Epilepsy & Behavior 40 (2014) 115–116
Contents lists available at ScienceDirect
Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh
Letter to the Editor About some behavioral and psychosocial aspects related to epilepsy
To the Editor One of the great merits of Epilepsy & Behavior is its contribution to our knowledge in many behavioral and psychosocial aspects related to epilepsy. Among the different aspects of research that this journal has promoted, we would like to stress the relevance of two topics: sexual dysfunction in subjects with epilepsy and psychogenic nonepileptic seizures (PNES). Over the past decade, there has been increased interest in the quality of life (QoL) in patients with epilepsy, and sexual health certainly constitutes one of the most relevant aspects of QoL. The association between sexual dysfunction and epilepsy has long been known [1]. However, the prevalence of erectile dysfunction in subjects with epilepsy has not been well established, ranging from 3% to 57%, because of methodological differences among studies in inclusion criteria (outpatients vs. patients admitted for epilepsy surgery; age of subjects), presence or absence of control groups, or method of assessments (interview vs. questionnaire). In clinical practice, erectile dysfunction is often underdiagnosed since patients may be embarrassed to discuss their sexual problems and clinicians are often uncomfortable about addressing them. The etiology of sexual dysfunction in patients with epilepsy is still unclear, but it is likely to be multifactorial, involving mainly neurological, endocrine, iatrogenic, psychiatric, and psychosocial factors. Old, liver enzyme-inducing, antiepileptic drugs (AEDs) (such as phenobarbital, phenytoin, or carbamazepine) may provoke sexual dysfunctions by decreasing bioactive testosterone, accelerating sexual hormone metabolism, and stimulating binding hormone production. New AEDs may also induce sexual dysfunctions, as reported and highlighted by this journal in recent years [2–6], but pathogenesis remains often unknown. We strongly believe that physicians should always bear in mind the possible occurrence of sexual dysfunction in patients with epilepsy and address this problem during a routine outpatient evaluation. Future studies are needed to clarify the prevalence of sexual dysfunctions in patients with different forms of epilepsy (both drug-resistant or drugresponsive), the prevalence and type of sexual dysfunctions induced by AEDs, and the usefulness of standardized questionnaires in an outpatient setting to improve QoL. Another topic strongly promoted by this journal is PNES. Many aspects of PNES were highlighted over the years, such as pathogenesis [7,8], psychiatric comorbidities [7,9], benefits and harms of provocative techniques [10,11], usefulness of clinimetric scale [12], QoL [13], and treatment challenges [7,14]. As regards pathogenesis, it is now recognized that there may be an organic basis in patients with PNES. Indeed, advanced neuroimaging studies showed abnormal cortical atrophy of the motor and premotor regions in the right hemisphere and the cerebellum bilaterally [15], while neurophysiological studies pointed
http://dx.doi.org/10.1016/j.yebeh.2014.09.016 1525-5050/© 2014 Elsevier Inc. All rights reserved.
towards a dysfunction of the parietal cortex [8]. Of course, further studies are needed to clarify whether these structural abnormalities are related to psychiatric comorbid disorders per se rather than PNES. In any case, these findings suggest a multistep model in the pathogenesis of PNES, in which the phenomenology is driven by psychological factors interacting with specific biologic abnormalities. Acknowledgments We wish to confirm that there has been no significant financial support for this work. Disclosure We wish to confirm that none of the authors have any actual or potential conflict of interest including any financial, personal, or other relationships with other people or organizations within three years of beginning the submitted work that could inappropriately influence or be perceived to influence this work. References [1] Gastaut H, Collomb H. Etude du comportement sexual chez les epileptiques psychomotors. Ann Med Psychol 1954;112:657–9. [2] Hitiris N, Barrett JA, Brodie MJ. Erectile dysfunction associated with pregabalin addon treatment in patients with partial seizures: five case reports. Epilepsy Behav 2006;8:418–21. [3] Calabrò RS, Bramanti P, Italiano D, Ferlazzo E. Topiramate-induced erectile dysfunction. Epilepsy Behav 2009;14:560–1. [4] Calabrò RS, Ferlazzo E, Bramanti P. Oxcarbazepine-related male infertility. Epilepsy Behav 2010;19:665. [5] Calabrò RS, Ferlazzo E, Italiano D, Bramanti P. Dose-dependent oxcarbazepinerelated anorgasmia. Epilepsy Behav 2010;17:287–8. [6] Kaufman KR, Struck PJ. Gabapentin-induced sexual dysfunction. Epilepsy Behav 2011;21:324–6. [7] Brown RJ, Syed TU, Benbadis S, LaFrance Jr WC, Reuber M. Psychogenic nonepileptic seizures. Epilepsy Behav 2011;22:85–93. [8] Arzy S, Halje P, Schechter DS, Spinelli L, Seeck M, Blanke O. Neural generators of psychogenic seizures: evidence from intracranial and extracranial brain recordings. Epilepsy Behav 2014;31:381–5. [9] Scévola L, Teitelbaum J, Oddo S, Centurión E, Loidl CF, Kochen S, et al. Psychiatric disorders in patients with psychogenic nonepileptic seizures and drug-resistant epilepsy: a study of an Argentine population. Epilepsy Behav 2013;29:155–60. [10] Benbadis SR. Provocative techniques should be used for the diagnosis of psychogenic nonepileptic seizures. Epilepsy Behav 2009;15:106–9. [11] Leeman BA. Provocative techniques should not be used for the diagnosis of psychogenic nonepileptic seizures. Epilepsy Behav 2009;15:110–4. [12] Cianci V, Ferlazzo E, Condino F, Mauvais HS, Farnarier G, Labate A, et al. Rating scale for psychogenic nonepileptic seizures: scale development and clinimetric testing. Epilepsy Behav 2011;21:128–31. [13] Akdemir D, Uzun O, Pehlivantürk Özsungur B, Topçu M. Health-related quality of life in adolescents with psychogenic nonepileptic seizures. Epilepsy Behav 2013;29: 516–20. [14] Fairclough G, Fox J, Mercer G, Reuber M, Brown RJ. Understanding the perceived treatment needs of patients with psychogenic nonepileptic seizures. Epilepsy Behav 2014;31:381–5. [15] Labate A, Cerasa A, Mula M, Mumoli L, Gioia MC, Aguglia U, et al. Neuroanatomic correlates of psychogenic nonepileptic seizures: a cortical thickness and VBM study. Epilepsia 2012;53:377–85.
116
Letter to the Editor
Edoardo Ferlazzo⁎ Umberto Aguglia Magna Graecia University of Catanzaro, Italy Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy ⁎Corresponding author at: Magna Graecia University of Catanzaro, Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Via Melacrino, 89100 Reggio Calabria, Italy. Tel.: +39 0965397986; fax: +39 0965397973. E-mail address: [email protected].
Contents lists available at ScienceDirect
Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh
Letter to the Editor About some behavioral and psychosocial aspects related to epilepsy
To the Editor One of the great merits of Epilepsy & Behavior is its contribution to our knowledge in many behavioral and psychosocial aspects related to epilepsy. Among the different aspects of research that this journal has promoted, we would like to stress the relevance of two topics: sexual dysfunction in subjects with epilepsy and psychogenic nonepileptic seizures (PNES). Over the past decade, there has been increased interest in the quality of life (QoL) in patients with epilepsy, and sexual health certainly constitutes one of the most relevant aspects of QoL. The association between sexual dysfunction and epilepsy has long been known [1]. However, the prevalence of erectile dysfunction in subjects with epilepsy has not been well established, ranging from 3% to 57%, because of methodological differences among studies in inclusion criteria (outpatients vs. patients admitted for epilepsy surgery; age of subjects), presence or absence of control groups, or method of assessments (interview vs. questionnaire). In clinical practice, erectile dysfunction is often underdiagnosed since patients may be embarrassed to discuss their sexual problems and clinicians are often uncomfortable about addressing them. The etiology of sexual dysfunction in patients with epilepsy is still unclear, but it is likely to be multifactorial, involving mainly neurological, endocrine, iatrogenic, psychiatric, and psychosocial factors. Old, liver enzyme-inducing, antiepileptic drugs (AEDs) (such as phenobarbital, phenytoin, or carbamazepine) may provoke sexual dysfunctions by decreasing bioactive testosterone, accelerating sexual hormone metabolism, and stimulating binding hormone production. New AEDs may also induce sexual dysfunctions, as reported and highlighted by this journal in recent years [2–6], but pathogenesis remains often unknown. We strongly believe that physicians should always bear in mind the possible occurrence of sexual dysfunction in patients with epilepsy and address this problem during a routine outpatient evaluation. Future studies are needed to clarify the prevalence of sexual dysfunctions in patients with different forms of epilepsy (both drug-resistant or drugresponsive), the prevalence and type of sexual dysfunctions induced by AEDs, and the usefulness of standardized questionnaires in an outpatient setting to improve QoL. Another topic strongly promoted by this journal is PNES. Many aspects of PNES were highlighted over the years, such as pathogenesis [7,8], psychiatric comorbidities [7,9], benefits and harms of provocative techniques [10,11], usefulness of clinimetric scale [12], QoL [13], and treatment challenges [7,14]. As regards pathogenesis, it is now recognized that there may be an organic basis in patients with PNES. Indeed, advanced neuroimaging studies showed abnormal cortical atrophy of the motor and premotor regions in the right hemisphere and the cerebellum bilaterally [15], while neurophysiological studies pointed
http://dx.doi.org/10.1016/j.yebeh.2014.09.016 1525-5050/© 2014 Elsevier Inc. All rights reserved.
towards a dysfunction of the parietal cortex [8]. Of course, further studies are needed to clarify whether these structural abnormalities are related to psychiatric comorbid disorders per se rather than PNES. In any case, these findings suggest a multistep model in the pathogenesis of PNES, in which the phenomenology is driven by psychological factors interacting with specific biologic abnormalities. Acknowledgments We wish to confirm that there has been no significant financial support for this work. Disclosure We wish to confirm that none of the authors have any actual or potential conflict of interest including any financial, personal, or other relationships with other people or organizations within three years of beginning the submitted work that could inappropriately influence or be perceived to influence this work. References [1] Gastaut H, Collomb H. Etude du comportement sexual chez les epileptiques psychomotors. Ann Med Psychol 1954;112:657–9. [2] Hitiris N, Barrett JA, Brodie MJ. Erectile dysfunction associated with pregabalin addon treatment in patients with partial seizures: five case reports. Epilepsy Behav 2006;8:418–21. [3] Calabrò RS, Bramanti P, Italiano D, Ferlazzo E. Topiramate-induced erectile dysfunction. Epilepsy Behav 2009;14:560–1. [4] Calabrò RS, Ferlazzo E, Bramanti P. Oxcarbazepine-related male infertility. Epilepsy Behav 2010;19:665. [5] Calabrò RS, Ferlazzo E, Italiano D, Bramanti P. Dose-dependent oxcarbazepinerelated anorgasmia. Epilepsy Behav 2010;17:287–8. [6] Kaufman KR, Struck PJ. Gabapentin-induced sexual dysfunction. Epilepsy Behav 2011;21:324–6. [7] Brown RJ, Syed TU, Benbadis S, LaFrance Jr WC, Reuber M. Psychogenic nonepileptic seizures. Epilepsy Behav 2011;22:85–93. [8] Arzy S, Halje P, Schechter DS, Spinelli L, Seeck M, Blanke O. Neural generators of psychogenic seizures: evidence from intracranial and extracranial brain recordings. Epilepsy Behav 2014;31:381–5. [9] Scévola L, Teitelbaum J, Oddo S, Centurión E, Loidl CF, Kochen S, et al. Psychiatric disorders in patients with psychogenic nonepileptic seizures and drug-resistant epilepsy: a study of an Argentine population. Epilepsy Behav 2013;29:155–60. [10] Benbadis SR. Provocative techniques should be used for the diagnosis of psychogenic nonepileptic seizures. Epilepsy Behav 2009;15:106–9. [11] Leeman BA. Provocative techniques should not be used for the diagnosis of psychogenic nonepileptic seizures. Epilepsy Behav 2009;15:110–4. [12] Cianci V, Ferlazzo E, Condino F, Mauvais HS, Farnarier G, Labate A, et al. Rating scale for psychogenic nonepileptic seizures: scale development and clinimetric testing. Epilepsy Behav 2011;21:128–31. [13] Akdemir D, Uzun O, Pehlivantürk Özsungur B, Topçu M. Health-related quality of life in adolescents with psychogenic nonepileptic seizures. Epilepsy Behav 2013;29: 516–20. [14] Fairclough G, Fox J, Mercer G, Reuber M, Brown RJ. Understanding the perceived treatment needs of patients with psychogenic nonepileptic seizures. Epilepsy Behav 2014;31:381–5. [15] Labate A, Cerasa A, Mula M, Mumoli L, Gioia MC, Aguglia U, et al. Neuroanatomic correlates of psychogenic nonepileptic seizures: a cortical thickness and VBM study. Epilepsia 2012;53:377–85.
116
Letter to the Editor
Edoardo Ferlazzo⁎ Umberto Aguglia Magna Graecia University of Catanzaro, Italy Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy ⁎Corresponding author at: Magna Graecia University of Catanzaro, Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Via Melacrino, 89100 Reggio Calabria, Italy. Tel.: +39 0965397986; fax: +39 0965397973. E-mail address: [email protected].
