The Japanese Journal of Psychiatry and Neurology, Vol. 46, No. 2, 1992
Depressive Symptoms in Patients with Epilepsy Jiro Hosokawa, M.D., Mami Fukuma, M.D., Toshiaki Kugoh, M.D., Hiroshi Suwaki, M.D. and Kiyoshi Hosokawa, M.D. Department of Neuropsychiatry, Kagawa Medical School, Kagawa Introduction Recently, the association between depressive symptoms and lateralization of epileptogenic foci has received much attention. To evaluate the degree of depressive symptoms, we performed several psychological examinations on adult epileptic outpatients who have been leading ordinary social life. This study was undertaken with special attention to evaluate the relationships between the seizure type, lateralization of epileptogenic foci and the degree of interictal depression. Subjects and Methods We performed 5 psychological tests, that is, Beck's Quantitative Rating of Depressive State, Zung's Self-Rating Depression Scale, General Health Questionnaire (GHQ), Cornell Medical Index (CMI), and Washington Psychosocial Seizure Inventory (WPSI) on 53 adult outpatients. To keep the reliability of the results, we excluded 5 patients who showed 7 points or above in the WPSI Lie Scale. Accordingly, the remaining 48 patients were the
449
subjects of this study. The localization of epilepsy was determined according to the findings of electroencephalograms and image analysis. The patients were divided into 5 categories; left temporal lobe epilepsy (left TLE), right TLE, bilateral TLE, non-TLE, and generalized epilepsy. Results The characteristics of the patients are shown in Table 1. Fig. 1 (A) demonstrates the mean Beck scores in each subgroup. There were significant differences between the left TLE and generalized epilepsy groups. The left TLE group showed the highest mean Beck score, but the non-TLE group had also higher scores. Fig. 1 (B) demonstrates the mean Zung scores in each subgroup. There were significant differences between the left TLE and generalized epilepsy groups. On the other hand, there were no significant differences among the 3 groups with temporal lobe foci. The non-TLE group had the highest mean Zung scores. Fig. 1 (C) demonstrates the results of GHQ. The left TLE group had the highest total GHQ scores. But, the non-TLE group had also higher scores, and this group had the highest scores of subscale of depression. Fig. 1 (D) demonstrates the results of CMI. This examination also shows that the partial epilepsy group had the higher total CMI scores than the generalized epilepsy group. In the partial epilepsy group, the
Table 1: The Characteristics of the Patients
Sex (males: females) Age9 Y Age at onset, y Duration of epilepsy, y 'TLE indicates temporal lobe epilepsy.
Left TLE' (n= 15)
Right TLE (n=9)
Bilateral TLE (n=8)
Non-TLE (n=6)
Generalized (n= 10)
8:7
6:3 38k 10 23-t15 15f 1 1
4:4 34-t10 14f 10 21f8
2:4 31+7 15f9 16k8
4:6 28f11 15+ 12 13f6
28k8 13f8 15f7
1.
450
Selected Papers: Adult Epilepsy
Fig. 1: Results of psychometries. (A)-Mean Beck scores in each subgroup. (B)Mean Zung scores in each subgroup. (C)-Results of GHQ: Bars indicate mean total GHQ scores; circles, mean depression subscale scores. (D)-Results of CMI: Solid bars indicate mean CIJ scores; slashed bars, mean M-R scores; circles, mean depression subscale scores. LTLE indicates left temporal lobe epilepsy; RTLE, right; BTLE, bilateral; NTLE, non; generalized, generalized seizures. *p< 0.01.
2). The high correlation coefficient above
0.6 was shown in Beck vs. GHQ, Zung vs. GHQ, Beck vs. Zung and Zung vs. M-R of CMI. Discussion
Fig. 2 Correlation coefficients between psychometries used. Solid bars indicate correlation coefficient above 0.6.
non-TLE group had the highest CIJ and M-R scores, and the bilateral TLE group had the highest scores of subscale of depression. We also examined the correlation between each psychological examination (Fig.
The patients with partial epilepsy had higher depressive scores compared to those with generalized epilepsy. Regarding the temporal lobe focus, the left TLE group had higher depression scores. This was consistent with earlier studies by Altschuler e? al.' But, since non-TLE had also high depression scores, we could not find the definite association between the depression and temporal lobe focus. From these results, we suggest that depressive symptoms should not be easily associated with the
The Japanese Journal of Psychiatry and Neurology, Vol. 46, No. 2, 1992
lateralization of brain lesion, but rather, as Robertson et al. reported2, this is considered as a nonspecific phenomenon that accompanies the presence of epilepsy. References 1. Altshuler, L.L., Devinsky, 0. Post, R.M. and Theodore, W.: Depression, anxiety, and
45 1
temporal lobe epilepsy. Laterality of focus and symptoms. Arch Neurol 47: 284-288, 1990. 2. Robertson, M.M. and Trimble,
M.R.:Depressive illness in patients with epilepsy-A review. Epilepsia 24 (Suppl. 2): S109-S116, 1983.
Depressive Symptoms in Patients with Epilepsy Jiro Hosokawa, M.D., Mami Fukuma, M.D., Toshiaki Kugoh, M.D., Hiroshi Suwaki, M.D. and Kiyoshi Hosokawa, M.D. Department of Neuropsychiatry, Kagawa Medical School, Kagawa Introduction Recently, the association between depressive symptoms and lateralization of epileptogenic foci has received much attention. To evaluate the degree of depressive symptoms, we performed several psychological examinations on adult epileptic outpatients who have been leading ordinary social life. This study was undertaken with special attention to evaluate the relationships between the seizure type, lateralization of epileptogenic foci and the degree of interictal depression. Subjects and Methods We performed 5 psychological tests, that is, Beck's Quantitative Rating of Depressive State, Zung's Self-Rating Depression Scale, General Health Questionnaire (GHQ), Cornell Medical Index (CMI), and Washington Psychosocial Seizure Inventory (WPSI) on 53 adult outpatients. To keep the reliability of the results, we excluded 5 patients who showed 7 points or above in the WPSI Lie Scale. Accordingly, the remaining 48 patients were the
449
subjects of this study. The localization of epilepsy was determined according to the findings of electroencephalograms and image analysis. The patients were divided into 5 categories; left temporal lobe epilepsy (left TLE), right TLE, bilateral TLE, non-TLE, and generalized epilepsy. Results The characteristics of the patients are shown in Table 1. Fig. 1 (A) demonstrates the mean Beck scores in each subgroup. There were significant differences between the left TLE and generalized epilepsy groups. The left TLE group showed the highest mean Beck score, but the non-TLE group had also higher scores. Fig. 1 (B) demonstrates the mean Zung scores in each subgroup. There were significant differences between the left TLE and generalized epilepsy groups. On the other hand, there were no significant differences among the 3 groups with temporal lobe foci. The non-TLE group had the highest mean Zung scores. Fig. 1 (C) demonstrates the results of GHQ. The left TLE group had the highest total GHQ scores. But, the non-TLE group had also higher scores, and this group had the highest scores of subscale of depression. Fig. 1 (D) demonstrates the results of CMI. This examination also shows that the partial epilepsy group had the higher total CMI scores than the generalized epilepsy group. In the partial epilepsy group, the
Table 1: The Characteristics of the Patients
Sex (males: females) Age9 Y Age at onset, y Duration of epilepsy, y 'TLE indicates temporal lobe epilepsy.
Left TLE' (n= 15)
Right TLE (n=9)
Bilateral TLE (n=8)
Non-TLE (n=6)
Generalized (n= 10)
8:7
6:3 38k 10 23-t15 15f 1 1
4:4 34-t10 14f 10 21f8
2:4 31+7 15f9 16k8
4:6 28f11 15+ 12 13f6
28k8 13f8 15f7
1.
450
Selected Papers: Adult Epilepsy
Fig. 1: Results of psychometries. (A)-Mean Beck scores in each subgroup. (B)Mean Zung scores in each subgroup. (C)-Results of GHQ: Bars indicate mean total GHQ scores; circles, mean depression subscale scores. (D)-Results of CMI: Solid bars indicate mean CIJ scores; slashed bars, mean M-R scores; circles, mean depression subscale scores. LTLE indicates left temporal lobe epilepsy; RTLE, right; BTLE, bilateral; NTLE, non; generalized, generalized seizures. *p< 0.01.
2). The high correlation coefficient above
0.6 was shown in Beck vs. GHQ, Zung vs. GHQ, Beck vs. Zung and Zung vs. M-R of CMI. Discussion
Fig. 2 Correlation coefficients between psychometries used. Solid bars indicate correlation coefficient above 0.6.
non-TLE group had the highest CIJ and M-R scores, and the bilateral TLE group had the highest scores of subscale of depression. We also examined the correlation between each psychological examination (Fig.
The patients with partial epilepsy had higher depressive scores compared to those with generalized epilepsy. Regarding the temporal lobe focus, the left TLE group had higher depression scores. This was consistent with earlier studies by Altschuler e? al.' But, since non-TLE had also high depression scores, we could not find the definite association between the depression and temporal lobe focus. From these results, we suggest that depressive symptoms should not be easily associated with the
The Japanese Journal of Psychiatry and Neurology, Vol. 46, No. 2, 1992
lateralization of brain lesion, but rather, as Robertson et al. reported2, this is considered as a nonspecific phenomenon that accompanies the presence of epilepsy. References 1. Altshuler, L.L., Devinsky, 0. Post, R.M. and Theodore, W.: Depression, anxiety, and
45 1
temporal lobe epilepsy. Laterality of focus and symptoms. Arch Neurol 47: 284-288, 1990. 2. Robertson, M.M. and Trimble,
M.R.:Depressive illness in patients with epilepsy-A review. Epilepsia 24 (Suppl. 2): S109-S116, 1983.
