Association between depressive and anxious symptoms with cognitive function and quality of life in drug-resistant epilepsy.

•Depressive/anxious disorders and cognitive impairment are frequent comorbidities in epilepsy and have a more deleterious effect in DRE.•Studies concerning the relationship between anxiety and depression and cognitive performance in DRE are scarce.•Higher scores in HADS are associated with lower QOLIE-31 scores and might be considered as predictors of QOL in DRE.•A relationship between anxious and depressive symptoms -measured with HADS and SCL-90R- and cognition might not exist.•There remains an unexplored study area regarding this relationship which requires more attention to improve the assessment of DRE.

Clinical relevance of interictal dysphoric disorder and its impact on quality of life in drug-resistant epilepsy.

OBJECTIVE: This study aims to assess the prevalence of Interictal Dysphoric Disorder (IDD) in drug-resistant epilepsy (DRE) and to describe its clinical and psychopathological profile, including personality, as well as its impact on quality of life (QOL). METHOD: A retrospective cross-sectional study from an Epilepsy Unit from January 2007 to December 2017. All patients were diagnosed with DRE. Patients underwent a battery of tests (HADS, SCL-90R, PDQ-4+, QOLIE-31) and a psychiatrist assessed the presence of Axis-I disorders and IDD. Statistical procedures were carried out using R-4.0.1 software. RESULTS: A total of 282 patients were included. A statistically significant association was found between IDD and mood and anxiety disorders (p < 0.001 and p < 0.05 respectively), and between IDD and higher scores in all HADS and SCL-90-R items compared to subjects without IDD (p < 0.001). A statistically significant association was also found between IDD and obsessive-compulsive, borderline and depressive personality disorder (p < 0.05). Scores in all QOLIE-31 items except for 'medication effects' were significantly lower in subjects with IDD compared with subjects without IDD (p < 0.001). CONCLUSIONS: In DRE, IDD subjects show differences in the psychopathological profile and QOL scores compared to subjects without a diagnosis of IDD. An early diagnosis of IDD could facilitate prompt interventions which might positively impact QOL.

[Peri-ictal SPECT in temporal lobe epilepsy: post-surgical evaluation]. / SPECT periictal en la epilepsia del lóbulo temporal: valoración tras cirugía.

INTRODUCTION: our aim was to evaluate the usefulness of peri-ictal SPECT in localising the epileptogenic region (ER) in candidates for temporal lobectomy to treat medically refractory complex partial seizures (CPS). Interictal and ictal SPECT, MRI and video-EEG results were compared and the positive predictive value (PPV) was calculated in those patients with good surgical outcome. MATERIALS AND METHODS: 37 patients who had a minimum of 3 years follow-up after surgery were studied retrospectively. Pre-surgical evaluation had included video-EEG monitoring, MRI and interictal and ictal SPECT. These results were compared to the surgically treated ER and successful outcome confirmed by post-surgical clinical follow-up. 29/37 patients remained seizure-free in the post-surgical follow-up. Interictal and peri-ictal SPECT were performed using 740 MBq of 99mTc-HMPAO. Peri-ictal SPECT was ictal in 25 patients and postictal in 12. RESULTS: ER concordance with video-EEG and peri-ictal SPECT was 86% (32/37 patients). It was 84% (31/37) for MRI and 54% (20/37 patients) for interictal SPECT. Peri-ictal SPECT localised the ER in 8/11 patients with discordant MRI and video-EEG results. Ictal SPECT localised the ER in the correct temporal lobe in 23/25 patients (92% concordance). In the 29 patients with a good surgical outcome, the PPV of video-EEG was 95% (27/29) and it was 90% (26/29) for both MRI and peri-ictal SPECT. CONCLUSIONS: peri-ictal brain SPECT is well able to localize ER in patients with temporal lobe epilepsy. Periictal SPECT concordance with ER was as good as video-EEG and MRI and its PPV was as good as that of MRI. We strongly recommend its use in the pre-surgical evaluation of temporal lobe epilepsy, especially when MRI and EEG are discordant.

SPECT periictal en la epilepsia del lóbulo temporal: valoración tras cirugía / Peri-ictal SPECT in temporal lobe epilepsy: post-surgical evaluation

Introducción: el objetivo de este trabajo fue valorar la utilidad de la tomografía computarizada por emisión monofotónica (SPECT) periictal para localizar la región epileptógena (RE) en pacientes con crisis parciales complejas (CPC) del lóbulo temporal. Material y métodos: de forma retrospectiva se ha evaluado a 37 pacientes con CPC del lóbulo temporal a quienes se realizó una lobectomía temporal completa o selectiva. Para ello, se comparó la concordancia de la RE quirúrgica con los hallazgos de la resonancia magnética (RM), el videoelectroencefalograma (vídeo-EEG) y las SPECT cerebrales interictal y periictal. En segundo lugar, se valoró el valor predictivo positivo (VPP) de estas exploraciones en los 29 pacientes que presentaron un buen control de las crisis tras la cirugía. La SPECT se realizó tras la inyección de 740 MBq de 99mTc-HMPAO. Resultados: la concordancia de la RE quirúrgica con el vídeo-EEG, la RM, la SPECT icterictal y la SPECT periictal fue del 86% (32/37 pacientes), el 84% (31/37 pacientes), el 54% (20/37 pacientes) y el 86% (32/37 pacientes), respectivamente. En los 11 casos con RM y vídeo-EEG discordante o normal, la SPECT periictal fue decisivo en 8 (73%). En los 29 pacientes con evolución favorable tras la cirugía, el VPP del vídeo-EEG fue del 95% (27/29) y el de la RM y la SPECT periictal fue del 90% (26/29). Conclusiones: la concordancia de la RE quirúrgica con la SPECT periictal fue similar al del vídeo-EEG y la RM y tuvo el mismo VPP que la RM. Por ello, creemos que la SPECT periictal debe emplearse de forma sistemática en la evaluación prequirúrgica de la epilepsia del lóbulo temporal, especialmente cuando vídeo-EEG y RM son discordantes o normales(AU)

Introduction: our aim was to evaluate the usefulness of peri-ictal SPECT in localising the epileptogenic region (ER) in candidates for temporal lobectomy to treat medically refractory complex partial seizures (CPS). Interictal and ictal SPECT, MRI and video-EEG results were compared and the positive predictive value (PPV) was calculated in those patients with good surgical outcome. Materials and methods: 37 patients who had a minimum of 3 years follow-up after surgery were studied retrospectively. Pre-surgical evaluation had included video-EEG monitoring, MRI and interictal and ictal SPECT. These results were compared to the surgically treated ER and successful outcome confirmed by post-surgical clinical follow-up. 29/37 patients remained seizure-free in the post-surgical follow-up. Interictal and peri-ictal SPECT were performed using 740 MBq of 99mTc-HMPAO. Peri-ictal SPECT was ictal in 25 patients and postictal in 12. Results: ER concordance with video-EEG and peri-ictal SPECT was 86% (32/37 patients). It was 84% (31/37) for MRI and 54% (20/37 patients) for interictal SPECT. Peri-ictal SPECT localised the ER in 8/11 patients with discordant MRI and video-EEG results. Ictal SPECT localised the ER in the correct temporal lobe in 23/25 patients (92% concordance). In the 29 patients with a good surgical outcome, the PPV of video-EEG was 95% (27/29) and it was 90% (26/29) for both MRI and peri-ictal SPECT. Conclusions: peri-ictal brain SPECT is well able to localize ER in patients with temporal lobe epilepsy. Periictal SPECT concordance with ER was as good as video-EEG and MRI and its PPV was as good as that of MRI. We strongly recommend its use in the pre-surgical evaluation of temporal lobe epilepsy, especially when MRI and EEG are discordant(AU)

[Selective alteration of the declarative memory systems in patients treated with a high number of electroconvulsive therapy sessions]. / Alteracion selectiva de los sistemas declarativos de memoria en los pacientes tratados con un elevado numero de sesiones de terapia electroconvulsiva.

INTRODUCTION: The reversible electrochemical effects of electroconvulsive therapy (ECT) on specific areas of the brain enable the neuroanatomical bases of some cognitive functions to be studied. In research carried out on memory systems, a selective alteration of the declarative ones has been observed after treatment with ECT. Little work has been done to explore the differential alteration of the memory subsystems in patients with a high number of ECT sessions. AIM. To study the declarative and non declarative memory system in psychiatric patients submitted to maintenance ECT treatment, with a high number of previous ECT sessions. PATIENTS AND METHODS: 20 patients submitted to treatment with ECT (10 diagnosed as having depression and 10 with schizophrenia) and 20 controls, who were paired by age, sex and psychopathological diagnosis. For the evaluation of the declarative memory system, the Wechsler Memory Scale (WMS) logical memory test was used. The Hanoi Tower procedural test was employed to evaluate the non declarative system. RESULTS: Patients treated with ECT performed worse in the WMS logical memory test, but this was only significant in patients diagnosed as suffering from depression. No significant differences were observed in the Hanoi Tower test. CONCLUSIONS: A selective alteration of the declarative systems was observed in patients who had been treated with a high number of ECT sessions, while the non declarative memory systems remain unaffected.

[Neuropsychological aspects of obsessive compulsive disorder]. / Aspectos neuropsicológicos del trastorno obsesivocompulsivo.

INTRODUCTION AND OBJECTIVE: Neuropsychological performance in obsessive compulsive disorder (OCD) and its association with disfunctions in neuroanatomic structures and clinical symptoms of disorder has been reviewed. DEVELOPMENT: OCD symptoms and different aspects between children and adult psychopatology are presented. Briefly neurobiologic studies related with the etiology and patophisiology of OCD has been revised. This article summarizes some last studies about OCD cognitive functioning and its impairment. CONCLUSION: The more impaired cognitive functions in OCD are executive functions and visual abilities, specially non verbal memory. In addition, other studies have identified verbal memory deficits. These deficits are consistent with neurodevelopmental models, which hypothesizes that abnormalities of ventral prefrontal striatal and thalamic circuits may be involved in the etiology and patophisiology of OCD. The cognitive deficits could be functioning as a intermediate variable between neurobiological abnormalities and OCD symptoms. More studies are needed to analize the OCD cognitive impairment.

Alteración selectiva de los sistemas declarativos de memoriaen los pacientes tratados con un elevado número de sesionesde terapia electroconvulsiva / Selective alteration of the declarative memory systems in patients treated with a high number of electroconvulsive therapy sessions

Introducción. Los efectos electroquímicos reversibles de la terapia electroconvulsiva (TEC) sobre zonas cerebrales específicas permiten el estudio de las bases neuroanatómicas de algunas funciones cognitivas. Los estudios sobre los sistemas de memoria observan una alteración selectiva de los declarativos después de un tratamiento con TEC. Pocos trabajos han estudiado la alteración diferencial de los subsistemas de memoria en pacientes con un elevado número de sesiones de TEC. Objetivo. Estudiar el sistema declarativo y no declarativo de memoria en pacientes psiquiátricos sometidos a un tratamiento de TEC de mantenimiento, con un elevado número de sesiones de TEC previas. Pacientes y métodos. 20 pacientes sometidos a tratamiento con TEC (10 diagnosticados de depresión y 10 de esquizofrenia) y 20 pacientes controles apareados por edad, sexo y diagnóstico psicopatológico. Para la evaluación del sistema declarativo de memoria se utilizó la prueba de memoria lógica Wechsler Memory Scale (WMS). La prueba procedimental de la Torre de Hanoi se utilizó para valorar el sistema no declarativo. Resultados. Se observa un peor rendimiento de la prueba de memoria lógica de la WMS en pacientes tratados con TEC, que sólo es significativo en los pacientes diagnosticados de depresión. No se observan diferencias significativas en la Torre de Hanoi. Conclusiones. Se detecta una alteración selectiva de los sistemas declarativos en pacientes tratados con un número elevado de sesiones de TEC, mientras que los sistemas no declarativos de memoria se preservan (AU)

Aspectos neuropsicológicos del trastorno obsesivocompulsivo / Neuropsychological aspects of obsessive-compulsive disorder

Introducción y objetivo. En este artículo se revisan algunas de las últimas investigaciones sobre el funcionamiento neuropsicológico del trastorno obsesivocompulsivo (TOC), con relación a las estructuras neuroanatómicas alteradas y los síntomas clínicos del trastorno. Desarrollo. Se describen los síntomas clínicos del TOC, así como aspectos diferenciales de la psicopatología entre niños y adultos. A continuación se revisan brevemente las bases biológicas implicadas en la etiopatogenia del trastorno. El núcleo del trabajo consiste en la revisión de los últimos trabajos acerca de las funciones cognitivas y sus alteraciones en los pacientes diagnosticados de TOC. Conclusión. Se ha determinado que las funciones cognitivas afectadas con mayor frecuencia en el TOC son las ejecutivas y las aptitudes visuoespaciales, especialmente la memoria no verbal. Últimamente diversos estudios también han hallado evidencias de alteraciones en el funcionamiento de la memoria verbal. Estos déficit son compatibles con los actuales modelos del neurodesarrollo, que hipotetizan la existencia de alteraciones en circuitos frontoestriatales y talámicos implicados en la etiología y patofisiología del trastorno, mientras que las alteraciones cognitivas actuarían como una variable intermedia entre las alteraciones neurobiológicas y la fenomenología del trastorno. A pesar de que los conocimientos de las funciones cognitivas en el TOC han aumentado en los últimos años, se requieren más estudios para aclarar las contradicciones y ambigüedades aún existentes (AU)

[Epilepsy surgery in a reference centre]. / Cirugía de la epilepsia en un centro de referencia.

INTRODUCTION: Patients with drug resistant epilepsy are potential candidates for surgery. The pre surgical study of these patients involves a multidisciplinary approach. PATIENTS AND METHODS: We included patients who had been submitted to EEG video monitoring in our centre (a tertiary university hospital) between April 1995 and May 2000. The evaluation protocol included magnetic resonance (MR) brain scan (according to a specific protocol), neuropsychological and psychiatric evaluation, and ictal/interictal SPECT, when possible. Patients who underwent surgery were followed up at regular intervals until at least two years after surgery. RESULTS: Of the 299 patients with EEG video monitoring, 87 had been submitted to surgery up to June 2000. Nine of these patients required invasive subdural studies or studies of the foramen ovale using electrodes. Of the patients who underwent surgery, 44.8% had sclerosis of the hippocampus in the MR and in 10% it was found to be normal. The results of pathological anatomy revealed: 49.3% with sclerosis of the hippocampus, 15.1% with benign tumours, 13.7% with gliosis, 4.1% heterotopias and 4.1% cavernomas. Just one patient has been submitted to surgery again because of badly controlled seizures. Eight patients have presented post surgical complications (four with permanent morbidity). Of the 73 patients who were followed up for at least a year, 83.6% are in Engel class I, 9.6% in class II, 2.7% in class III and 4.1% in class IV. Among patients who underwent a temporal resection, 88.7% were in class I and 0% in class IV. CONCLUSIONS: Epilepsy surgery, in selected patients, has a very low morbidity/mortality rate and the chances that seizures will disappear or greatly improve are high.

Cirugía de la epilepsia en un centro de referencia / Epilepsy surgery in a reference centre

Introducción. Los pacientes con epilepsia farmacorresistente son potencialmente candidatos a cirugía. El estudio prequirúrgico de estos pacientes implica un abordaje multidisciplinario. Pacientes y métodos. Se incluyeron los pacientes a los que realizamos en nuestro centro (hospital universitario terciario) registro vídeo-EEG, entre abril de 1995 y mayo de 2000. El protocolo de evaluación incluyó resonancia magnética (RM) craneal (según un protocolo específico), evaluación neuropsicológica, valoración psiquiátrica y SPECT ictal/interictal, cuando fue posible. Aquellos pacientes intervenidos se siguieron a intervalos regulares, hasta como mínimo dos años tras la cirugía. Resultados. De los 299 pacientes con registro vídeo-EEG, 87 se han intervenido hasta junio de 2000. Nueve de estos pacientes precisaron estudios invasivos con electrodos de foramen ovale o subdurales. De los pacientes intervenidos, 44,8 por ciento tenían esclerosis del hipocampo en la RM y en el 10 por ciento ésta fue normal. Los resultados de anatomía patológica mostraron: 49,3 por ciento con esclerosis del hipocampo, 15,1 por ciento con tumores benignos, 13,7 por ciento con gliosis, 4,1 por ciento heterotopías y 4,1 por ciento de cavernomas. Un sólo paciente se ha reintervenido por mal control de sus crisis. Ocho pacientes han presentado complicaciones posquirúrgicas (cuatro con morbilidad permanente). De los 73 pacientes con seguimiento mínimo de un año, 83,6 por ciento están en clase I de Engel, 9,6 por ciento en clase II, 2,7 por ciento en clase III y 4,1 por ciento en clase IV. Entre los pacientes intervenidos con resección temporal, 88,7 por ciento están en clase I y 0 por ciento en clase IV. Conclusiones. La cirugía de la epilepsia, en pacientes seleccionados, tiene una morbimortalidad mínima y ofrece una elevada esperanza de desaparición o mejoría importante de las crisis (AU)