Depression, Stress and Vulnerability Factors in Drug Resistant Focal Epilepsies

Study Overview
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Brief Summary
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Psychiatric disturbances, notably depression, occur frequently as co-morbid conditions with epilepsy. A complex, probably bidirectional relationship between epilepsy and depression has been postulated. Both epilepsy and depression also interact with stressful life events, but only some patients develop these disorders after a stressful event, indicating the possibility of a vulnerable population. Animal and human studies have looked at the role of brain derived neurotrophic factor (BDNF) in this context. Low serum and/or CSF levels of BDNF are associated with higher incidence of depression, and thus indicate the vulnerable population. Animal studies of BDNF have looked specifically at the relation between epilepsy and depression using a novel double hit design. After chronic stress exposure, measurement of BDNF levels allowed identification of 2 sub-groups: a vulnerable population and non-vulnerable population. A second hit of kainic acid induced status epilepticus (SE) was then applied to both the vulnerable and non-vulnerable populations. Only the vulnerable population exposed to SE developed a depression-like profile. In a proof of concept approach we propose studying the relation between epilepsy, depression, anxiety and stressful life events, using serum BDNF levels in patients with pharmacoresistant epilepsy. Evaluation of epilepsy type and co-morbid psychiatric profile will be performed in 150 subjects. By comparing BDNF levels for different epilepsy subgroups to BDNF levels for healthy subjects and for depressed subjects without epilepsy, we hope to identify whether risk of co-morbid depression and/or anxiety in epilepsy may be predicted using BDNF levels. In addition, in a subgroup of 25 patients, we propose a pilot study in which cortisol and C-reactive protein will be measured in addition to BDNF.

Official Title
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Depression, Stress and Vulnerability Factors in Drug Resistant Focal Epilepsies

Conditions
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Depression and Epilepsy

Intervention / Treatment
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* Behavioral: Self-measurement scale of sensitivity to stress/emotion


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Definite diagnosis of epilepsy, of any type (partial or generalised) and at any stage from diagnosis onwards Known or unknown etiology (symptomatic or cryptogenic epilepsy) Exclusion Criteria: Psychogenic non-epileptic seizures Psychotic disorders and bipolar disorders

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Epileptic patient<br> | Behavioral: Self-measurement scale of sensitivity to stress/emotion<br>* Patient will answer self-questionner on Depression<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Depression | Score assessment of Becks Depression Inventory sacle | 24 months |