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Andres M. Kanner

Publications and source records attributed to Andres M. Kanner.

12 recordsLinked to original sources
PubMed2002

Forced normalization at the interface between epilepsy and psychiatry.

In 1953, Landolt described a group of patients with poorly controlled epilepsy who had psychotic episodes associated with remission of their seizures and disappearance of epileptiform activity on their EEGs. He called this phenomenon "forced normalization." Since then, neurologists and psychiatrists have been intrigued by this phenomenon, and although it has been also reported by others, its existence continues to be the source of much debate. In this article, we review the clinical characteristics and potential pathogenic mechanisms of forced normalization and illustrate the complexities inherent in reaching this diagnosis, as well as its differential diagnosis in two representative cases.

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PubMed2002

Psychiatric comorbidity in patients with developmental disorders and epilepsy: a practical approach to its diagnosis and treatment.

Psychiatric comorbidity in patients with developmental disorders and epilepsy (PDDEs) is relatively frequent. The majority of its pharmacological treatment has consisted of the use of neuroleptic drugs in an attempt to control behavioral disturbances, despite the fact that these symptoms may often mask underlying psychiatric disorders such as anxiety and depression, which require other types of psychotropic drugs. In this article, we review the pathogenic mechanisms that mediate the clinical manifestations of psychiatric disorders in PDDEs, highlight diagnostic strategies that may help in elucidating the correct psychiatric diagnosis, and review the psychopharmacological treatments available.

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PubMed2002

Treatment of depressive disorders in epilepsy patients.

Epilepsy is a complex disorder that is associated with multiple adverse psychosocial effects. Depression appears to be the most prevalent psychiatric condition in epilepsy and has the greatest impact on subjective health status. Advances in neuroimaging indicate that depressive symptoms are predominantly associated with brain dysfunction, as opposed to social or vocational disability. These findings underscore the need to routinely screen persons with epilepsy for depression, using simple but accurate instruments, and to select the best treatment for each patient, based on adequate understanding of the available pharmacological and interpersonal therapies. This paper reviews epidemiological, health impact, screening and diagnosis, and treatment considerations in depressive disorders associated with epilepsy.

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PubMed2001

The Behavioral Aspects of Epilepsy: An Overview of Controversial Issues.

The field of epilepsy and behavior is rich with controversial issues. In anticipation of an upcoming new feature of Epilepsy & Behavior called Controversial Issues in Epilepsy and Behavior, several highly debated issues are reviewed in this article. These include whether epilepsy is a neuropsychiatric disorder, the relationship between epilepsy and depression and the possible "bidirectional" interaction between the two disorders, and the differences in clinical expression of depression and psychotic disorders in epileptic and nonepileptic patients and the associated implications with respect to diagnosis and treatment. In addition, forced normalization and the very limited involvement of psychiatrists in the evaluation and management of patients with epilepsy are discussed.

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PubMed2001

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PubMed2000

The Use of Sertraline in Patients with Epilepsy: Is It Safe?

Purpose. The purpose of this study was to assess the impact of the selective serotonin-reuptake inhibitor (SSRI) sertraline (SRT) on the severity and frequency of seizures of patients with epilepsy.Methods. We prospectively assessed the seizure frequency of 100 consecutive patients with partial (n = 95) and primary (n = 5) generalized epilepsy during a trial with SRT for the treatment of a depressive (n = 97) or obsessive-compulsive (n = 3) disorder. We compared the monthly seizure frequency recorded while on SRT with those logged during the 3 and 12 months preceding the start of SRT. A definite causality between seizure worsening and SRT was considered in the following circumstances: (1) occurrence of de novo generalized tonic-clonic seizure (GTC); (2) recurrence of a GTC following a period of at least 1 year without this seizure type; and (3) an increase in the monthly seizure frequency beyond the maximal recorded monthly frequency during both 3- and 12-month periods preceding SRT. A probable causality between SRT and seizure worsening was considered in the case of an increase in monthly seizures beyond the maximal frequency recorded during the 3-month, but not the 12-month, period preceding SRT.Results. Six patients (6%) experienced an increase in seizure frequency after starting SRT. One and five patients met criteria for definite and probable causality between SRT and seizure worsening, respectively. Adjustment of antiepileptic drug doses resulted in a return to baseline seizure frequency in the latter five patients; four patients were kept on SRT at the same doses. The SRT dose of these six patients was significantly lower (57.1 +/- 23.8 mg/day vs 111.8 +/- 56.8 mg/day; F = 6.35, P = 0.01) than that of the other 94 patients.Conclusion. SRT can be safely used in the vast majority of patients with epilepsy.

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PubMed2000

Psychosis of Epilepsy: A Neurologist's Perspective.

Psychosis of epilepsy (POE) comprises a group of disorders that are closely associated with epileptic seizures. These include interictal POE, postictal psychosis, and alternative psychosis (also known as "forced normalization"). Neurologists have, in general, played a limited role in the evaluation and management of patients with POE. Yet, as reviewed in this paper, a good understanding of electrophysiologic, neuroradiologic, and neuropathologic variables associated with POE can yield valuable data in the evaluation of the seizure disorder of these patients. The purpose of this review article is to highlight the clinical, neuroradiologic, neurophysiologic, and neuropathologic aspects of POE that can assist in the evaluation and management of the associated seizure disorder and to identify the circumstances in which a timely therapeutic intervention by neurologists can avert or minimize the occurrence of a psychotic episode. Specifically, the clinical characteristics of interictal POE and ictal, postictal, and alternative psychotic episodes are highlighted together with their potential pathogenic mechanisms and the associated treatment issues. Finally, discussions of psychotic disorders following epilepsy surgery and the pharmacotherapy of psychotic disorders in patients with epilepsy are presented.

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