Clinical and psychopathological features of drug-resistant epilepsy in adults

Clinical and psychopathological features of drug-resistant epilepsy in adults

 

Authors

 

N.A. Sivakova

Federal State Budgetary Institution “V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology” of the Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation

I.A. Draganik

Federal State Budgetary Institution “V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology” of the Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation

A.P. Kotsyubinsky

Federal State Budgetary Institution “V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology” of the Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation

V.A. Mikhailov

Federal State Budgetary Institution “V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology” of the Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation

 

https://doi.org/10.26617/1810-3111-2024-3(124)-88-96

 

Journal: Siberian Herald of Psychiatry and Addiction Psychiatry. 2024; 3 (124):  88-96.

 

Abstract

Background.Drug-resistant epilepsy (DRE) is a multifactorial phenomenon based on numerous genetic and ac-quired (previous TBI, brain diseases, infections, circulatory disorders) mechanisms. Treatment-resistant, incurable or drug-resistant forms of the disease are determined by the types of epilepsy, generalized or focal types of seizures, frequency of epileptic seizures, and the presence of interictal epileptiform discharges according to EEG data. Many researchers have shown an association between therapeutic resistance and various types of psychopathological phenomena. Objective: to study the features of the clinical picture in drug-resistant epilepsy, to establish the clinical features of nonpsychotic mental disorders (NMD) in patients with epilepsy in the interictal period. Materials and Methods.The study was conducted at the Department of Treatment of Patients with Exogenous Organic Disorders and Epilepsy of Federal State Budgetary Institution “V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology”. The study included 160 inpatients diagnosed with epilepsy (G40) according to ICD-10 criteria. The sample of patients was divided into two groups: the first group included 80 patients with drug-resistant epilepsy (ineffectiveness of therapy with two or more antiepileptic drugs), the second group included 80 patients with a controlled course of the disease (absence of seizures for more than 12 months). Clinical-psychopathological, clinical-neurological, and psychometric methods were used. Statistical analysis included descriptive statistics methods, com-parative analysis was carried out using χ2 and Fisher criteria, correlations were assessed using Spearman's correlation coefficient, differences were considered statistically significant at p<0.05. Results. In the DRE group, an earlier onset of the disease was revealed (12.3±0.1 years; t=7.232, p<0.001), a more frequent history of birth trauma (45%; φ=3.238, p<0.01), neuroinfections (22.5%; φ=1.72), p<0.05), febrile seizures (φ=4.731, p<0.01), more frequent at-tacks (93.8%) with a tendency to serial course, a higher incidence of affective disorders (86.3%) and depressive experiences (51.3%) of mild (15.0%), moderate (25.0%) and severe (11.3%) degree, the prevalence of subclinical (12.5%) and clinical (38.8%) depressive symptoms, subclinically (11.3 points) and clinically (17.5%) expressed anxiety ac-cording to the Hamilton Anxiety and Depression Scale, in the range from mild (8.8%) anxiety to moderate, symptomatic (15.0%) and severe, substantial (5.0%) anxiety according to the Hamilton Anxiety Rating Scale (HAM-A). In the DRE group, a mild degree of expression of NMD correlated with rare (less than 1 per week) epileptic seizures, the severity of NMD correlated with the lowest (9.5±4.6 years) age of seizure onset and the longest (23.0±9.9 years) duration of epilepsy. A correlation was established between the occurrence of affective spectrum disorders with the early age of onset (r=-0.16; p=0.04) and long course (r=0.24; p=0.002) of the disease in the general group of patients with epilepsy. The prevalence of affective disorders in the DRE group (86.3%) is more than 2.5 times higher than in the curable epilepsy group. Conclusion. The correlation between the paroxysmal and psychopathological characteristics of the epileptic process is shown, which indicates the need for considering the disease as a dynamic condition characterized by paroxysmal activity in combination with psychopathological disorders in the form of nonpsychotic phenomena. Subsequently, NMDs identified in the interictal period are the source of the formation of typical characterological traits, which, when included in the structure of personality changes of an individual, create a well-known psychological profile of a “changed” patient with epilepsy, which a psychiatrist encounters in his daily professional activities. The results of the study may be of great importance in the development of comprehensive treatment and correction programs for patients with epilepsy based on a personalized approach.

 

Keywords: epilepsy, drug resistance, nonpsychotic mental disorders, affective disorders, depression, anxiety.

 

Article (pdf)

 

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Materials  

For citation: Sivakova N.A., Draganik I.A., Kotsyubinsky A.P., Mikhailov V.A. Clinical and psychopathological features of drug-resistant epilepsy in adults. Siberian Herald of Psychiatry and Addiction Psychiatry.2024; 3 (124): 88-96. https://doi.org/10.26617/1810-3111-2024-3(124)-88-96

 

REFERENCES

  1. Asadi-Pooya AA, Brigo F, Lattanzi S, Blumcke I. Adult epilepsy. Lancet. 2023 Jul 29;402(10399):412-424. doi: 10.1016/S0140-6736(23)01048-6. Epub 2023 Jul 14. PMID: 37459868.
  2. Xue-Ping W, Hai-Jiao W, Li-Na Z, Xu D, Ling L. Risk factors for drug-resistant epilepsy: A systematic review and meta-analysis. Medicine (Baltimore). 2019 Jul;98(30):e16402. doi: 10.1097/MD.0000000000016402. PMID: 31348240; PMCID: PMC6708813.
  3. Karlov VA, Mukhin KYu, Gulyaeva NV, Fedin AI, Burd SG, Morozova EA, Bogdanov EI, Dmitrenko DV, Mikhailov VA, Kissin MYa, Lebedeva AV, Zhidkova IA, Guzeva VI, Vlasov PN, Agranovich OV, Belousova ED, Rudakova IG, Maslova NN, Magzhanov RV. Resolution of the meeting of the Expert Council of the Russian Antiepileptic League (September 7, 2023). Epilepsy and Paroxysmal Conditions under the guidance of VA Karlov. 2024;2(1):7-15. https://doi.org/10.34707/EpiKar.2024.2.1.001(in Russian).
  4. Karlov VA. Pharmacoresistance and tolerance in epilepsy. Epilepsy. NG Neznanov, ed. St. Petersburg: Publishing House of the VM Bekhterev Scientific Research Institute, 2010. Chapter 26 (III):730-741(in Russian).
  5. Jiang T, Zhang X, Zhang M, Liu M, Zhu H, Sun Y. Drug-resistant idiopathic generalized epilepsy: A meta-analysis of prevalence and risk factors. Epilepsy Behav. 2023 Sep;146:109364. doi: 10.1016/j.yebeh.2023.109364. Epub 2023 Jul 29. PMID: 37523796.
  6. Giussani G, Bianchi E, Beretta S, Carone D, DiFrancesco JC, Stabile A, Zanchi C, Pirovano M, Trentini C, Padovano G, Colombo M, Cereda D, Tinti L, Scanziani S, Gasparini S, Bogliun G, Ferrarese C, Beghi E; PRO-LONG Study Group. Comorbidities in patients with epilepsy: Frequency, mechanisms and effects on long-term outcome. Epilepsia. 2021 Oct;62(10):2395-2404. doi: 10.1111/epi.17022. Epub 2021 Jul 26. PMID: 34309011.
  7. Dagar A, Falcone T. Psychiatric comorbidities in pediatric epilepsy. Curr Psychiatry Rep. 2020 Oct 31;22(12):77. doi: 10.1007/s11920-020-01195-8. PMID: 33128638.
  8. Jansen C, Francomme L, Vignal JP, Jacquot C, Schwan R, Tyvaert L, Maillard L, Hingray C. Interictal psychiatric comorbidities of drug-resistant focal epilepsy: Prevalence and influence of the localization of the epilepsy. Epilepsy Behav. 2019 May;94:288-296. doi: 10.1016/j.yebeh.2018.06.046. Epub 2018 Nov 11. PMID: 30429057.
  9. Gonçalves EB, de Oliveira Cardoso TAM, Yasuda CL, Cendes F. Depressive disorders in patients with pharmaco-resistant mesial temporal lobe epilepsy. J Int Med Res. 2018 Feb;46(2):752-760. doi: 10.1177/0300060517717825. Epub 2017 Sep 27. PMID: 29239239; PMCID: PMC5971495.
  10. Kim M, Kim YS, Kim DH, Yang TW, Kwon OY. Major depressive disorder in epilepsy clinics: A meta-analysis. Epilepsy Behav. 2018 Jul;84:56-69. doi: 10.1016/j.yebeh.2018.04.015. Epub 2018 May 10. PMID: 29753295.
  11. Vacca M, Fernandes M, Spanetta M, Placidi F, Izzi F, Lombardo C, Mercuri NB, Liguori C. Depressive symptoms in patients with epilepsy and clinically associated features in a single tertiary center. Neurol Sci. 2022 Mar;43(3):1965-1974. doi: 10.1007/s10072-021-05589-1. Epub 2021 Sep 15. PMID: 34528181; PMCID: PMC8860796.
  12. Tracy JI, Lippincott C, Mahmood T, Waldron B, Kanauss K, Glosser D, Sperling MR. Are depression and cognitive performance related in temporal lobe epilepsy? Epilepsia. 2007 Dec;48(12):2327-35. doi: 10.1111/j.1528-1167.2007.01254. x. Epub 2007 Aug 14. PMID: 17697111.
  13. Nogueira MH, Yasuda CL, Coan AC, Kanner AM, Cendes F. Concurrent mood and anxiety disorders are associated with pharmacoresistant seizures in patients with MTLE. Epilepsia. 2017 Jul;58(7):1268-1276. doi: 10.1111/epi.13781. Epub 2017 May 26. PMID: 28555776.
  14. Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, Moshé SL, Perucca E, Wiebe S, French J. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010 Jun;51(6):1069-77. doi: 10.1111/j.1528-1167.2009.02397.x. Epub 2009 Nov 3. Erratum in: Epilepsia. 2010 Sep;51(9):1922. PMID: 19889013.
  15. Cohen NT, Chang P, You X, Zhang A, Havens KA, Oluigbo CO, Whitehead MT, Gholipour T, Gaillard WD. Prevalence and risk factors for pharmacoresistance in children with focal cortical dysplasia-related epilepsy. Neurology. 2022 Oct 31;99(18):e2006-e2013. doi: 10.1212/WNL.0000000000201033. PMID: 35985831; PMCID: PMC9651467.