HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

Correspondence to:

ARTICLES: L. S. Boylan, L. A. Flint, D. L. Labovitz, S. C. Jackson, K. Starner, and O. Devinsky Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy Neurology 2004; 62: 258-261 [Abstract] [Full text] [PDF]

Correspondence: Submit a response to this article

Correspondence published:

Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy

Ludger Tebartz van Elst, Michael R. Trimble   (5 March 2004)

In reply to van Elst et al

Laura S. Boylan, Daniel L. Labovitz, Lynn A . Flint, Orrin Devinsky   (5 March 2004)

Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy 5 March 2004
Ludger Tebartz van Elst, University of Freiburg, Medical School, Department of Psychiatry Hauptstr. 5, 79104 Freiburg, Germany, Michael R. Trimble Send Correspondence to journal: Re: Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy ludger_vanelst{at}psyallg.ukl.uni-freiburg.de Ludger Tebartz van Elst, et al.	The interesting article by Boylan et al examines the treatment of depressive comorbidity in patients with refractory epilepsy. [1] According to their data, depression measured with the Beck Depression Inventory (BDI) but not seizure frequency predicts the quality of life in affected patients. The authors also stress the high prevalence of depression and the low rate of respective diagnosis and treatment in this patient sample. According to our experience, this article is very relevant as we have found similar rates of depression in similar patient samples and a severe neglect of this problem in the treatment of patients with refractory epilepsy. Even when antidepressive treatment is recommended by liaison psychiatrists, the majority of cases are not treated in the course of the disease. One possible reason might be that the presentation of depressive symptoms in epilepsy is often atypical compared to classic major depression. Patients with refractory epilepsy often suffer from interictal dysphoric disorder of epilepsy (IDD) with irritability, anger attacks, mood swings and other pleiomorphic affective-somatoform symptoms. [2] While specialists easily recognize IDD, non specialists might interpret these symptoms as non-pathological reactions to seizures. This psychodynamic interpretation of psychopathological symptoms might explain the resistance in the medical profession to treat this condition while also focusing on reducing seizure frequency. Furthermore, there is indirect evidence that chronic and untreated IDD might be associated with psychotic disorders of epilepsy (POE). [3,4] While a causal relationship between IDD and POE is unclear, such considerations underline the need to treat affective symptoms in patients with epilepsy. The paper by Boylan et al will hopefully increase the awareness of the need to recognize and treat depression in refractory epilepsy. References 1. Boylan LS, Flint LA, Labovitz DL, Jackson SC, Starner K, Devinsky O. Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy. Neurology 2004; 62(2):258-261. 2. Blumer D. Dysphoric disorders and paroxysmal affects: recognition and treatment of epilepsy-related psychiatric disorders. Harvard Review of Psychiatry 2000; 8:8-17. 3. Tebartz van Elst L, Trimble M. Amygdala pathology in schizophrenia and psychoses of epilepsy. Current Opinion in Psychiatry 2003; 16:321-326. 4. Tebartz vE, Baeumer D, Lemieux L, Woermann FG, Koepp M, Krishnamoorthy S et al. Amygdala pathology in psychosis of epilepsy: A magnetic resonance imaging study in patients with temporal lobe epilepsy. Brain 2002; 125(Pt 1):140-149.
In reply to van Elst et al 5 March 2004
Laura S. Boylan, Dept of Neurology, New York University 462 First Ave., New York, NY 10016, Daniel L. Labovitz, Lynn A . Flint, Orrin Devinsky Send Correspondence to journal: Re: In reply to van Elst et al laura.boylan{at}med.nyu.edu Laura S. Boylan, et al.	We thank Tebartz van Elst et al for their comments. They point out that neurologists frequently disregard recommendations for depression treatment made by consulting psychiatrists. They go on to suggest that the reluctance to treat may result from neurologists’ failure to recognize atypical psychiatric syndromes or a tendency to think their patients’ reactions are ‘normal’ or expected. We agree that these are important issues. Further, we note that neurologists are sometimes uncomfortable taking on the management of depression. At the same time, some patients are averse to seeing a psychiatrist. Neurologists should be willing to initiate treatment with antidepressants. Educational efforts starting at least as early as residency could be helpful. There are more barriers to the treatment of depression in epilepsy. The time available for neurology encounters is limited. Perhaps use of screening tools to be filled in by patients while they wait could be helpful. In a recent study by Gilliam et al, this approach was demonstrated to work to reduce adverse effects of antiepileptic drugs. [1] We plan to initiate screening with brief depression and quality of life scales. It is our hope that routine use of these measures will help promote awareness and diagnosis as well as followup on progress and outcomes. References 1. Gilliam FG, Fessler AJ, Baker G, Vahle V, Carter J, Attarian H. Systematic screening allows reduction of adverse antiepileptic drug effects: a randomized trial. Neurology 2004: 2(1):23-7.