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Neuropsychiatric morbidity in focal epilepsy

Melbourne Neuropsychiatry Centre, University of Melbourne and Royal Melbourne Hospital, Melbourne

Terence J. O'Brien, MBBS, MD, FRACP

Departments of Medicine and Surgery, University of Melbourne and Department of Neurology, Royal Melbourne Hospital

John Lloyd, MBBS, FRANZCP

Neuropsychiatry Unit, Royal Melbourne Hospital

Christine J. Kilpatrick, MBBS, MD, FRACP

Royal Melbourne Hospital – Melbourne Health

Michael R. Salzberg, MBBS, FRANZCP

St Vincent's Hospital, Melbourne

Dennis Velakoulis, MBBS, FRANZCP

Melbourne Neuropsychiatry Centre, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia

Correspondence: Sophia J. Adams, Melbourne Neuropsychiatry Centre, The University of Melbourne and Royal Melbourne Hospital, Level 2, John Cade Building, Melbourne, Australia. Email: Sophia.Adams{at}mh.org.au

Declaration of interest

S.J.A. was supported for 1 year by a UCB Pharma Neurosciences scholarship awarded by the Epilepsy Society of Australia in 2004.

Background

Previous work has identified elevated prevalence rates for psychiatric disorders in individuals with medically refractory focal epilepsy, particularly temporal lobe epilepsy. Many studies were undertaken before the advent of video electroencephalogram monitoring (VEM) and magnetic resonance imaging (MRI).

Aims

To investigate which characteristics of the focal epilepsy syndromes are associated with the presence of depression or psychosis.

Method

Three hundred and nineteen individuals with focal epilepsy admitted for VEM were seen over an 11-year period. The lifetime history of depression and psychosis, epileptic site, laterality and type of lesion were determined by clinical assessment, VEM and MRI scan.

Results

There was a significant association between the prevalence of depressive symptoms and non-lesional focal epilepsy. There were no significant differences in prevalence of neuropsychiatric disorders between the groups with temporal lobe epilepsy and those with extratemporal lobe epilepsy.

Conclusions

These findings contrast with previous findings in smaller cohorts. The association between non-lesional focal epilepsy and depression may be due to the effects of a more diffuse epileptogenic area.

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BJP 2008 192: A22. [Full Text]