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Biomedical subjects

Marco Mula

Publications and source records attributed to Marco Mula.

At least 19 recordsLinked to original sources
PubMed2006

Optimizing therapy of seizures in adult patients with psychiatric comorbidity.

This article provides an overview of appropriate antiepileptic treatment in adult patients with chronic epilepsy and concomitant psychiatric disorders. It highlights the influence of various treatment options for epilepsy on psychiatric symptoms. Six specific topics are discussed: psychosocial aspects and treatment compliance; positive and negative psychotropic effects of antiepileptic drugs (AEDs); pharmacokinetic and pharmacodynamic interactions between AEDs and psychoactive drugs; risks and benefits of resective surgery; the effect of vagal nerve stimulation; and recommended strategies for optimizing epilepsy therapy in patients with psychiatric disorders. Given the multitude of epilepsy treatment options with various CNS effects, it is crucial to select treatments according to the clinical profile of each individual patient.

Adult↗
PubMed2006

The neurobiology and clinical significance of depersonalization in mood and anxiety disorders: a critical reappraisal.

Depersonalization and derealization occur on a continuum of situations, from healthy individuals to a severely debilitating disorder where the symptoms can persist chronically. Since 1960s, different neurobiological models have been hypothesized and they have been associated with the temporal lobes. Recent advances in the functioning of the limbic system and the application of Geschwind's concept of disconnection in the cortico-limbic networks, pointed the role of the amygdala and its connections with medial prefrontal cortex and anterior cingulate cortex, the same structures that are strictly interlinked with the neurobiology of emotions and affective disorders. In this paper, we hypothesize that depersonalization may represent a clinical index of disease severity, poorer response to treatment and high level of comorbidity, in mood and anxiety disorders, discussing the neurobiology of depersonalization and the available clinical evidence.

Amygdala↗
PubMed2006

Antiepileptic drug-induced mania in patients with epilepsy: what do we know?

Although mood disorders have a major impact on quality of life in patients with epilepsy, the nature of some aspects, such as mania, has received little attention. With the introduction of several new antiepileptic drugs into clinical practice, attention to psychiatric treatment-emergent adverse effects has been renewed. This article explores the relationship between antiepileptic drugs and mania in patients with epilepsy, with special emphasis on the clinical pathophysiology of this phenomenon.

Anticonvulsants↗
PubMed2006

The role of hippocampal sclerosis in antiepileptic drug-related depression in patients with epilepsy: a study on levetiracetam.

OBJECTIVE: Hippocampal sclerosis (HS) has been described as a relevant factor for the development of topiramate-related depression and cognitive deficits. The aim of our study was to clarify whether patients with temporal lobe epilepsy (TLE) and HS were also at risk during therapy with levetiracetam (LEV). METHODS: Data of 156 patients was analysed: 78 with TLE and HS and 78 with TLE and normal MRI matched for age, starting dose and titration schedule of LEV. Patients were selected from a population of consecutive patients started on LEV between 2000 and 2002. RESULTS: No differences were observed in prevalence of cognitive adverse events and depression between the two groups. CONCLUSIONS: LEV treatment is not associated with cognitive adverse events and depression in patients with hippocampal sclerosis.

Adult↗
PubMed2006

Neuropharmacological aspects of cognitive neurorehabilitation in epilepsy.

The role of CNS neuromodulators in cognitive neurorehabilitation can be related to two main issues: 1) the negative impact on cognition of drug categories prescribed for different neurologic symptoms, such as spasticity, extrapyramidal symptoms, or epileptic seizures; 2) their possible role in neuroprotection and amelioration of the cognitive status of the patient, especially attention and memory. This paper reviews different pharmacological aspects of cognitive neurorehabilitation in epilepsy.

Animals↗
PubMed2006

The role of aura in psychopathology and dissociative experiences in epilepsy.

Cognitive auras seem to be associated with depression and anxiety, especially in patients with temporal lobe epilepsy (TLE). Dissociative symptoms may occur as an aura or in the context of psychiatric disorders such as depression, anxiety or schizophrenia. This is a cross-sectional study of 62 patients with TLE, using personality and dissociation measures to investigate their relationship with the presence of aura and its different subtypes. Our findings show no difference in psychopathology in patients with different types of aura and reveal that dissociative symptoms correlate with specific measures of anxiety, suggesting a possible link between these experiences and anxiety disorders.

Adult↗
PubMed2005

Obsessionality, obsessive-compulsive disorder, and temporal lobe epilepsy.

We evaluated the prevalence of obsessive-compulsive disorder (OCD) in patients with temporal lobe epilepsy (TLE) and we investigated the hypothesis that obsessionality may represent a trait in TLE. Eighty-two consecutive patients with epilepsy, 62 with TLE and 20 with idiopathic generalized epilepsy (IGE), and 82 matched healthy controls were evaluated using the SCID-IP, Y-BOCS, MMPI-2 (specifically the Psychasthenia and Obsessiveness scales), BDI, and STAI Y1 and Y2. Nine of the TLE patients, none of the IGE patients, and one of the controls had a diagnosis of OCD. Psychasthenia and Obsessiveness scores were significantly higher in the TLE than in the IGE and control groups. Patients with TLE and OCD differed significantly with respect to history of depression when compared with patients with TLE without OCD, whereas there were no differences in age at onset and duration of epilepsy, seizure pattern and frequency, MRI features, laterality of the EEG focus, antiepileptic drug therapy and combinations, and BDI scores.

Adolescent↗
PubMed2005

Consciousness, epilepsy, and emotional qualia.

The last decade has seen a renaissance of consciousness studies, witnessed by the growing number of scientific investigations on this topic. The concept of consciousness is central in epileptology, despite the methodological difficulties concerning its application to the multifaced ictal phenomenology. The authors provide an up-to-date review of the neurological literature on the relationship between epilepsy and consciousness and propose a bidimensional model (level vs contents of consciousness) for the description of seizure-induced alterations of conscious states, according to the findings of recent neuroimaging studies. The neurophysiological correlates of ictal loss and impairment of consciousness are also reviewed. Special attention is paid to the subjective experiential states associated with medial temporal lobe epilepsy. Such ictal phenomenal experiences are suggested as a paradigm for a neuroscientific approach to the apparently elusive philosophical concept of qualia. Epilepsy is confirmed to represent a privileged window over basic neurobiological mechanisms of consciousness.

Consciousness↗
PubMed2004

Psychiatric adverse events in patients with epilepsy and learning disabilities taking levetiracetam.

PURPOSE: To investigate the prevalence and psychopathological features of psychiatric adverse events (PAEs) in patients with learning disabilities (LD) in therapy with levetiracetam (LEV). METHOD: From a population of 517 consecutively patients with epilepsy started on LEV, we identified 118 patients with epilepsy and LD. RESULTS: Fifteen patients (12.7%) experienced PAEs during LEV therapy. Two (1.7%) developed an affective disorder, nine (7.6%) aggressive behaviour, two (1.7%) emotion lability and two (1.7%) other personality changes such as agitation, anger and hostile behaviour. We observed a significant association with a previous history of status epilepticus and a previous psychiatric history. We did not find a statistically significant association with epilepsy diagnosis, age at onset or duration of the epilepsy, EEG or MRI features. The titration schedule of LEV appeared not to be relevant. CONCLUSIONS: LEV therapy was well tolerated in patients with epilepsy and LD and the main problems were related to aggressive behaviour. The titration schedule of LEV was not relevant and a subgroup of patients appeared to be biologically more vulnerable.

Adult↗
PubMed2004

Use of psychotropic drugs in patients with epilepsy: interactions and seizure risk.

It is now accepted that patients with epilepsy are more prone than the general population to develop psychiatric disorders, being significantly at risk due to psychosocial reasons, the presence of electrophysiologic and anatomopathologic abnormalities mainly in the limbic system, and because they are taking antiepileptic drugs which may have negative psychotropic effects. It is also known that many patients with epilepsy sometimes receive psychotropic medications on account of their psychiatric symptoms. This review focuses on the main problems that a clinician may encompass when treating psychiatric disorders in patients with epilepsy. On one hand, the effects of antiepileptic drugs on mood and behavior for a correct differential diagnosis of psychiatric symptoms. On the other hand, the main factors that may affect choice of therapy, patients' response and compliance, when prescribing antidepressants or antipsychotic drugs, drug interactions and the potential proconvulsive risk are reviewed.

Anticonvulsants↗
PubMed2003

Topiramate and word-finding difficulties in patients with epilepsy.

OBJECTIVE: To evaluate the prevalence of word-finding difficulties as a treatment-emergent adverse event in patients with epilepsy taking topiramate and to identify a clinical phenotype at risk. METHODS: The authors investigated the relationship of word-finding difficulties to topiramate titration schedule, seizure frequency and pattern, and EEG and neuroradiologic findings in 431 consecutively and prospectively collected patients taking topiramate. RESULTS: Thirty-one patients (7.2%) developed word-finding difficulties. Presence of simple partial seizures (OR = 6.7 p = 0.007) and a left temporal EEG epileptic focus (OR = 5.2 p = 0.021) were significantly associated with word-finding difficulties. CONCLUSIONS: The presence of word-finding difficulties seems to be a titration schedule independent phenomenon that occurs in a subgroup of patients with a specific biologic vulnerability.

Adult↗
PubMed2003

The importance of being seizure free: topiramate and psychopathology in epilepsy.

The aim of this study was to analyze in detail psychopathology associated with topiramate (TPM) prescription and to analyze the relationship between psychopathology and seizure freedom. We analyzed the data on 103 patients who developed psychiatric disorders during TPM therapy. Forty-six patients developed an affective disorder, 22 aggressive behavior, 16 psychosis, 11 anxiety, and 8 personality changes such as anger, agitation, and hostile behavior. Patients with psychosis were more likely to be seizure-free during psychopathology, to receive psychotropic drug prescription, and to be admitted to hospital. In general, patients seizure-free during psychopathology were more likely to have a diagnosis of idiopathic generalized epilepsy, to be in co-therapy with vigabatrin, and to remit after drug reduction. We observed that psychopathology was related to seizure control in a subgroup of patients. The role of forced normalization, interlinked with interactions with other antiepileptic drugs, could be relevant.

Adult↗
PubMed2003

Topiramate and psychiatric adverse events in patients with epilepsy.

PURPOSE: The aim of this study was to determine the prevalence of psychiatric adverse events (PAEs) in patients with epilepsy treated with topiramate (TPM). Classification, relation to TPM dosing, and outcome were evaluated to identify a patient profile at risk of developing PAEs. METHODS: We evaluated the data of the first consecutive and prospectively collected patients in therapy with TPM. RESULTS: Follow-up information was available for 431 patients. PAEs occurred in 103 (23.9%) patients; M/F ratio, 55:48; mean age (+/-SD), 36.5 +/- 11.2. In 46 (10.7%) patients, an affective disorder developed; in 16 (3.7%), a psychotic disorder; in 24 (5.6%), aggressive behavior with or without irritability; in 17 (3.9%), other behavior abnormalities such as agitated behavior, anger/hostility behavior, or anxiety. High starting dose and rapid titration schedule were relevant for the development of PAEs. Family psychiatric history and family history of epilepsy, personal history of febrile convulsions, psychiatric history, and presence of tonic-atonic seizures were found to be significant risk factors. Low seizure frequency before starting TPM and TPM/lamotrigine coadministration had a protective effect for PAEs. CONCLUSIONS: We found that PAEs associated with TPM were related to the titration schedule of the drug and that a unique patient profile is suggested by the clinical history.

Adult↗
PubMed2003

The role of hippocampal sclerosis in topiramate-related depression and cognitive deficits in people with epilepsy.

PURPOSE: To clarify the role of hippocampal sclerosis (HS) in developing psychiatric and cognitive adverse events during therapy with topiramate (TPM) in patients with temporal lobe epilepsy (TLE). METHODS: We analyzed the data of 70 patients with TLE and HS and 128 patients with cryptogenic TLE matched for age, sex, starting dose, and titration schedule of TPM. They were selected from the first consecutive 431 patients started on TPM between 1995 and 1999. RESULTS: Patients with HS were more likely to develop cognitive adverse events (CAEs; p = 0.002) and depression (p = 0.018) and to be receiving a polytherapy regimen (p = 0.007). However, regression analysis demonstrated that only HS was a predictive factor for the occurrence of CAEs (OR = 2.4; p < 0.001) and depression (OR = 2.3; p = 0.02). CONCLUSIONS: Patients with TLE and HS were more prone to develop CAEs and depression than were patients with cryptogenic TLE, during TPM therapy, despite the same titration schedule. The presence of HS and not duration of epilepsy or polytherapy regimen represented the main risk factor.

Adult↗
PubMed2003

Pharmacokinetic Interactions between Antiepileptic and Antidepressant Drugs.

The use of antiepileptic drugs (AEDs) for the treatment of psychiatric disorders has reached a new phase of clinical interest. They are commonly used in the therapy of psychoses, mood disorders, aggression and eating disorders. Pharmacotherapy combinations involving AEDs and antidepressant drugs are used to treat co-morbid psychiatric and neurological disorders, to reduce or control the adverse effects of a medication or to increase a medication effect. Therefore, the impact of pharmacokinetic interactions of this class of drugs is quite relevant. In this paper, the available data about the mechanisms of metabolic kinetic interactions between antidepressant and antiepileptic drugs, as well as their clinical significance, has been reviewed.

Anticonvulsants↗
PubMedDate not supplied

Carbamazepine-risperidone interactions in patients with epilepsy.

Because concomitant administration of psychoactive and antiepileptic drugs is increasing progressively in neurologic and psychiatric practice, the aim of the current study was to evaluate the pharmacokinetic interactions between risperidone (RISP) and carbamazepine (CBZ) plasma concentrations in a group of patients with epilepsy with behavioral disturbances. The authors assessed eight patients on CBZ monotherapy (CBZ extended-release capsules) at a mean dosage of 625 +/- 253 mg/day (range, 400-1,200 mg/day) for at least 1 year. RISP (1 mg in one daily dose) was added to CBZ therapy for the occurrence of behavior disturbances. CBZ blood levels were assessed before (T0), 24 hours after (T1), and 2 weeks after (T2) RISP administration. Steady-state plasma concentrations of CBZ increased from 6.67 +/- 0.41 microg/mL at baseline to 7.37 +/- 0.59 microg/mL (p < 0.01) at T1, to 7.95 +/- 0.47 microg/mL (p < 0.0001) at T2. The pharmacokinetic data suggest either a possible role of RISP in inhibiting the cytochrome P450 microsomal enzyme system (CYP)-3A4 pathway or a potential role of CYP2D6 in CBZ metabolism.

Adult↗
PubMedDate not supplied

Antiepileptic-antipsychotic drug interactions: a critical review of the evidence.

The potential for drug-drug interactions in psychiatry and patients with epilepsy is very high. Moreover, antiepileptic drugs are widely used outside epilepsy as psychotropic agents and their spectrum of activity on behavior is of considerable interest to psychopharmacology. In both neurologic and psychiatric practice, pharmacotherapy combinations are commonly used to treat comorbid psychiatric and neurologic disorders, to reduce or control the adverse effects of a medication or to increase its efficacy. This paper focuses on the metabolic pharmacokinetic interactions between two classes of psychotropic drugs: antiepileptic and antipsychotic drugs. The degree of documentation varies for many interactions from clinical case-report experiences to well established research outcomes. The evidence and the clinical significance of these interactions are reviewed. In general, it is better to use as few drugs as possible, as multicolored politherapies increase the possible adverse effects of drug interactions and reduce patient compliance.

Anticonvulsants↗