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"Depression is a common occurrence among epileptic patients and constitutes, along with anxiety disorders, the most frequent psychiatric condition in these patients," states Andres M. Kanner, MD and J.C. Nieto of the Department of Neurological Sciences, Rush Medical College and Rush Epilepsy Center, Rush Presbyterian St. Luke's Medical Center in Chicago, Illinois. "The relationship between depression and epilepsy is two-directional because patients with major depression also have a higher frequency of epilepsy."
In people with epilepsy, depression can be a psychological reaction to having the condition or to being treated differently because of it. Depression can sometimes be a side effect of medication, such as some barbiturates. The depression associated with barbiturates, such as Phenobarbital and primidone is often dose-related, which means the higher the dose of the drug, the greater the risk of depression.1
The 2006 American Academy of Neurology Annual Meeting in San Diego, California, featured more than 1,400 scientific presentations, with well over one hundred illustrating advances in epilepsy research. The abstract and platform sessions included updates on long-term results with the ketogenic diet, predictors of employment after epilepsy surgery, epilepsy and hepatitis C, epilepsy in women, and the relationship between sleep apnea, epilepsy, and quality of life. Brief summaries of these presentations are presented below.
Perhaps fueled by enthusiasm for more natural therapies, there has been a resurgence of interest in the ketogenic diet, an epilepsy treatment that has been available for more than seventy-five years. The ketogenic diet gets its name because the high fat content of the diet results in conversion of fat-to-ketones that are utilized as an energy source in place of glucose. Other diets also being explored for the treatment of epilepsy include the medium-chain triglyceride, Atkins, and South Beach diets. Efficacy and adverse events of these diets for people with epilepsy have not yet been fully characterized.
"The best predictor for gainful employment postsurgically is to have been working before surgery," reported Andres M. Kanner, MD, Professor of Neurological Sciences, Rush Medical College, Chicago, Illinois.
Dr. Kanner and his colleagues Marlis Frey, RN, a nurse practitioner, and Richard Byrne, MD, a neurosurgeon, reviewed the employment records of 88 consecutive adults (57 men, 31 women; mean age, 30.7) who had a left (N = 47) or right (N = 41) temporal lobectomy for intractable epilepsy (mean duration, 19.7 years).Patients were followed after surgery for a mean of 6.9 years.
Dr. Kanner recommended, "Patients with epilepsy who are not working at the time of an initial epilepsy evaluation should undergo a vocational evaluation and be referred to vocational rehabilitation programs whereafter being trained they are assisted in getting gainful employment."
"Chronic hepatitis C does not seem to be a risk for seizures," observed Anne Mai, MD, an epilepsy fellow at the Comprehensive Epilepsy Center, Mayo Clinic, Phoenix, Arizona. Dr. Mai and her colleagues performed a retrospective analysis of 1,482 patients with hepatitis C virus between 1998 and 2005 who were included in the Mayo Clinic Arizona database. Only 12 patients (0.81%; 6 men, 6 women; age, 43-62) had epilepsy, which is consistent with the expected prevalence of epilepsy in the general population.
Andrew Herzog, MD, Director of the Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts, reported seizure frequency is increased by 28% when women don't ovulate (anovulation, which is more common when the menstrual cycle is shorter than 26 days or longer than 30 days).
Dr. Herzog observed "there is very much a reciprocal relationship between seizures and hormones. Anovulatory cycles feature estrogen without progesterone, and estrogen is epileptogenic. Failure of ovulation and the hormonal changes that accompany it (unopposed estrogen) may be associated with more seizures."
Symptoms of sleep apnea may be missed by the Quality of Life in Epilepsy (QOLIE-89) inventory, according to a study presented by Bradley Vaughn, MD, Professor of Neurology, Division of Sleep Disorders and Epilepsy, University of North Carolina at Chapel Hill.
Dr. Vaughn and colleagues participated in a multicenter, double-blind, controlled study of continuous positive airway pressure that included 35 adult inpatients (18 men, 17 women; mean age, 40.1) with intractable epilepsy and symptoms of snoring to determine whether continuous positive airway pressure treatment of obstructive sleep apnea improves seizure frequency and quality of life.
Dr. Vaughn observed the results suggest one or more of the following three explanations: (1) The QOLIE-89 is the wrong tool to detect obstructive sleep apnea; (2) it may be that obstructive sleep apnea has little impact on individuals with epilepsy; (3) individuals with epilepsy don't recognize the impact of obstructive sleep apnea because they have so many other issues.
Beth Malow, MD, a coauthor of the study, concluded: "Quality of life is a real important issue in epilepsy, and we want to make sure the measures we are using are sensitive to sleep problems. The QOLIE-89 does address energy and fatigue, but not sleep per se. When we develop quality-of-life scales for epilepsy, we need to include specific questions about sleep. Clinicians should be aware that the QOLIE-89 may not be a sensitive tool for detecting obstructive sleep apnea."
This brief review of selected presentations from the American Academy of Neurology's 58th Annual Meeting hints at the wide breadth of topics covered and the increasing depth of the research studies. For example, data in regard to long-term success of the ketogenic diet is helping to propel the diet from an "alternative" approach to a well-studied mainstream treatment for epilepsy. With respect to epilepsy surgery in children, the question is no longer whether surgery is appropriate, but how we can intervene to maximize its psychosocial benefit. Dr. Herzog's report on women and epilepsy continues to lay a foundation for understanding the complex interactions between hormones and seizures. Dr. Vaughn's study seeks to establish whether symptoms of sleep apnea, which are increasingly recognized as important to people with epilepsy, are detected by the QOLIE inventory. With these studies as groundwork, one may expect that next year's presentations will advance our knowledge even further, leading to improved outcomes for people with epilepsy.
References
- Epilepsy and depression. http://www.epilepsy.org.uk/info/depression.html
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