Eduardo Jardel Portela

Brazilian version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)

OBJECTIVE The purpose of this research was to evaluate the Brazilian-Portuguese version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and to assess its psychometric properties. METHODS This study involved 98 outpatients who underwent psychopathological evaluation with the Mini International Neuropsychiatric Interview-Plus Version, Hamilton Depression Scale (HAM-D), and a Portuguese version of the NDDI-E. RESULTS The NDDI-E was easily understood and quickly administered to most of the patients. At a cutoff score >15, NDDI-E had a sensitivity of 81.5%, a specificity of 83.1%, and a negative predictive value of 92.2% for diagnosis of major depression. Internal consistency reliability of the NDDI-E was 0.79, and there was also a positive correlation between the NDDI-E and the HAM-D (P<0.001). CONCLUSION The Brazilian-Portuguese version of NDDI-E can be used as a practical screening tool to improve recognition of depression in Brazilian people with epilepsy.

Psychiatric disorders in temporal lobe epilepsy: An overview from a tertiary service in Brazil

PURPOSE To evaluate the frequency and intensity of psychiatric disorders in a group of temporal lobe epilepsy (TLE) patients from a tertiary-care center. METHODS Clinical and sociodemographic data of 73 patients were collected and a neuropsychiatric evaluation was performed with the following instruments: Mini-Mental State Examination (MMSE), structured clinical interview (MINI-PLUS), Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D), Brief Psychiatric Rating Scale (BPRS). RESULTS Patients with TLE showed a high frequency of lifetime psychiatric disorders (70%), the most frequent being mood disorders (49.3%). At assessment, 27.4% of the patients were depressed and 9.6% met criteria for bipolar disorder. Nevertheless, depression had not been properly diagnosed nor treated. Anxiety disorders were also frequent (42.5%), mainly generalized anxiety disorder (GAD) (21.9%). Obsessive compulsive disorder (OCD) was present in 11.0% and psychotic disorders in 5.5% of the sample. Patients with left mesial temporal sclerosis (LMTS) exhibited more psychopathologic features, mainly anxiety disorders (p=0.006), and scored higher on HAM-A and HAM-D (p<0.05 in both). CONCLUSION TLE is related to a high frequency of psychiatric disorders, such as anxiety and depression, which are usually underdiagnosed and undertreated. Damage to the left mesial temporal lobe, seen in LMTS, seems to be an important pathogenic lesion linked to a broad range of psychopathological features in TLE, mainly anxiety disorders. The present study prompts discussion on the recognition of the common psychiatric disorders in TLE, especially on the Brazilian setting.

Screening for depression in people with epilepsy: Comparative study among Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Hospital Anxiety and Depression Scale Depression Subscale (HADS-D), and Beck Depression Inventory (BDI)

PURPOSE We aimed to assess and compare the psychometric properties of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Hospital Anxiety and Depression Scale Depression Subscale (HADS-D), and Beck Depression Inventory (BDI) as screening instruments for depression and suicidality in people with epilepsy. METHODS One hundred twenty-six people (54% women) diagnosed with epilepsy were recruited and evaluated on their sociodemographic and clinical features. Depression and suicide risk were assessed with a structured psychiatric interview, the Mini International Neuropsychiatric Interview (MINI-Plus), and the performance of NDDI-E, HADS-D, and BDI was evaluated. RESULTS The sensitivity and specificity of BDI for the diagnosis of depression was around 90%; HADS-D and NDDI-E have sensitivity higher than 80%, and specificity was greater than 75%. For identifying suicide risk, the NDDI-E sensitivity was 92.9%, and HADS-D sensitivity was 85.7%, and a reasonable specificity (68%) was observed for both instruments. All instruments showed a negative predictive value of over 90%. Comparisons of the areas under the ROC curve for these instruments were not significantly different regarding depression or moderate/severe risk of suicide. CONCLUSION All three instruments evaluated have clinical utility in the screening of depression in people with epilepsy. Both NDDI-E and HADS-D are brief efficient screening instruments to identify depression in people with epilepsy. The BDI is a more robust instrument, but it takes longer to apply, which hampers its use by busy clinicians and by people with cognitive impairment.

Inventário de Depressão em Transtornos Neurológicos para a Epilepsia (IDTN-E): versão brasileira de um instrumento de rastreamento

INTRODUCTION: Depression is the most common psychiatric comorbidity in epilepsy, being its identification frequently neglected in most epilepsy centers. OBJECTIVE: To evaluate the performance of the Brazilian version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) in a group of patients from a specialized center. METHODS: The recently validated Brazilian version of the NDDI-E was applied to a group of 142 outpatients with epilepsy. We used the MINI-Plus as a gold standard to diagnosis major depressive episode. Results: Forty patients (28.2%) were depressed at the time of evaluation. The ROC curve analysis indicated that the cutoff at 15 (>15) represented the greatest dichotomy between depressed and nondepressed (sensitivity 70.0%, specificity of 87.3%, positive predictive value of 68.3% and negative predictive value of 88.1%). The use of lower cutoff points may eventually be adopted to provide greater sensitivity to the instrument. CONCLUSION: The Brazilian version of NDDI-E is a sensitive and practical tool that can help in tracking depression in epilepsy in order to reduce its underdiagnosis.

Inventário de Depressão de Beck (BDI) e Escala de Avaliação de Depressão de Hamilton (HAM-D) em pacientes com epilepsia

OBJECTIVE: To determine cutoff points of highest sensitivity and specificity on the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAM-D) for depression diagnosis in epilepsy. METHODS: Seventy-three patients from a referral center for the treatment of epilepsy underwent neuropsychiatric evaluation. We collected clinical and socio-demographic data, and applied the following instruments: Structured Clinical Interview (MINI-PLUS) for psychiatric diagnosis according to DSM-IV, HAM-D and BDI. RESULTS: At assessment, 27.4% of the patients were depressed and 37% met diagnostic criteria for lifetime major depression. The ROC curve analysis indicated that a score > 16 on the BDI (94.4% sensitivity, 90.6% specificity) and > 16 on the HAM-D (95% sensitivity, 75.5% specificity) revealed great dichotomy between depressed and nondepressed patients. Both instruments showed a negative predictive value exceeding 95%. CONCLUSION: The frequency of major depression is elevated in patients with epilepsy. BDI and HAM-D can help physicians in the identification of depression in epilepsy, reducing its underdiagnosis.

Adaptação transcultural do inventário neurocomportamental (NBI) para o Brasil

OBJETIVO: Realizar a adaptacao transcultural de instrumento para avaliacao das alteracoes comportamentais tipicamente descritas em portadores de epilepsia do lobo temporal (ELT), o Inventario Neuro-Comportamental (NBI) para a populacao brasileira. METODOS: Inicialmente, foi feita a traducao do instrumento original para o portugues. Esta versao foi revisada e retrotraduzida para o ingles. A seguir, a versao retrotraduzida foi comparada a versao original em ingles, sendo corrigidas as divergencias no texto em portugues. Em um segundo momento, 15 pacientes do Ambulatorio de Epilepsia do Hospital das Clinicas da UFMG portadores de ELT responderam ao inventario. A aplicacao do questionario, eventuais dificuldades e os itens mal compreendidos foram analisados pelos autores. RESULTADOS: Na versao final para o portugues, os itens 11, 14, 17, 61 e 75 foram modificados. Sete pacientes (46,7%) eram do sexo feminino, com idade entre 26 e 65 anos. A maioria dos pacientes (93,3%) apresentou uma pontuacao total elevada. Os dominios mais comumente alterados foram hiperreligiosidade, detalhismo e crenca na predestinacao pessoal (73,3% dos pacientes em cada um deles). CONCLUSAO: A versao em portugues do NBI pode ser um instrumento util para avaliar alteracoes comportamentais na ELT aplicada ao contexto clinico dos pacientes brasileiros.

Tratamento cirúrgico das epilepsias na criança

INTRODUCTION: This review article is based on critical analysis of the literature concerning the surgical treatment of epilepsy in childhood. OBJECTIVE: To review and update knowledge about epilpsy surgery in childhood. RESULTS: Epilepsy surgery is used successfully to treat medically resistant seizures in children. Surgical therapy aims to reduce the occurrence or strength of incapacitating seizures, preferably to make the patient seizure-free, without unacceptable sequelae. If drug resistance is established the patient should start the investigation for localization of the seizure-producing area with combined video-EEG recording during seizures; also a neuropsychological investigation, functional and anatomic imaging studies should be carried out Regarding the time of surgery, we do know that: (1) younger patients have a better psychosocial prognosis after surgery than do older patients; (2) the high incidence of unsuspected tumors in refractory partial epilepsy of childhood favors early intervention; (3) a long latency between the onset of epilepsy and surgery may predispose to poorer postoperative seizure control; and (4) developmental plasticity may offer reduced risk for postoperative neurological deficits. The most important benefit that we are looking for is the seizure free outcome. Also, a global outcome, including parental satisfaction, developmental and social outcome, as well as activities of daily living (ADL), schooling, and behavioral changes should be considered. Pediatric epilepsy surgical series show that 60-100% of the patients have a good seizure outcome. Temporal epilepsy patients have higher free seizure rates than the extratemporal group. CONCLUSIONS: Surgery for epilepsy has now become a realistic therapeutic option for selected children and the field is likely to increase in the near future. It is now realized that procrastination in the hope that new antiepileptic drugs or new combinations of drugs will become efficacious, is not justified for some forms of epilepsy that can often be recognized from onset or after a relatively short course. Surgical therapy should not be considered unless there is a reasonably good chance of improving the patients quality of life.