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Inflammation in Children With Epilepsy May Be Key to Psychosis
PHILADELPHIA—Systemic inflammation may be a mechanism for psychosis independent of seizure history, according to researchers from the Cleveland Clinic Foundation. Tatiana Falcone, MD, and colleagues presented their study of children and adolescents with epilepsy admitted to the psychiatric unit of a single hospital at the 61st Annual Meeting of the American Epilepsy Society.
A retrospective review of 1,800 patient records from 2003 to 2007 revealed that 92 inpatients had first-episode psychosis (schizophreniform disorder, schizoaffective disorder, schizophrenia, or psychosis not otherwise specified); 12 also had epilepsy. Hallucinations, a history of violence, and delusions were common among these patients, reported the researchers. They also noted that the psychotic episodes were interictal, lasted an average of one month, and were temporarily not seizure-related, in contrast to reported findings in adults.
Complete blood count assessments indicated absolute monocytosis in all of the study participants. However, there was a significant difference in absolute monocyte values when compared with age- and gender-matched inpatients with epilepsy who were admitted for reasons other than psychosis. “This suggests that inflammatory processes leading to acute blood-brain barrier disruption may be a mechanism of acute psychosis independent from a previous history of seizures,” they concluded.
The present study is part of a larger investigation into systemic inflammation and neurologic disease, Damir Janigro, PhD, Director of the Cerebrovascular Research Center at the Cleveland Clinic, told NeuroPsychiatry Reviews. Although the best understood relationship is that between multiple sclerosis and inflammation, “there was a suspicion that there is some inflammatory component in [psychosis], but it was not very clear what it was or how to address it,” he said.
Dr. Janigro pointed out that S100B, a brain protein that appears in serum when the blood-brain barrier is breached, was also detected on complete blood counts. Although this has been used as a marker of brain damage in adult studies, “the children did not have any obvious brain damage,” he said. “They just have damage to the blood-brain barrier.
“If you have damage to a blood vessel in the brain, there are ways of treating [it],” added Dr. Janigro. “If you [treat] the pediatric population, it is very likely that … you will lessen the burden of future disease.”
In an interview with NeuroPsychiatry Reviews, Dr. Falcone, an associate staff member in the Department of Neurology at the Cleveland Clinic, discussed the use—or lack thereof—of antipsychotic medications in pediatric patients. “Sometimes clinicians avoid using antipsychotics because of the risk of decreasing the seizure threshold,” she said.
However, in the present study, she and her coauthors noted that a variety of antipsychotic mediations, including risperidone, quetiapine, and olanzapine, were used. Most patients with psychosis showed drastic improvement in psychiatric symptoms between two weeks and one month, especially in irritability and violence, with no change in baseline seizure frequency. “If the seizures are in good control and there is a careful monitoring in case of any new symptoms, [medications] should be used to shorten the duration of the psychotic episode,” asserted Dr. Falcone
—Jessica Dziedzic
Suggested Reading
Hitiris N, Mohanraj R, Norrie J, et al. Predictors of pharmacoresistant epilepsy. Epilepsy Res. 2007;75(2-3):192-196.
Marchi N, Angelov L, Masaryk T, et al. Seizure-promoting effect of blood-brain barrier disruption. Epilepsia. 2007;48(4):732-742.
Qin P, Xu H, Laursen TM, et al. Risk for schizophrenia and schizophrenia-like psychosis among patients with epilepsy: population based cohort study. BMJ. 2005;331(7507):23.
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