Postictal Psychosis in Epilepsy: A Clinicogenetic Study.

Autor: Braatz V; Department of Neurology, Neurological and Neurosurgical Clinic of Joinville, Joinville, Brazil.; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK., Martins Custodio H; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.; Chalfont Centre for Epilepsy, Buckinghamshire, UK., Leu C; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.; Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.; Stanley Center of Psychiatric Research, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA., Agrò L; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.; Chalfont Centre for Epilepsy, Buckinghamshire, UK., Wang B; Mental Health Neuroscience Research Department, Division of Psychiatry, University College London, London, UK., Calafato S; Mental Health Neuroscience Research Department, Division of Psychiatry, University College London, London, UK., Rayner G; Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia.; Department of Clinical Neuropsychology, Austin Health, Melbourne, Victoria, Australia., Doyle MG; Epilepsy Programme, Department of Neurology, Beaumont Hospital, Dublin, Ireland.; FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland., Hengsbach C; Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany., Bisulli F; IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the ERN EpiCARE, delle Scienze Neurologiche di Bologna (EpiCARE reference center), Bologna, Italy.; Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy., Weber YG; Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.; Department of Epileptology and Neurology, University of Aachen, Aachen, Germany., Gambardella A; Department of Medical and Surgical Sciences, Institute of Neurology, University Magna Graecia, Catanzaro, Italy., Delanty N; Epilepsy Programme, Department of Neurology, Beaumont Hospital, Dublin, Ireland.; FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland., Cavalleri G; FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.; Department of Molecular and Cellular Therapeutics and FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland., Foong J; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK., Scheffer IE; University of Melbourne, Austin Health, and Royal Children's Hospital, Florey Institute and Murdoch Children's Research Institute, Melbourne, Victoria, Australia., Berkovic SF; Epilepsy Research Centre, Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia., Bramon E; Mental Health Neuroscience Research Department, Division of Psychiatry, University College London, London, UK.; Institute of Psychiatry, Psychology, & Neuroscience at King's College London, London, UK.; Institute of Cognitive Neuroscience, University College London, London, UK., Balestrini S; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.; Chalfont Centre for Epilepsy, Buckinghamshire, UK.; Neuroscience Department, Children's Hospital 'Anna Meyer'-University of Florence, Florence, Italy., Sisodiya SM; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.; Chalfont Centre for Epilepsy, Buckinghamshire, UK.
Jazyk: angličtina
Zdroj: Annals of neurology [Ann Neurol] 2021 Sep; Vol. 90 (3), pp. 464-476. Date of Electronic Publication: 2021 Aug 03.
DOI: 10.1002/ana.26174
Abstrakt: Objective: Psychoses affecting people with epilepsy increase disease burden and diminish quality of life. We characterized postictal psychosis, which comprises about one quarter of epilepsy-related psychoses, and has unknown causation.
Methods: We conducted a case-control cohort study including patients diagnosed with postictal psychosis, confirmed by psychiatric assessment, with available data regarding epilepsy, treatment, psychiatric history, psychosis profile, and outcomes. After screening 3,288 epilepsy patients, we identified 83 with psychosis; 49 had postictal psychosis. Controls were 98 adults, matched by age and epilepsy type, with no history of psychosis. Logistic regression was used to investigate clinical factors associated with postictal psychosis; univariate associations with a p value < 0.20 were used to build a multivariate model. Polygenic risk scores for schizophrenia were calculated.
Results: Cases were more likely to have seizure clustering (odds ratio [OR] = 7.59, p < 0.001), seizures with a recollected aura (OR = 2.49, p = 0.013), and a family history of psychiatric disease (OR = 5.17, p = 0.022). Cases showed predominance of right temporal epileptiform discharges (OR = 4.87, p = 0.007). There was no difference in epilepsy duration, neuroimaging findings, or antiseizure treatment between cases and controls. Polygenic risk scores for schizophrenia in an extended cohort of postictal psychosis cases (n = 58) were significantly higher than in 1,366 epilepsy controls (R 2  = 3%, p = 6 × 10 -3 ), but not significantly different from 945 independent patients with schizophrenia (R 2  = 0.1%, p = 0.775).
Interpretation: Postictal psychosis occurs under particular circumstances in people with epilepsy with a heightened genetic predisposition to schizophrenia, illustrating how disease biology (seizures) and trait susceptibility (schizophrenia) may interact to produce particular outcomes (postictal psychosis) in a common disease. ANN NEUROL 2021;90:464-476.
(© 2021 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)
Databáze: MEDLINE
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