Magdalena Bosak

Subtypes of interictal depressive disorders according to ICD-10 in patients with epilepsy

BACKGROUND AND PURPOSE The purpose of the study was to evaluate the frequency of interictal depressive symptoms and different subtypes of depressive disorders according to 10th revision of the International Classification of Diseases (ICD-10) criteria in patients with epilepsy and its association with the type of epilepsy. MATERIAL AND METHODS 289 outpatients with epilepsy (169 females, 120 males) aged 18-82 years completed Beck Depression Inventory (BDI). Subjects who scored >11 in BDI were further evaluated by the psychiatrist according to the ICD-10 diagnostic criteria. RESULTS 41.9% (121) of the 289 participants scored >11 in BDI. 104 (85.9%) patients who scored >11 in BDI had comorbid mental disorders according to ICD-10 criteria. The most common were organic mood disorders (F06.3 - 31.4%), depressive episode (F32 - 22.3%) and dysthymia (F34.1 - 9.1%) There were no differences in the prevalence of depression and subtypes of depression in patients with certain epilepsy types. Depression was diagnosed before entering the study in only one third of patients with final diagnosis of depression. CONCLUSIONS Our results confirm the prevailing view that interictal depression is common in epilepsy patients. Depression remains underrecognized and undertreated in patients with epilepsy.

Depressogenic medications and other risk factors for depression among Polish patients with epilepsy

Purpose The aim of this study was to assess the prevalence of depression among patients with epilepsy and to establish the risk factors of depression in that group, with special focus on the use of potentially depressogenic medications. Patients and methods We studied 289 consecutive patients who visited epilepsy outpatient clinic (University Hospital of Krakow) and met inclusion criteria. All patients were screened with Beck Depression Inventory (BDI), and those with BDI score ≥12 were further evaluated by a psychiatrist. Results Mean age of patients was 35.7 years, and mean duration of epilepsy was 14.7 years. Idiopathic generalized epilepsy was diagnosed in 63 patients (21.8%), focal epilepsy was found in 189 subjects (65.4%), and unclassified epilepsy was diagnosed in 37 patients (12.8%). Frequent seizures (>1 per month) were reported in 107 patients (37.0%). Thirty-five patients (12.1%) reported an ongoing treatment with one or more of the predefined potentially depressogenic medication (β-blockers, combined estrogen and progestogen, corticosteroid, or flunarizine). In a group of 115 patients (39.8%) who scored ≥12 points in BDI, depression was finally diagnosed in 84 subjects (29.1%) after psychiatric evaluation. Only 20 of those patients (23.8%) were treated with antidepressant. Independent variables associated with the diagnosis of depression in the logistic regression model included frequent seizures (odds ratio [OR] =2.43 [95% confidence interval, 95% CI =1.38–4.29], P=0.002), use of potentially depression-inducing medications (OR =3.33 [95% CI =1.50–7.39], P=0.003), age (OR =1.03 [95% CI =1.01–1.05] per year], P=0.005), and use of oxcarbazepine (OR =2.26 [95% CI =1.04–4.9], P=0.038). Conclusion The prevalence of depression among consecutive Polish patients with epilepsy reached 29.1%. Less than quarter of them received antidepressant treatment at the moment of evaluation. Independent variables associated with depression included age, frequent seizures, and the use of oxcarbazepine or predefined depressogenic medications.

Psychiatric comedication in patients with epilepsy

Psychiatric disorders are more common in patients with epilepsy than in the general population. The aims of the study were to assess the frequency and type of psychotropic drug usage in patients with epilepsy, to assess the risk factors for their use, and to assess their proconvulsive potential and the risk of interactions with antiepileptic drugs. This 20-month prospective study included patients treated at the university hospital outpatient clinic. Psychotropic drugs have been classified according to the Anatomical Therapeutic Chemical Classification System. Of the 621 patients (with a mean age of 35.4years), 60% were women, and 37.5% were in remission; 54.8% of the patients used antiepileptic drug monotherapy. The most commonly used antiepileptic drugs were valproate, levetiracetam, lamotrigine, and carbamazepine. Eighty-nine (14.3%) patients received psychiatric comedication. Sertraline, perazine, and hydroxyzine were the predominantly used psychotropic drugs. Independent variables associated with psychotropic drug usage in the logistic regression model included age, active epilepsy, combined focal and generalized epilepsy type, use of somatic comedication, and phenobarbital. Over one-third of the patients simultaneously received antiepileptic drugs and psychotropic drugs, between which clinically significant interactions may occur, 10% of patients used psychotropic drugs to lower the seizure threshold. The results of the study indicate the need for closer cooperation between doctors of various specialties when caring for patients with epilepsy.

Common allergies do not influence the prevalence of cutaneous hypersensitivity reactions to antiepileptic drugs

OBJECTIVE The aim of the study was to establish whether the presence of common allergies increases the risk of drug-related hypersensitivity reactions among patients with epilepsy treated with antiepileptic drugs (AEDs). METHODS We studied 753 patients with epilepsy seen in tertiary outpatient epilepsy clinic. We obtained data related to epilepsy type, past and ongoing treatment with AEDs, occurrence of maculopapular exanthema or more serious cutaneous adverse reactions (Stevens-Johnson syndrome - SJS) and their characteristics. We noted an occurrence of allergic reactions unrelated to treatment with AED, including rash unrelated to AED, bronchial asthma, persistent or seasonal allergic rhinitis, atopic dermatitis, rash after specific food and other allergic reactions. RESULTS There were 61 cases of AED-related cutaneous hypersensitivity reaction (including 3 cases of SJS) noted in association with 2319 exposures to AEDs (2.63%) among 55 out of 753 patients (7.3%). Cutaneous hypersensitivity reaction to AED was most commonly noted after lamotrigine (12.1%), carbamazepine (5.4%) and oxcarbazepine (4.1%). Prevalence of allergic reactions unrelated to AED was similar between patients with and without AED-related cutaneous hypersensitivity reaction (rash unrelated to AED: 16.4% vs. 10.2%; bronchial asthma: 1.8% vs. 0.1%; persistent allergic rhinitis: 7.3% vs. 10.2%; seasonal allergic rhinitis: 7.3% vs. 11.7%; atopic dermatitis: 0 vs. 0.7%; rash after specific food: 5.4% vs. 6.4%; other allergic reactions: 5.4% vs. 5.2%, respectively; P>0.1 for each difference). CONCLUSIONS Presence of common allergies is not a significant risk factor for AED-related cutaneous hypersensitivity reaction among patients with epilepsy.

Safety of switching from brand-name to generic levetiracetam in patients with epilepsy

Purpose The approach to the use of generic antiepileptic drugs has recently evolved from major concern to general acceptance, but the evidence related specifically to the safety of switching from brand-name to generic levetiracetam (LEV) is scarce. The aim of the study was to assess the risk of increased frequency of seizures or other adverse events after replacement of a brand-name LEV with a generic one. Patients and methods This retrospective analysis included 159 patients treated with LEV in a tertiary outpatient epilepsy clinic. We included all patients diagnosed with epilepsy who were treated with LEV as at March 1, 2013. Most patients were forced to switch to the generic LEV because of the sudden rise in cost of the branded LEV. We recorded data on age, sex, age at onset of epilepsy, type of epilepsy, and its treatment. We analyzed data from one visit before potential switching and from two visits after the potential switching. The interval between visits was typically 3 months. We registered an increase in the frequency of seizures and in the occurrence of adverse events. Results Among 151 subjects who switched to generic LEV after March 1, 2013, increased frequency of seizures was noted in 9 patients (6%) during the first follow-up visit. Patients with increased frequency of seizures did not differ from other patients regarding sex, age, age at the onset of epilepsy, and the median dose of LEV before switching or the median duration of treatment with LEV before switching. Two patients returned to brand-name LEV. Adverse events were noted in six other patients (4%) and included somnolence, irritability, or dizziness. Conclusion Switching from brand-name to generic LEV is generally safe.

Menstrual disorders and their determinants among women with epilepsy

Introduction The purpose of the present study was to assess the prevalence and determinants of menstrual cycle disorders among women with epilepsy. Materials and methods The study included consecutive women with epilepsy who visited a university epilepsy clinic. A number of variables, including demographics, characteristics of epilepsy and its treatment, and data related to reproductive health (regularity of menstrual cycle, number of pregnancies and childbirths), were collected from medical records, seizure diaries, and a dedicated questionnaire. Results The study involved 271 women with epilepsy. Focal epilepsy was diagnosed in 182 (67.2%) patients; 108 (39.8%) women had rare seizures (<1 per year), and 164 patients (60.5%) were on monotherapy. Menstrual abnormalities were found in 78 patients (28.8%). Independent variables associated with irregular cycle included younger age at onset of epilepsy (OR=0.95 per 1-year increase; P=0.008), current use of clonazepam (OR=5.36; P=0.010), and chronic use of medication(s) other than antiepileptic drug(s) (AEDs; OR=2.48; P=0.003). Childbirth rate was low in our cohort (0.50 per patient); independent predictors of being childless in studied patients included younger age, presence of menstrual disorders, and greater number of currently used AEDs. Conclusion Menstrual disturbances were present in 28.8% of studied women with epilepsy. Increased prevalence of menstrual abnormalities was associated with epilepsy itself (younger age at onset of epilepsy) and its treatment (ongoing use of clonazepam), as well as with chronic use of medications other than AEDs.