ABSTRACT
Depression is common in neurological conditions. Patients with epilepsy are significantly more likely to have depression than the general population. However, no published studies have examined the effects of antidepressants and psychotherapy on the brain in patients with epilepsy. A systematic review of 34 relevant neuroimaging articles was conducted on temporal lobe epilepsy (with and without depression), depression (with and without epilepsy), and cognitive behavioral therapy (CBT) and antidepressants through PET, functional MRI, SPECT or proton spectroscopic imaging. Results indicate hypoactivity in the frontal cortex and hippocampus, and hyperactivity in the left dorsomedial prefrontal cortex for depression (with and without epilepsy). Hypoactivity was consistently found in the frontal cortex and temporal region in temporal lobe epilepsy (with and without depression). Studies of nonepilepsy groups suggest that CBT impacts the frontal cortex, prefrontal cortex, temporal lobe, thalamus and hippocampus--all of these areas are dysfunctional in temporal lobe epilepsy with depression. The findings suggest that patients with epilepsy may benefit from CBT. More research is needed to establish CBT as evidence-based practice for epilepsy with depression.
Subject(s)
Cognitive Behavioral Therapy , Epilepsy, Temporal Lobe/psychology , Epilepsy, Temporal Lobe/therapy , Epilepsy/psychology , Epilepsy/therapy , Antidepressive Agents/therapeutic use , Depression/diagnostic imaging , Depression/drug therapy , Depression/physiopathology , Depression/psychology , Depressive Disorder/diagnostic imaging , Depressive Disorder/drug therapy , Depressive Disorder/physiopathology , Depressive Disorder/psychology , Diagnostic Imaging , Epilepsy/diagnostic imaging , Epilepsy/physiopathology , Epilepsy, Temporal Lobe/diagnostic imaging , Epilepsy, Temporal Lobe/physiopathology , Female , Frontal Lobe/diagnostic imaging , Frontal Lobe/physiopathology , Humans , Male , Prefrontal Cortex/diagnostic imaging , Prefrontal Cortex/physiopathology , Radionuclide Imaging , Temporal Lobe/diagnostic imaging , Temporal Lobe/physiopathologyABSTRACT
PURPOSE: To compare the prevalence of self-reported serious psychological distress using the Kessler 6 (K6) in persons with a history of epilepsy (PWE) to those without epilepsy from a population-based survey. METHODS: Data were analyzed from adults aged >or=18 years (n = 43,020) who participated in the 2005 California Health Interview Survey (CHIS). RESULTS: California adults with a history of epilepsy, after controlling for demographics and comorbidities, reported higher rates of feeling nervous [odds ratio (OR) 2.22], feeling hopeless (OR 1.35), feeling restless (OR 2.07), feeling depressed (OR 3.14), and feeling worthless (OR 2.57), and reported that everything has been an effort (OR 2.28) in the last 30 days. The K6 score showed that serious psychological distress is more common in PWE (OR 2.24). After adjusting for demographics, comorbidities, and serious psychological distress, PWE are more likely to report having 14 or more physical, mental, and general unhealthy days in the last 30 days. DISCUSSION: PWE have significantly higher rates of serious psychological distress and poor health-related quality of life after controlling for demographics, comorbidities. These comorbid conditions need to be factored into any comprehensive treatment strategy for managing PWE to achieve optimum quality of life.
Subject(s)
Epilepsy/epidemiology , Health Surveys , Stress, Psychological/epidemiology , Adolescent , Adult , Aged , California/epidemiology , Epilepsy/psychology , Female , Humans , Interviews as Topic , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Retrospective Studies , Stress, Psychological/psychology , Young AdultABSTRACT
A retrospective chart review was performed on 130 patients from the Ohio State University Memory Disorders Clinic to examine the long-term effects of combination therapy with donepezil and vitamin E on patients with Alzheimer disease. Subjects were included if they met National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer disease, had taken at least 5 mg donepezil and at least 1000 U vitamin E daily, had at least a 1-year follow-up while continuing these medications, and had a Mini-Mental State Examination score of 10-24. The Mini-Mental State Examination was then recorded annually thereafter. These data were compared with the Consortium to Establish a Registry for Alzheimer's Disease database for patients collected prior to the availability of these treatment options. Patients declined at a significantly lower rate as compared with the Consortium to Establish a Registry for Alzheimer's Disease data. The long-term combination therapy of donepezil and vitamin E appears beneficial for patients with Alzheimer disease. Future prospective studies would be needed to compare combination treatment to vitamin E and donepezil alone.
