Abstracts

RATIONALE: Mesial temporal lobe epilepsy (MTLE) is a surgically remediable syndrome associated with considerable psychosocial, neuropsychological, and psychiatric co-morbidity. The relative risk of DSM-IV defined psychiatric co-morbidity compared to control populations has yet to be fully characterized. This investigation conducted standardized psychiatric interviews of patients with MTLE and familial controls in order to characterize the nature and degree of risk of current and lifetime-to-date psychiatric co-morbidity.
METHODS: Subjects included patients with complex partial seizures of definite or probable temporal lobe origin and mesial temporal atrophy determined by quantitative MRI volumetrics (MTLE, N=37) and healthy familial controls of the patients (siblings, spouses, parents or children, N=24). All subjects underwent a standardized psychiatric interview (SCID-CV) to characterize current and lifetime-to-date rates of DSM-IV Axis 1 disorders. To characterize current psychiatric symptoms, subjects completed the Beck Depression Inventory (BDI) and Symptom Checklist-90-Revised (SCL-90-R).
RESULTS: The MTLE and control groups were comparable in gender (59.5% vs. 53.5%) and age (35.2 yrs vs. 36.8 yrs). There were no significant differences (p [gt] 0.10) between the MTLE and control groups in the overall rate of lifetime-to-date [50% vs. 40%, OR=1.5 (95th CI=.53, 4.27) ] or current [30.3% vs. 29.2%, OR=1.1 (.33, 3.3)] Axis I disorders. Among specifc lifetime-to-date Axis I disorders, Mood Disorders were more common in MTLE [41.2% vs. 20%, p= .085, OR= 2.8 (.85, 9.2)] in general, with more lifetime-to-date Major Depressive Episodes (MDE) in particular [27.3% vs. 12%, p=.16 OR=2.8(.66, 11.5)]. Current MDE was uncommon in this sample (5.8% vs. 0%), but occurred significantly (p=0.03) more often in MTLE. Examining self-report symptom inventories, MTLE patients were significantly more likely to score in the clinically elevated range on both the BDI ([gt]11) [p=.002, OR= 14.8 (1.8, 122.5)] and the SCL-90-R (T[gt] 63) [p=.001, OR = 6.7(1.9, 22.9)]. Among MTLE patients, there was no significant relationship between gender or laterality of MTLE and the risk of lifetime-to-date Axis I disorders overall or MDE in particular.
CONCLUSIONS: The following are the major findings: 1) Overall rates of current and lifetime-to-date Axis 1 disorders occurred with similar frequency in both MTLE and familial controls and reflected the general US population rates reported by the National Comorbidity Survey (Kessler et al., 1994); 2) Lifetime-to-date and current MDE were more frequent in MTLE compared to familial controls; 3) Self-report symptom inventories revealed very significantly elevated rates of distress including depression; 4) The discordance between the rates of DSM-IV diagnoses versus depressive symptoms endorsed on self-report measures may suggest the presence of subsyndromal depressive episodes.
[Supported by: NIH NS RO1 37738
Participants should be able to discuss the relationships between MTLE and psychiatric co-morbidity.]