A great prevalence of psychiatric disorders in epilepsy is well demonstrated, although most studies have used unstructured psychiatric interviews for diagnosis. Here we present a study evaluating the prevalence of psychiatric comorbidities in a cohort of Southern Brazilian patients with temporal lobe epilepsy (TLE) using a structured clinical interview. We analyzed 166 patients with TLE regarding neuropsychiatric symptoms through the Structured Clinical Interview for DSM-IV. One hundred-six patients (63.9%) presented psychiatric comorbidities. Mood disorders were observed in 80 patients (48.2%), anxiety disorders in 51 patients (30.7%), psychotic disorders in 14 (8.4%), and substance abuse in 8 patients (4.8%) respectively. Our results agree with literature data where most authors detected mental disorders in 10 to 60% of epileptic patients. This wide variation is probably attributable to different patient groups investigated and to the great variety of diagnostic methods. Structured psychiatric interviews might contribute to a better evaluation of prevalence of psychiatric comorbidities in TLE. Key words: seizures, epidemiology, behavioral neurology, chronic psychiatric illness, neurology.Prevalência de comorbidades psiquiátricas na epilepsia do lobo temporal em uma população do sul do Brasil RESUMO Embora muitos estudos tenham demonstrado uma alta prevalência de transtornos psiquiátricos em pacientes com epilepsia, a maioria utilizou entrevistas psiquiátricas não-estruturadas para o diagnóstico. Este método pode levar a diferenças significativas nos resultados. Nós estudamos a prevalência de comorbidades psiquiátricas em pacientes com epilepsia do lobo temporal (ELT), utilizando uma entrevista clínica estruturada. Foram estudados 166 pacientes com ELT, aos quais foi aplicada a Entrevista Clínica Estruturada para o DSM-IV (SCID). Cento e seis pacientes (63,9%) apresentaram comorbidades psiquiátricas. Transtornos de humor, observados em 80 pacientes (48,2%), foram o transtorno neuropsiquiátrico mais comum. Transtornos de ansiedade, observados em 51 pacientes (30,7%), foram a segunda comorbidade psiquiátrica mais frequente. Transtornos psicóticos foram encontrados em 14 (8,4%), e abuso de substâncias foram observados em 8 pacientes (4,8%), respectivamente. Nossos resultados estão de acordo com os dados da literatura, que demonstra problemas psiquiátricos em 10-60% dos pacientes com epilepsia. A grande variação dos resultados pode ser atribuída aos diferentes grupos de pacientes estudados e à variabilidade de métodos diagnósticos empregados. Entrevistas psiquiátricas estruturadas podem contribuir para uma avaliação mais adequada da real prevalência de comorbidades psiquiátricas na ELT.

The recognition and treatment of psychosis in persons with epilepsy (PWE) is recommended with the apparent dilemma between treating psychosis and opening the possibility of exacerbating seizures. The pooled prevalence estimate of psychosis in PWE is 5.6%. It has been proposed that a 'two hit' model, requiring both aberrant limbic activity and impaired frontal control, may account for the wide range of clinical phenotypes. The role of antiepileptic drugs in psychosis in PWE remains unclear. Alternating psychosis, the clinical phenomenon of a reciprocal relationship between psychosis and seizures, is unlikely to be an exclusively antiepileptic drug-specific phenomenon but rather, linked to the neurobiological mechanisms underlying seizure control. Reevaluation of antiepileptic treatment, including the agent/s being used and degree of epileptic seizure control is recommended. The authors found very few controlled studies to inform evidence-based treatment of psychosis in PWE. However, antipsychotics and benzodiazepines are recommended as the symptomatic clinical treatments of choice for postictal and brief interictal psychoses. The general principle of early symptomatic treatment of psychotic symptoms applies in epilepsy-related psychoses, as for primary psychotic disorders. In the authors' experience, low doses of antipsychotic medications do not significantly increase clinical risk of seizures in PWE being concurrently treated with an efficacious antiepileptic regimen.

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INTRODUCTION: Among epileptic patients, those with temporal lobe epilepsy (TLE) are at risk to develop psychiatric disorders. Evidence suggests that the association of psychiatric disorders with epilepsy might be related to common biological substrates. Studies support that serotonin (5-HT) may also contribute to a predisposition to epilepsy. The 5-HTTLPR and 5-HTTVNTR polymorphisms in the 5-HTT gene and the C-1019G polymorphism in the 5-HT1A gene have been studied in psychiatric diseases. As far as we know, this is the first study evaluating a possible genetic involvement in the development of psychiatric comorbidities in epilepsy. OBJECTIVE: It is biologically plausible that alterations in serotonin-related genes may be involved in higher susceptibility to psychiatric disease in the individuals with TLE. Here we report results of an association study of serotonin gene polymorphisms and psychiatry comorbidities in TLE. METHODS: Case-control study of 155 patients with temporal lobe epilepsy. We evaluate the influence of 5-HTTLPR and 5-HTTVNTR polymorphisms in the 5-HTT gene and the C-1019G polymorphism in the 5-HT1A gene in psychiatric comorbidities of TLE. RESULTS: After logistic regression, female sex (O.R.=2.38; 95%CI 1.08 to 5.28; p=0.03) and the presence of C allele of 5-HT1A C-1019G polymorphism (O.R.=2.82; 95% CI 1.02 to 7.81; p=0.04) remained independent risk factors for anxiety disorders in temporal lobe epilepsy (O.R.=2.82; 95% CI 1.02 to 7.81; p=0.04). CONCLUSION: C allele of 5-HT1A C-1019G polymorphism is independent risk factor for anxiety disorders in temporal lobe epilepsy. Other studies will shade some light on molecular mechanisms involved in psychiatric comorbidities in epilepsy. Financiamento: CNPQ e FIPE-HCPA