Frequência e fatores relacionados a transtornos psiquiátricos na epilepsia do lobo temporal

Abstract

Introduction: Temporal lobe epilepsy (TLE) is the most common epileptic syndrome in adults. The psychiatric comorbidities in epilepsy, especially in TLE, are very frequent and their complex relationship has been a recurrent issue in literature. Objectives: To evaluate the frequency and intensity of psychiatric disorders in patients with TLE considering their clinical and sociodemographic characteristics. Analyze the studied variables according to the laterality of mesial temporal sclerosis, depression and risk of suicide. Evaluate clinical tools that can help indescribing psychopathological features and recognition of psychiatric disorders in epilepsy. Methods: Seventy-three patients of the Epilepsy Service of Hospital das Clínicas of UFMG were selected and underwent psychiatric evaluation. Clinical and socio-demographic data werecollected and applied the following instruments: Mini-Mental State Examination (MMSE), structured clinical interview (MINI-PLUS), Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D), Beck Depression Inventory (BDI), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Brief Psychiatric Rating Scale (BPRS) and GlobalAssessment of Functioning (GAF). Results: Patients with TLE showed a high frequency of psychiatric disorders throughout their lives (70%), being mood disorders the most frequent (49.3%). 27.4% of the patients were depressed when evaluated, 37% met diagnostic criteria for lifetime major depression and 9.6% for bipolar disorder. Anxiety disorders were also frequent (42.5%), mainly generalized anxiety disorder (GAD) (21.9%). The obsessive compulsive disorder (OCD) was present in 11.0% and psychotic disorders in 5.5%. Depression is rarely diagnosed and treated in TLE and this should be considered an alarming finding as depression is often associated with suicide risk. Patients with left mesial temporal sclerosis (LMTS) had longer duration of epilepsy, a higher frequency of psychiatric disorders, mainly TAG, but also depression, anxiety and psychotic symptoms. The ROC curve analysis indicated that the cutoff at16 for the BDI and HAM-D and that the cutoff at 14 for the NDDI-E represent optimal dichotomization between patients with TLE depressed and non-depressed. All these instruments were sensitive and had a negative predictive value exceeding 95%, can help screening depressionin TLE, reducing its underdiagnosis. Conclusion: TLE is related to a higher frequency of psychiatric disorders, mainly anxiety and depression. Patients with LMTS showed higher frequency of depressive, anxiety and psychotic symptoms. Depression is underdiagnosed, undertreated and related to a high risk of suicide in ELT. The better recognition of depression in TLE with BDI, HAM-D and NDDI-E can guide treatment and help prevent suicide in these patients. The neuropsychiatry of ELT research is important in the development of programs for the improvement of patients' quality of life through proper diagnosis and treatment of mental disorders associated with this epileptic syndrome.