illness. It damages motor neurons and consequently impairs the patient's capacity to perform daily life activities. Patients may present psychological disorders (emotional and cognitive) that reflects on family dynamics and requires a multi-displinary approach. Case report: The subject is male, 55 years old, married with children, trader, with high school studies, from Florianópolis, Santa Catarina, diagnosed with ALS 1 ago, presenting gradual worsening of the illness, with impairment of respiratory muscles, attended at University Hospital ­ Federal University of Santa Catarina (UFSC). The Neuropsychological Assessment used Wechsler Adult Intelligence Scale subtests and Wechsler Memory Scale , verbal, semantic and phonetics fluency tasks, Schlindwein-Zanini and Cruz (SZC) Inventory of Neuropsychological Changes, and Lateral Amyotrophic Sclerosis Functional Rating Scale-Revised. Generally speaking, cortical functions were preserved, showing Estimated Average IQ; normal performance in orientation, operational memory, attention and mental flexibility, vocabulary, word knowledge, constructional praxes and perceptual organization; being that recent and delayed verbal memory showed rather poor performance than expected (next to normality nonetheless); visual discrimination was classified as lower middle; semantic verbal fluency deficit (- 2,6 dp) and phonetic verbal fluency (- 1,7 dp). However, depressive symptomatology and damage in the daily life activities were perceived, followed by autonomy and motor functions' reduction in addition to increasing irritability and low tolerance to frustration, which had effects in his family relationships.