Sigita Plioplys

Consensus statement: the evaluation and treatment of people with epilepsy and affective disorders.

Affective disorders in people with epilepsy (PWE) have become increasingly recognized as a primary factor in the morbidity and mortality of epilepsy. To improve the recognition and treatment of affective disorders in PWE, an expert panel comprising members from the Epilepsy Foundations Mood Disorders Initiative have composed a Consensus Statement. This document focuses on depressive disorders in particular and reviews the appearance and treatment of the disorder in children, adolescents, and adults. Idiosyncratic aspects of the appearance of depression in this population, along with physiological and cognitive issues and barriers to treatment, are reviewed. Finally, a suggested approach to the diagnosis of affective disorders in PWE is presented in detail. This includes the use of psychometric tools for diagnosis and a stepwise algorithmic approach to treatment. Recommendations are based on the general depression literature as well as epilepsy-specific studies. It is hoped that this document will improve the overall detection and subsequent treatment of affective illnesses in PWE.

Depression in children and adolescents with epilepsy

Depression in children and adolescents with epilepsy is a common but often unrecognized disorder. Both epilepsy and depression are characterized by a chronic course and poor long-term psychosocial outcome. The risk of suicide is even greater in depressed youth with epilepsy than in the general youth population. Educating parents about mood disorders may allow them to be more receptive to psychiatric treatment for their child or themselves. Epidemiological and clinical data on depression in children/adolescents with epilepsy are presented. Seizure-related and general risk factors for the development of depression in youth with epilepsy are reviewed. General guidelines for diagnosis and treatment of depression in children and adolescents are discussed. The early identification and treatment of childhood-onset depression is an important clinical task for all pediatric specialists. Safe and effective multimodal treatment approaches are available.

Epilepsy and Autism: Is there a special relationship?

Increasingly, there has been an interest in the association between epilepsy and autism. The high frequency of autism in some of the early-onset developmental encephalopathic epilepsies is frequently cited as evidence of the relationship between autism and epilepsy. While these specific forms of epilepsy carry a higher-than-expected risk of autism, most, if not all, of the association may be due to intellectual disability (ID). The high prevalence of interictal EEG discharges in children with autism is also cited as further evidence although errors in the diagnosis of epilepsy seem to account for at least part of those findings. The prevalence of ID is substantially elevated in children with either epilepsy or autism. In the absence of ID, there is little evidence of a substantial, if any, increased risk of autism in children with epilepsy. Further, although the reported prevalence of autism has increased over the last several years, much of this increase may be attributable to changes in diagnostic practices, conceptualization of autism in the presence of ID, and laws requiring provision of services for children with autism. In the context of these temporal trends, any further efforts to tease apart the relationships between epilepsy, ID, and autism will have to address head-on the accuracy of diagnosis of all three conditions before we can determine whether there is, indeed, a special relationship between autism and epilepsy.

Estimating rates of chronic fatigue syndrome from a community-based sample: a pilot study.

Most of the Chronic Fatigue Syndrome (CFS) epidemiological studies have relied on physicians who refer patients having at least 6 months of chronic fatigue and other symptoms. However, there are a number of potential problems when using this method to derive prevalence statistics. For example, some individuals with CFS might not have the economic resources to access medical care. Other individuals with CFS might be reluctant to use medical personnel, particularly if they have encountered physicians skeptical of the authenticity of their illness. In addition, physicians that are skeptical of the existence of CFS might not identify cases. In the present pilot study, a random community sample (N=1,031) was interviewed by telephone in order to identify and comprehensively evaluate individuals with symptoms of CFS and those who self-report having CFS. Different definitions of CFS were employed, and higher rates (0.2%) of CFS were found than in previous studies. Methodological benefits in using more rigorous epidemiological methods when estimating CFS prevalence rates are discussed.

Amantadine and L-Carnitine Treatment of Chronic Fatigue Syndrome

Carnitine is essential for mitochondrial energy production. Disturbance in mitochondrial function may contribute to or cause the fatigue seen in Chronic Fatigue Syndrome (CFS) patients. Previous investigations have reported decreased carnitine levels in CFS. Orally administered L-carnitine is an effective medicine in treating the fatigue seen in a number of chronic neurologic diseases. Amantadine is one of the most effective medicines for treating the fatigue seen in multiple sclerosis patients. Isolated reports suggest that it may also be effective in treating CFS patients. Formal investigations of the use of L-carnitine and amantadine for treating CFS have not been previously reported. We treated 30 CFS patients in a crossover design comparing L-carnitine and amantadine. Each medicine was given for 2 months, with a 2-week washout period between medicines. L-Carnitine or amantadine was alternately assigned as fist medicine. Amantadine was poorly tolerated by the CFS patients. Only 15 were able to complete 8 weeks of treatment, the others had to stop taking the medicine due to side effects. In those individuals who completed 8 weeks of treatment, there was no statistically significant difference in any of the clinical parameters that were followed. However, with L-carnitine we found statistically significant clinical improvement in 12 of the 18 studied parameters after 8 weeks of treatment. None of the clinical parameters showed any deterioration. The greatest improvement took place between 4 and 8 weeks of L-carnitine treatment. Only 1 patient was unable to complete 8 weeks of treatment due to diarrhea. L-Carnitine is a safe and very well tolerated medicine which improves the clinical status of CFS patients. In this study we also analyzed clinical and laboratory correlates of CFS symptomatology and improvement parameters.

Risk and Correlates of Autism Spectrum Disorder in Children With Epilepsy: A Community-Based Study

The prevalence of autism spectrum disorders for children with epilepsy in the general population is unknown. In a prospective community-based study of newly diagnosed childhood epilepsy, autism spectrum disorder was determined from parental interviews, medical records, and expert reviews by a child psychiatrist. A total of 28 (5%) participants had autism spectrum disorders. West syndrome (prevalence ratio = 4.53, P = .002) and intellectual impairment (prevalence ratio = 4.34, P = .002) were independently associated with autism spectrum disorder. Absent West syndrome, male gender was associated with autism spectrum disorder (prevalence ratio = 3.71, P = .02). For participants with overall normal cognitive abilities, 2.2% had autism spectrum disorder, which is substantially higher than estimates from the general population (0.5%-0.9%). In addition to West syndrome, which has repeatedly been shown to have a special relationship with autism spectrum disorder, the most important determinants of autism spectrum disorder in the general population (intellectual impairment and male sex) are also important in young people with epilepsy.

Estimating the prevalence of chronic fatigue syndrome among nurses

The present study assessed the prevalence of chronic fatigue syndrome (CFS) in a sample of nurses. There is a paucity of studies on the prevalence of CFS in healthcare professionals. Two samples of nurses were recruited through mailed questionnaires. Data were collected on demographic characteristics and symptoms. In addition from the sample, those nurses with CFS-like symptoms were more comprehensively evaluated using a structured clinical interview and reviewing their medical records. A physician review team estimated the prevalence of CFS to be 1,088 per 100,000. These findings suggest that nurses might represent a high-risk group for this illness, possibly due to occupational stressors such as exposure to viruses in the work setting, stressful shift work that is disruptive to biologic rhythms, or to other possible stressors in the work settings (e.g., accidents).

Serum Levels of Carnitine in Chronic Fatigue Syndrome: Clinical Correlates

Carnitine is essential for mitochondrial energy production. Disturbance in mitochondrial function may contribute to or cause the fatigue seen in chronic fatigue syndrome (CFS) patients. One previous investigation has reported decreased acylcarnitine levels in 38 CFS patients. We investigated 35 CFS patients (27 females and 8 males); our results indicate that CFS patients have statistically significantly lower serum total carnitine, free carnitine and acylcarnitine levels, not only lower acylcarnitine levels as previously reported. We also found a statistically significant correlation between serum levels of total and free carnitine and clinical symptomatology. Higher serum carnitine levels correlated with better functional capacity. These findings may be indicative of mitochondrial dysfunction, which may contribute to or cause symptoms of fatigue in CFS patients.

Psychiatric disorders in children and adolescents who have epilepsy

1. Jana E. Jones, PhD* 2. Joan K. Austin, DNS, RN† 3. Rochelle Caplan, MD‡ 4. David Dunn, MD§ 5. Sigita Plioplys, MD** 6. Jay A. Salpekar, MD¶ 1. *Assistant Professor, Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisc 2. †Distinguished Professor of Nursing, Indiana University School of Nursing, Indianapolis, Ind 3. ‡Professor, Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Calif 4. §Arthur B. Richter Professor of Child Psychiatry, Indiana University, Indianapolis, Ind 5. **Assistant Professor, Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Ill 6. ¶Assistant Professor of Psychiatry and Pediatrics, George Washington University School of Medicine, Washington, DC Epilepsy occurs in approximately 1% of the population. It is the third most common neurologic disorder in the United States after Alzheimer disease and stroke. The prevalence of epilepsy is equal to the combined prevalence of cerebral palsy, multiple sclerosis, and Parkinson disease. Epilepsy is the most common childhood neurologic disorder, affecting 0.5% to 1.0% of children younger than age 16 years. (1) More than 326,000 children younger than age 15 years have epilepsy, and approximately 90,000 have seizures that are not controlled completely by treatment. Epilepsy often occurs in conjunction with other conditions, including autism spectrum disorder, cerebral palsy, Down syndrome, and intellectual disability. Although seizures are the most readily identifiable feature of epilepsy, behavior and cognitive functioning also are affected negatively in a substantial number of children. The prevalence of psychiatric comorbidity in epilepsy is significantly higher than in healthy controls or in children who have other chronic health conditions. This article reviews the current knowledge of coexisting psychiatric disorders in children who have epilepsy and discusses diagnostic and treatment issues. Two epidemiologic investigations, conducted in the United Kingdom 3 decades apart, demonstrate that psychiatric comorbidity is overrepresented in pediatric epilepsy. In the classic Isle of Wight study, Rutter and associates (2) reported that 7% of children in the general population exhibited a mental health problem compared with 12% of children who had non-neurologic physical disorders. Significantly higher rates were reported in those having epilepsy, including 29% in children who had uncomplicated (idiopathic and cryptogenic) epilepsy and 58% in those who had complicated epilepsy (seizures in the context of structural central nervous system abnormalities). Strikingly similar findings were reported in a recent United Kingdom epidemiologic investigation by Davies and colleagues. (3) Among children ages 5 to 15 years of age, psychiatric disorders were found in 9.3% of the …

A multisite controlled study of risk factors in pediatric psychogenic nonepileptic seizures

Psychogenic nonepileptic seizures (PNES) in youth are symptoms of a difficult to diagnose and treat conversion disorder. PNES is associated with high medical and psychiatric morbidity, but specific PNES risk factors in the pediatric population are not known. We examined if youth with PNES have a distinct biopsychosocial risk factor profile compared to their siblings and if the interrelationships between these risk factors differentiate the PNES probands from the sibling group.