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Cannabidiol oil (CBD) has been approved as an antiseizure medication for the treatment of drug -resistant epilepsy in pediatric patients in 2018 for some special types of epilepsy. Since this time its use was extended to other forms of epilepsy. However, to date, there are few publications on the use of CBD in adult patients with drug-resistant focal epilepsy and psychiatric comorbidities. We conducted a prospective, observational, open cohort study, with a before-after design, in adult patients, we assessed the effectiveness, dosage, and tolerance of adjunctive CBD treatment. Our study concluded that CBD was effective and safe.Our study in line with others examining CBD use in adult patients with drug-resistant epilepsy, omits consideration of psychiatric aspects. The aim of this study was to evaluate, in the same patient population that was part of a previous observational study, depression, quality of life, anxious symptoms and daytime sleepiness before and after CBD treatment. RESULTS: Forty-four patients were enrolled in the study. Prior to CBD treatment, 50 % of participants exhibited symptoms of depression. Following CBD treatment, 95.4 % of these individuals demonstrated a marked improvement (p = 0.001). Among this cohort, 71.5 % of patients reported minimal or no depressive symptoms post-treatment. Moreover, 68 % of patients experienced an enhancement in their overall quality of life. Comparative analysis of BDI-II and QOLIE-10 scores before and after CBD treatment revealed a statistically significant positive correlation (p < 0.036 and < 0.001, respectively). Improvements in depressive symptoms were found to correspond with enhancements in quality of life. In terms of anxiety symptoms, 54.5 % of patients exhibited such symptoms prior to CBD treatment, with 71 % showing improvement post-treatment. Adjunctive CBD treatment in adult patients with drug-resistant focal epilepsy was effective, safe, well tolerated and associated with significant improvement in depressive symptoms, anxiety and quality of life., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To analyze patients with drug-resistant focal epilepsy from temporal (TLE) and extra-temporal origin (ETE) and to compare the prevalence of psychiatric comorbid disorders and impulsivity between them and a control group., Methods: Consecutively studied patients with TLE and ETE confirmed with Video-EEG were included. Standardized psychiatric assessment was conducted using the Structured Clinical Interview for Axis I and II diagnosis of DSM-IV (SCID I-II), the Barrat-11 scale for impulsivity, and Beck inventory for depression. Parametric and nonparametric tests were performed., Results: Seventy-three patients with temporal lobe epilepsy (TLE), 21 extra-temporal epilepsy (ETE) and 58 healthy control subjects were included. Both groups of patients showed a high frequency of Axis I comorbid psychiatric disorders: Depression was the most frequent disorder followed by Anxiety Disorders. Furthermore, Axis II (Personality disorders) were also diagnosed, similarly in both groups of patients (p > 0.05). In addition, both TLE and ETE groups presented higher impulsivity scores compared with the control group (p < 0.01). ETE showed a tendency to a higher impulsivity in the motor factor (p = 0.05). Among patients with TLE, a left laterality of the epileptogenic zone, and the presence of comorbid psychiatric disorders (depression), were found as independent factors associated with higher impulsivity (p < 0.05)., Conclusion: Comorbid depression associated with higher impulsivity are important issues to consider in behavioral and clinical evaluation of patients with drug-resistant focal epilepsies, with the aim to set up a prompt treatment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Cannabidiol oil (CBD) has been approved as an anti-seizure medication for the treatment of uncommon types of epilepsy, occurring in children: Dravet syndrome, Lennox-Gastaut syndrome, and Tuberous Sclerosis Complex. There are few publications in relation to use the CBD in adult patients with focal drug-resistant epilepsy. The objective of this study was to evaluate the efficacy, tolerability, safety, and quality of life, of adjuvant treatment with CBD, in adult patients with drug-resistant focal epilepsy for at least 6 months. An open, observational, prospective cohort study was conducted using a before-after design (time series) in adult patients undergoing outpatient follow-up in a public hospital in Buenos Aires, Argentina. From a total of 44 patients, 5% of patients were seizure-free, 32% of patients reduced more than 80% of their seizures and 87% of patients reduced 50% of their monthly seizures. Eleven percent presented a decrease of less than 50% in seizure frequency. The average final dose was 335 mg/d orally administered. Thirty-four percent of patients reported mild adverse events and no patient reported severe adverse effects. At the end of the study, we found in most patients a significant improvement in the quality of life, in all the items evaluated. Adjuvant treatment with CBD in adult patients with drug-resistant focal epilepsy was effective, safe, well tolerated, and associated with a significant improvement in their quality of life., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)

Background: Psychiatric comorbidities in patients with drug-resistant epilepsy (DRE) are frequently observed before and after epilepsy surgery. Impulsivity, defined as behaviors that are poorly conceived, are also frequent among patients with epilepsy. The aim of this study was to determine the presence of comorbid impulsivity in patients with DRE after one year of epilepsy surgery., Methods: Patients who underwent epilepsy surgery for DRE and completed the postsurgical assessment protocol one year after surgery were included. All patients underwent a presurgical protocol comprising of neurological, psychiatric, neuropsychological, video-EEG and MRI assessments. The psychiatric evaluation was performed before and one year after surgery using SCID-I, SCID-II, GAF scale of DSM IV, and Beck Depression Inventory II. One year after surgery, Barratt Impulsiveness Scale 11, and Engel classification of seizures, were administered., Results: A total of 38 patients were included in this study, 21 women (55.3%) and 17 men (44.7%), mean age 36 years (SD = 9.4). Higher impulsivity was associated with a worse epilepsy seizure outcome (p < 0.05), one year after surgery. According to the multiple linear regression analysis, a worse epilepsy seizure outcome was associated with higher levels of nonplanning impulsivity (p < 0.05) (p < 0.05, β -0.5, r 2 0.25). The GAF score was negatively associated with motor score (p < 0.05, β -0.584, r 2 0.42) and with the total BIS-11 score (p < 0.05, β -0.557, r 2 0.39)., Conclusions: Impulsivity has been associated with a worse post-surgical seizure outcome. Larger studies about impulsivity might confirm these preliminary findings., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Depression is the most frequent psychiatric co-morbidity in patients with epilepsy. Lifetime prevalence of depression is reported more frequently in temporal lobe epilepsy and is estimated at 35%. This co-morbidity appears to be related with various mechanisms. The aim of this study was to determine the quality of life (QoL) of patients with pharmacoresistant epilepsy with and without co-morbid depression in an Argentinean population., Methods: Patients admitted to the video-EEG monitoring unit during the period 2010-2013 went through a standardized psychiatric assessment using SCID-I (Structured Clinical Interview for Axis I diagnoses of DSM-IV), BDI II (Beck Depression Inventory) GAF (Global assessment of functioning), and Q LES Q-SF (for quality of life). Patients were divided in two groups: with and without depression (according to DSM-IV). Sociodemographic data, BDI II scores, GAF, and quality of life (QoL) were compared between the two groups. Comparisons were made using Student's t-test and Mann-Whitney U test. Frequency distributions were compared by Chi-square test. Spearman correlation coefficients were determined., Results: Seventy-seven patients with pharmacoresistant epilepsy were eligible for this study, 41 patients were included in the group with depression (mean BDI II 15.93), and 36 in the group without depression (mean BDI II 3.36) (p=0.001). The overall QoL was significantly lower in the group with depression compared to the group without depression (p<0.01). The most affected areas were: physical health (p=0.013), mood (p=0.006), course activities (referring to school as well as to hobbies or classes outside of school) (p=0.003), leisure time activities (p=0.011), social activities (p=0.047), general activities (p=0.042), and medication (p=0.022). Severity of depression according to BDI II had a negative correlation with overall QoL (r - 0.339, p<0.01). No correlations were found between seizure frequency, QoL and BDI II., Conclusion: Patients with pharmacoresistant epilepsy and co-morbid depression reported worst QoL. Depression disrupts daily functioning (leisure, social functioning) and is a negative influence for subjective perception of health and medication. Interdisciplinary treatment should be considered (neurology-psychiatry-psychotherapy)., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objectives: Temporal lobe resistant epilepsy has been associated with a high incidence of psychotic disorders; however, there are many controversies; while some patients get better after surgery from their psychiatric condition, others develop psychosis or de novo depression. The aim of this study was to determine the psychiatric and seizure outcome after epilepsy surgery in patients with a previous history of psychoses., Methods: Surgical candidates with temporal lobe drug-resistant epilepsy and a positive history of psychosis diagnosed during the presurgical psychiatric assessment were included. A two-year prospective follow-up was determined after surgery. The DSM-IV Structural Interview, GAF (global assessment of functionality, DSM-IV), Ictal Classification for psychoses, and Engel's classification were used. The Student t test and chi-square-Fisher tests were used., Results: During 2000-2010, 89 patients were admitted to the epilepsy surgery program, 14 patients (15.7%) presented psychoses and were included in this series. After surgery, six patients (43%) did not develop any psychiatric complications, three patients (21%) with chronic interictal psychosis continued with no exacerbation, three patients (21%) developed acute and transient psychotic symptoms, and two patients (14%) developed de novo depression. Seizure outcome was Engel class I-II in 10 patients (71%). Total GAF scores were higher after surgery in patients found to be in Engel class I-II (p<0.05)., Conclusions: Patients with comorbid psychosis and temporal lobe drug-resistant epilepsy may benefit from epilepsy surgery under close psychiatric supervision., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Epidemiological data show that up to 20-30% of patients with psychogenic nonepileptic seizures (PNESs), resembling drug-resistant epilepsy (DRE), are referred to tertiary epilepsy centers. Furthermore, both disorders present high psychiatric comorbidity, and video-EEG is the gold standard to make differential diagnoses. In this study, we described and compared the clinical presentation and the frequency of psychiatric disorders codified in DSM IV in two groups of patients, one with PNESs and the other with DRE, admitted in a tertiary care epilepsy center of Buenos Aires, Argentina. We included 35 patients with PNESs and 49 with DRE; all were admitted in the video-EEG unit in order to confirm an epilepsy diagnosis and determine surgical treatment possibilities. All patients underwent a neurological and psychiatric assessment, according to standardized protocol (SCID I and II; DSM IV criteria). Student's t test was performed to compare continuous variables and Chi square test to compare qualitative variables. In this study, 33 (67%) patients with DRE and 35 (100%) patients with PNESs met criteria for at least one disorder codified in Axis I of DSM IV (p=0.003). Differences in the frequency of psychiatric disorder presentation were found between groups. Anxiety disorders (16.32% vs 40%; p=0.015), trauma history (24.5% vs 48.57%; p=0.02), posttraumatic stress disorder (4.08% vs 22.85%; p=0.009), and personality cluster B disorders (18.37% vs 42.86%; p=0.02) were more frequent in the group with PNESs. Psychotic disorders were more frequent in the group with DRE (20.4% vs 2.85%; p=0.019). Depression was equally prevalent in both groups. Standardized psychiatric assessment provides information that could be used by the mental health professional who receives the referral in order to improve quality of care and smooth transitions to proper PNES treatment, which should include a multidisciplinary approach including neurology and psychiatry., (© 2013.)

The issue of psychotic disorders in epilepsy has given rise to great controversy among professionals; however, there are not many studies in this area and the physiopathological mechanisms remain unknown. The aim of this study was to describe the spectrum of psychotic disorders in an Argentine population with refractory temporal lobe epilepsy (RTLE) and to determine the risk factors associated with psychotic disorders. Clinical variables of the epileptic syndrome were compared among a selected population with RTLE with and without psychotic disorders (DSM-IV/Ictal Classification of psychoses). Logistic regression was performed. Sixty-three patients with psychotic disorders (Psychotic Group, PG) and 60 controls (Control Group, CG) were included. The most frequent psychotic disorders were brief psychotic episodes (35%) (DSM-IV) and interictal psychosis (50%) (Ictal Classification). Risk factors for psychotic disorders were bilateral hippocampal sclerosis, history of status epilepticus, and duration of epilepsy greater than 20 years.

Purpose: The goal of this study was to assess the cognitive function status in patients with mesial temporal lobe epilepsy and hippocampal sclerosis (TLE+HS) to determine their cognitive function profile and to correlate material-specific memory deficits with HS laterality diagnosed by MRI., Methods: Seventy-one patients were assessed with a neuropsychological protocol that includes IQ, attention, handedness, verbal memory, visual memory, language, and the executive function. chi(2) and correlation tests were used., Results: Memory impairment was found in 46 patients (66%): patients without any memory deficit (n=25), patients with verbal memory deficit (n=21), patients with visual memory deficit (n=17), patients with deficit for both types of memory (n=8). Correlation between MRI lesion and memory was 66%. Language was impaired in 33 patients (46%). Eighteen patients (25%) had a deficit of the executive function., Conclusions: Patients with TLE+HS presented with a deficit in material-specific episodic memory correlating in large proportion with HS lateralization. We also found language and executive function impairments.