The intersections of stress, anxiety and epilepsy

Salpekar, Jay A.; Basu, Trina; Thangaraj, Swami; Maguire, Jamie

doi:10.1016/bs.irn.2020.02.001

Cited by 31 publications

(17 citation statements)

References 117 publications

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“…In addition to epilepsy, current research have linked the brain–gut axis to the development of many other neuropsychiatric disorders, such as neurodegenerative diseases and mental disorders ( 191 , 192 ). Psychiatric diseases are often comorbid with epilepsy ( 193 , 194 ). Patients with epilepsy have an increased risk of mental illness, which increases their disability and mortality rates ( 193 , 194 ).…”

Section: Gut–brain Psychology and Epilepsymentioning

confidence: 99%

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Microbiota–Gut–Brain Axis and Epilepsy: A Review on Mechanisms and Potential Therapeutics

et al. 2021

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The gut–brain axis refers to the bidirectional communication between the gut and brain, and regulates intestinal homeostasis and the central nervous system via neural networks and neuroendocrine, immune, and inflammatory pathways. The development of sequencing technology has evidenced the key regulatory role of the gut microbiota in several neurological disorders, including Parkinson’s disease, Alzheimer’s disease, and multiple sclerosis. Epilepsy is a complex disease with multiple risk factors that affect more than 50 million people worldwide; nearly 30% of patients with epilepsy cannot be controlled with drugs. Interestingly, patients with inflammatory bowel disease are more susceptible to epilepsy, and a ketogenic diet is an effective treatment for patients with intractable epilepsy. Based on these clinical facts, the role of the microbiome and the gut–brain axis in epilepsy cannot be ignored. In this review, we discuss the relationship between the gut microbiota and epilepsy, summarize the possible pathogenic mechanisms of epilepsy from the perspective of the microbiota gut–brain axis, and discuss novel therapies targeting the gut microbiota. A better understanding of the role of the microbiota in the gut–brain axis, especially the intestinal one, would help investigate the mechanism, diagnosis, prognosis evaluation, and treatment of intractable epilepsy.

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Section: Gut–brain Psychology and Epilepsymentioning

confidence: 99%

“…Psychiatric diseases are often comorbid with epilepsy ( 193 , 194 ). Patients with epilepsy have an increased risk of mental illness, which increases their disability and mortality rates ( 193 , 194 ). Depression is the most common comorbidity in patients with epilepsy ( 195 ).…”

Section: Gut–brain Psychology and Epilepsymentioning

confidence: 99%

Microbiota–Gut–Brain Axis and Epilepsy: A Review on Mechanisms and Potential Therapeutics

et al. 2021

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“…For instance, HPA axis dysfunction is an attractive mechanism linking network abnormalities with psychiatric comorbidities and epilepsy given that hypercortisolism is a hallmark characteristic of depression and stress hormone levels are altered in people with epilepsy. 52 Furthermore, stress is a major risk factor for both epilepsy and depression. 52 In animal models, corticosterone levels are elevated in chronically epileptic mice exhibiting depression-like behaviors, 53 - 55 and blunted activation of the HPA axis improves outcomes in epilepsy including decreased comorbid depression-like behaviors.…”

Section: Potential Mechanisms Mediating Aberrant Network Activity Relmentioning

confidence: 99%

“… 52 Furthermore, stress is a major risk factor for both epilepsy and depression. 52 In animal models, corticosterone levels are elevated in chronically epileptic mice exhibiting depression-like behaviors, 53 - 55 and blunted activation of the HPA axis improves outcomes in epilepsy including decreased comorbid depression-like behaviors. 56 Neuroendocrine changes, such as elevated levels of stress hormones, have the ability to exert widespread impacts throughout the brain, particularly in limbic regions expressing high levels of mineralocorticoid and glucocorticoid receptors 57 , 58 including the hippocampus and amygdala.…”

Section: Potential Mechanisms Mediating Aberrant Network Activity Relmentioning

confidence: 99%

Network Dysfunction in Comorbid Psychiatric Illnesses and Epilepsy

Colmers

Maguire

2020

Epilepsy Curr

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The episodic nature of both epilepsy and psychiatric illnesses suggests that the brain switches between healthy and pathological states. The most obvious example of transitions between network states related to epilepsy is the manifestation of ictal events. In addition to seizures, there are more subtle changes in network communication within and between brain regions, which we propose may contribute to psychiatric illnesses associated with the epilepsies. This review will highlight evidence supporting aberrant network activity associated with epilepsy and the contribution to cognitive impairments and comorbid psychiatric illnesses. Further, we discuss potential mechanisms mediating the network dysfunction associated with comorbidities in epilepsy, including interneuron loss and hypothalamic–pituitary–adrenal axis dysfunction. Conceptually, it is necessary to think beyond ictal activity to appreciate the breadth of network dysfunction contributing to the spectrum of symptoms associated with epilepsy, including psychiatric comorbidities.

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“…It is well known that behavioral issues, especially psychiatric disorders, are overrepresented among people with epilepsy [8,9]. The overlap is so prominent that recent trends in epilepsy management include increased attention to cognitive and psychiatric comorbidities that are associated with seizure activity [10]. Accumulating evidence from laboratory experiments and observational studies suggest associations between CBD use and improved psychiatric health, sleep, and quality of life [e.g., [11,[12][13][14][15]].…”

Section: Introductionmentioning

confidence: 99%

Cross-sectional and longitudinal evaluation of cannabidiol (CBD) product use and health among people with epilepsy

Strickland

Jackson²,

Schlienz

et al. 2021

Epilepsy & Behavior

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Recent approval of Epidiolex Ò (pharmaceutical cannabidiol/CBD) for the treatment of Lennox Gastaut syndrome (LGS) and Dravet syndrome highlights a therapeutic efficacy of CBD in the treatment of epilepsy. However, a large number of patients with epilepsy elect to use alternative artisanal CBD products due to cost or access constraints. Despite widespread availability and variety of these artisanal CBD products, studies evaluating their safety or efficacy are rare, making conclusions about clinical utility uncertain. The purpose of the present study was to evaluate cross-sectional and longitudinal associations of artisanal CBD product use with quality of life, mental health, healthcare utilization, and epilepsyspecific outcomes within a large, observational cohort of people with epilepsy. Participants who reported using artisanal CBD products at baseline (Artisanal CBD Users; n = 280) and participants who used no cannabis-based products (Controls; n = 138) completed web-based assessments evaluating psychiatric symptoms, healthcare utilization, and epilepsy-specific factors. Follow-up surveys were collected in a subset of participants (n = 190) following baseline assessment for longitudinal comparison. Crosssectionally, higher quality of life, lower psychiatric symptom severity, and improved sleep were observed among Artisanal CBD Users at baseline compared with Controls. Initiation of artisanal CBD product use was also related to improved health outcomes longitudinally. No group differences were observed for seizure control, but both groups included a high number of individuals with no past month seizures. Artisanal CBD Users reported significantly better epilepsy medication tolerability, use of fewer prescription medications overall, and reduced healthcare utilization compared with Controls. These findings are consistent with research indicating that practitioners recommending CBD in clinical care for epilepsy report integrating the use of CBD both as a means to improve patient quality of life as well as for seizure control.

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The intersections of stress, anxiety and epilepsy

Cited by 31 publications

References 117 publications

Microbiota–Gut–Brain Axis and Epilepsy: A Review on Mechanisms and Potential Therapeutics

Microbiota–Gut–Brain Axis and Epilepsy: A Review on Mechanisms and Potential Therapeutics

Network Dysfunction in Comorbid Psychiatric Illnesses and Epilepsy

Cross-sectional and longitudinal evaluation of cannabidiol (CBD) product use and health among people with epilepsy

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