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Abstract Objective We investigated the association between the glucocorticoid receptor (GR) gene, also known as the nuclear receptor subfamily 3, group C, member 1 (NR3C1), rs41423247 polymorphism, and functional seizures (psychogenic nonepileptic seizures/attacks) in a case–control study. We hypothesized that the tested polymorphism has significant associations with functional seizures (psychogenic nonepileptic seizures/attacks) independent from comorbid depression. Methods Seventy patients with functional seizures (psychogenic nonepileptic seizures/attacks), 70 with major depressive disorder (MDD), and 70 healthy controls (HCs) were studied. Their DNAs were analyzed for NR3C1 rs41423247 polymorphism. Results Genotype and allele frequencies of rs41423247 were different between the three groups. G allele carriers were more frequent in patients with functional seizures (psychogenic nonepileptic seizures/attacks) and those with MDD compared to HCs (p = 0.0001). However no significant difference was observed with respect to allele distributions between functional seizures (psychogenic nonepileptic seizures/attacks) and MDD groups (p = 0.391). CC genotype was less often associated with functional seizures (psychogenic nonepileptic seizures/attacks) versus HC: Codominant model; p = 0.001, OR = 0.11, 95% CI = 0.05–0.24, and −2loglilkelihood = 231.7. In comparison between functional seizures (psychogenic nonepileptic seizures/attacks) group and other (MDD + HC) groups, we observed a significant association between CG genotype and functional seizures (psychogenic nonepileptic seizures/attacks) (Codominant model; p = 0.001, OR = 5.63, 95% CI = 2.60–12.40 and −2loglikelihood = 245.99). Significance Patients with functional seizures (psychogenic nonepileptic seizures/attacks) and those with MDD were significantly more often G allele carriers in rs41423247 compared with HCs. We observed a significant association between CG genotype and functional seizures (psychogenic nonepileptic seizures/attacks). However, we could not exclude the possibility of confounding effects of depression. Future genetic studies of patients with functional seizures (psychogenic nonepileptic seizures/attacks) should include a comparison group with depression in addition to a comparison group of HCs.

Abstract Objective We investigated the associations between FKBP5 single‐nucleotide polymorphisms (SNPs) and functional seizures (FS). Methods Seventy patients with FS, 140 with major depressive disorder (MDD), and 140 healthy controls were studied. Their DNAs were analyzed for the rs1360780 in the 3′ region and rs9470080 in the 5′ region of the FKBP5. Childhood trauma questionnaire and hospital anxiety and depression scale were used. Results Patients with FS and those with MDD had less GG and more AA genotypes in both rs9470080 and rs1360780 SNPs compared with those in healthy controls. Similar results were observed for allelic frequencies. There were no significant differences between FS and MDD groups in terms of genotype and allelic frequencies for both SNPs. The results of multinomial logistic regression analysis showed that FKBP5 polymorphisms were not associated with the diagnosis. Significance Patients with FS and those with MDD had significantly different genotypes in both rs9470080 and rs1360780 SNPs compared with those in healthy controls. However, it seems that FKBP5 polymorphisms were not associated with FS in the absence of depression. Further genetic investigations of patients with FS may increase our understanding of the neurobiological underpinnings of this condition, but such studies should be large enough and very well designed; they should include a comparison group with depression in addition to a healthy control group.

Background: Epilepsy surgery has become a successful treatment option for patients with drug-resistant epilepsies. Objectives: This study aimed to assess temporal lobe epilepsy (TLE) surgery outcome and its association with epilepsy duration, the presence of pre-surgical generalized tonic-clonic seizure (GTCS), and brain MRI findings. Materials & Methods: This retrospective study was performed from 2016 to 2020 at Loghman-Hakim Hospital, Tehran, Iran. The patients’ demographic data, epilepsy type, duration, frequency, brain image findings, the selected surgical approaches, and histopathological findings were collected. The post-operative seizure outcome was expressed one year according to the proposed International League Against Epilepsy (ILAE) classification system. The independent sample t-test, chi-square, and one-way analysis of variance were applied to analyze the differences between variables in terms of quantitative and categorical data. Results: A total number of 69 TLE surgeries were enrolled in our study. No differences were found in the surgical outcome base on the ILAE classification system of patients with lesional vs non-lesional MRIs (P=0.834). In patients with mesial temporal sclerosis, no correlation was found between the surgical approaches including selective amygdalohippocampectomy, anterior temporal lobectomy, and post-operative seizure outcome (P=0.142). Seven patients (10.1%) developed post-operative functional seizures. Conclusion: In our study, the epilepsy duration and the presence of GTCSs before surgery had no effect on the surgery outcome. In patients with mesial temporal sclerosis, amygdalohippocampectomy, and anterior temporal lobectomy did not confer different surgical outcomes. TLE patients with normal MRI showed similar surgical outcomes as lesional patients. A significantly high proportion of our patients developed functional seizures, postoperatively.

Background: We assessed the presence of brain volume loss in the extratemporal structures in patients with temporal lobe epilepsy (TLE). The associations between brain volume loss in these structures and epilepsy duration, magnetic resonance imaging (MRI) findings, and occurrence of focal to bilateral tonic-clonic seizures (TCS) were assessed. Methods: In this cross-sectional study, all adult patients with drug-resistant TLE, who were admitted to the epilepsy monitoring unit at Loghman-Hakim Hospital, Tehran, Iran, during 2016-2020, were included. For all the participants, brain MRI was performed and patients with TLE were divided into two subgroups of those with hippocampal sclerosis (TLE-HS) and patients with normal-appearing brain MRI findings (TLE-no). Independent sample t test was applied to compare quantitative variables in the study groups. Pearson correlation test examined the correlation between the clinical and volumetric features. Results: 203 participants (81 patients with TLE and 122 healthy controls) were studied. Compared with healthy controls, patients with TLE showed a decrease in their midbrain (P=0.02) and thalamus (P=0.01) volume. The degree of thalamic atrophy was more significant in TLE-HS (P=0.03). Moreover, the degree of midbrain volume loss was more significant (P=0.07) in patients who had TCS in the past two years (N=31) compared with those who did not (N=50). The volume of the thalamus (r: -0.252, P=0.02) and pallidum (r: -0.255, P=0.02) had inverse correlations with the epilepsy duration. Conclusion: Patients with TLE have lower midbrain and thalamus volume compared with the healthy controls, which may be attributed to the seizure-induced injury. Midbrain atrophy may theoretically increase the risk of sudden unexpected death in epilepsy (SUDEP) because of the enhanced autonomic dysfunction.