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Purpose: Changes in calbindin (CB) expression have been reported in patients with temporal lobe epilepsy (TLE) with controversial implications on hippocampal functions. The aim of this study was to determine the CB immunoreactivity in hippocampal dentate gyrus of patients who underwent epilepsy surgery for drug-resistant TLE with and without comorbid depression and/or memory deficits., Methods: Selected hippocampal samples from patients with TLE who underwent epilepsy surgery were included. Clinical and complementary assessment: EEG, video-EEG, MRI, psychiatric assessment (structured clinical interview, DSM-IV), and memory assessment (Rey auditory verbal learning test, RAVLT; Rey-Osterrieth complex figure test, RCFT), were determined before surgery. Hippocampal sections were processed using immunoperoxidase with the anti-calbindin antibody. The semiquantitative analysis of CB immunoreactivity was determined in dentate gyrus by computerized image analysis (ImageJ)., Results: Hippocampal sections of patients with TLE and HS ( n = 24) and postmortem controls ( n = 5) were included. A significant reduction of CB+ cells was found in patients with TLE ( p < 0.05, Student's t -test). Among TLE cases ( n = 24), depression ( n = 12) and memory deficit ( n = 17) were determined. Depression was associated with a higher % of cells with the CB dendritic expression (CB-sprouted cells) ( F (1, 20) = 11.81, p = 0.003, hp 2 = 0.37), a higher CB+ area ( μ m 2 ) ( F (1, 20) = 5.33, p = 0.032, hp 2 = 0.21), and a higher optical density ( F (1, 20) = 15.09, p = 0.001, hp 2 = 0.43) (two-way ANOVA). The GAF scale (general assessment of functioning) of DSM-IV inversely correlated with the % of CB-sprouted cells ( r = -0.52, p = 0.008) and with the CB+ area ( r = -0.46, p = 0.022)., Conclusions: In this exploratory study, comorbid depression was associated with a differential pattern of CB cell loss in dentate gyrus combined with a higher CB sprouting. These changes may indicate granular cell dysmaturation associated to the epileptic hyperexcitability phenomena. Further investigations should be carried out to confirm these preliminary findings.

Purpose: Depression and anxiety are psychiatric disorders related to chronic stress, commonly found in patients with drug-resistant epilepsy (DRE) and functional dissociative seizures (FDS). The present study compares the levels of perceived stress, resilience, and the styles of stress coping among patients with DRE (n=60), FDS (n=28), and controls (n=31).Methods: We performed a cross-sectional study. All patients underwent Video Electroencephalography to confirm the diagnosis and completed the psychiatric assessment (SCID I and II of DSM IV) supported by several instruments validated in Spanish.Results: FDS scored higher in perceived stress (p = 0.004) with lower levels of resilience compared to controls (p = 0.01). Stress coping subscales show higher scores in negative self-focus and hostility in patients with FDS compared to controls (p=0.003). Similarly, DRE patients scored higher in perceived stress (p = 0.001), and presented lower levels of resilience (p = 0.004) with higher levels of hostility compared to controls (p=0.02). However, no significant differences were found between FDS and DRE on stress coping variables. Anxiety scores and depression rates were higher in the FDS group compared to DRE (p=0.008) and higher in DRE compared to controls (p<0.05). A positive correlation between depression and perceived stress was found (r = 0.6, p=0.0001).Conclusions: Our results delineate a more detailed picture of the psychological profile of this population, emphasizing the importance of stress factors in patients with FDS and DRE. Combined intervention strategies which enhance stress coping may be appropriate to direct treatment and psychotherapy. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Status epilepticus increases the production of new neurons (hippocampal neurogenesis) and promotes aberrant migration. However chronic experimental models of epilepsy and studies performed in human epilepsy showed controversial results suggesting a reduction in hippocampal neurogenesis in late stages of the disease. Doublecortin (DCX) has been validated to determine alterations in the production of new neurons in the human hippocampus. Objectives: Determine DCX expression in human hippocampal sclerosis (HS) from patients who underwent epilepsy surgery for refractory temporal lobe epilepsy (TLE). Methods: Hippocampal sections of 9 patients with HS and TLE who underwent surgery, were processed using immunoperoxidase for DCX. Archival material from 5 normal post-mortem hippocampus were simultaneously processed. Results: Significantly lower staining intensity was observed in DCX-positive neurons localized in dentate gyrus (DG) and in CA1 of epileptic hippocampus; lower DCX reactive area was observed in pyramidal layers of CA1; and a reduced in the mean number of DCX-positive neurons were determined in DG compared to normal hippocampus (p <0.05). Conclusions: This study found a decrease in DCX expression in hippocampus of patients with HS and chronic and refractory TLE suggesting alterations in NG and hippocampal synaptogenesis with potential cognitive and emotional repercussion. [ABSTRACT FROM AUTHOR]

• Psychiatric comorbidities improve after adjuvant treatment with CBD in adult patients with drug resistant focal epilepsy. • Depressive and anxious symptoms improve after treatment with CBD. • Adjuvant treatment with CBD in drug resistant focal epilepsy was effective in seizure control, with acceptable tolerability. 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. 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. [ABSTRACT FROM AUTHOR]

• Temporal and extra-temporal focal resistant epilepsies were compared. • Impulsivity levels and psychiatric comorbid disorders were analyzed. • Both epilepsy groups presented higher impulsivity compared to control. • A left temporal epileptogenic zone was associated with higher impulsivity. • Depressive disorders were associated with higher impulsivity. 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. 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. 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). 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. [ABSTRACT FROM AUTHOR]

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). [ABSTRACT FROM AUTHOR]