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      Exploring the association between epilepsy and depression: A systematic review and meta-analysis

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          Abstract

          Objective

          This study offers meta-analytic data on the potential association between epilepsy and depression especially for the prevalence of depression in epilepsy or vice versa.

          Methods

          The relevant studies were searched and identified from nine electronic databases. Studies that mentioned the prevalence and/or incidence of epilepsy and depression were included. Hand searches were also included. The search language was English and the search time was through May 2022. Where feasible, random-effects models were used to generate pooled estimates.

          Results

          After screening electronic databases and other resources, 48 studies from 6,234 citations were included in this meta-analysis. The period prevalence of epilepsy ranged from 1% to 6% in patients with depression. In population-based settings, the pooled period prevalence of depression in patients with epilepsy was 27% (95% CI, 23–31) and 34% in clinical settings (95% CI, 30–39). Twenty studies reported that seizure frequency, low income, unemployment of the patients, perception of stigma, anxiety, being female, unmarried status, disease course, worse quality of life, higher disability scores, and focal-impaired awareness seizures were risk factors for depression.

          Conclusion

          Our study found that epilepsy was associated with an increased risk of depression. Depression was associated with the severity of epilepsy.

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          Most cited references67

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          Epilepsy in adults

          Epilepsy is one of the most common serious brain conditions, affecting over 70 million people worldwide. Its incidence has a bimodal distribution with the highest risk in infants and older age groups. Progress in genomic technology is exposing the complex genetic architecture of the common types of epilepsy, and is driving a paradigm shift. Epilepsy is a symptom complex with multiple risk factors and a strong genetic predisposition rather than a condition with a single expression and cause. These advances have resulted in the new classification of epileptic seizures and epilepsies. A detailed clinical history and a reliable eyewitness account of a seizure are the cornerstones of the diagnosis. Ancillary investigations can help to determine cause and prognosis. Advances in brain imaging are helping to identify the structural and functional causes and consequences of the epilepsies. Comorbidities are increasingly recognised as important aetiological and prognostic markers. Antiseizure medication might suppress seizures in up to two-thirds of all individuals but do not alter long-term prognosis. Epilepsy surgery is the most effective way to achieve long-term seizure freedom in selected individuals with drug-resistant focal epilepsy, but it is probably not used enough. With improved understanding of the gradual development of epilepsy, epigenetic determinants, and pharmacogenomics comes the hope for better, disease-modifying, or even curative, pharmacological and non-pharmacological treatment strategies. Other developments are clinical implementation of seizure detection devices and new neuromodulation techniques, including responsive neural stimulation.
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            Prevalence and incidence of epilepsy: A systematic review and meta-analysis of international studies.

            To review population-based studies of the prevalence and incidence of epilepsy worldwide and use meta-analytic techniques to explore factors that may explain heterogeneity between estimates.
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              Psychiatric comorbidity in epilepsy: a population-based analysis.

              The estimated prevalence of mental health disorders in those with epilepsy in the general population varies owing to differences in study methods and heterogeneity of epilepsy syndromes. We assessed the population-based prevalence of various psychiatric conditions associated with epilepsy using a large Canadian national population health survey. The Canadian Community Health Survey (CCHS 1.2) was used to explore numerous aspects of mental health in persons with epilepsy in the community compared with those without epilepsy. The CCHS includes administration of the World Mental Health Composite International Diagnostic Interview to a sample of 36,984 subjects. Age-specific prevalence of mental health conditions in epilepsy was assessed using logistic regression. The prevalence of epilepsy was 0.6%. Individuals with epilepsy were more likely than individuals without epilepsy to report lifetime anxiety disorders or suicidal thoughts with odds ratio of 2.4 (95% CI = 1.5-3.8) and 2.2 (1.4-3.3), respectively. In the crude analysis, the odds of lifetime major depression or panic disorder/agoraphobia were not greater in those with epilepsy than those without epilepsy, but the association with lifetime major depression became significant after adjustment for covariates. In the community, epilepsy is associated with an increased prevalence of mental health disorders compared with the general population. Epilepsy is also associated with a higher prevalence of suicidal ideation. Understanding the psychiatric correlates of epilepsy is important to adequately manage this patient population.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SoftwareRole: Writing – original draft
                Role: ConceptualizationRole: Formal analysisRole: SoftwareRole: Writing – original draft
                Role: Formal analysis
                Role: Formal analysisRole: Software
                Role: MethodologyRole: Software
                Role: Project administrationRole: Writing – review & editing
                Role: Funding acquisitionRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                15 December 2022
                2022
                : 17
                : 12
                : e0278907
                Affiliations
                [1 ] Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
                [2 ] Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
                [3 ] School of Chinese Medicine, North China University of Science and Technology, Tangshan, Hebei, China
                [4 ] Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, China
                UCSI University, MALAYSIA
                Author notes

                Competing Interests: None of the authors has any conflicts of interest to disclose.

                Author information
                https://orcid.org/0000-0002-4590-9125
                Article
                PONE-D-22-27098
                10.1371/journal.pone.0278907
                9754200
                36520790
                c6b26b98-84bc-4889-9ad5-15949ca8362f
                © 2022 Qin et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 4 October 2022
                : 28 November 2022
                Page count
                Figures: 4, Tables: 5, Pages: 17
                Funding
                1. The S&T Program of Hebei (grant no. 20567625H) provided computer and related software for this work, and Lin Pei is the recipient of the funding awards. 2. Pei Lin National Famous and Old Chinese Medicine Expert Inheritance Studio provided databases search costs, and Lin Pei is the recipient of the funding awards. 3. Postgraduate Innovation Funding Project of Hebei University of Chinese Medicine (grant no. XCXZZBS2022011) provided training funding for the meta-analysis, and Shao-kun Qin is the recipient of the funding awards.
                Categories
                Research Article
                Medicine and Health Sciences
                Neurology
                Epilepsy
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Medicine and Health Sciences
                Epidemiology
                Medicine and Health Sciences
                Diagnostic Medicine
                People and Places
                Geographical Locations
                Asia
                China
                Research and Analysis Methods
                Mathematical and Statistical Techniques
                Statistical Methods
                Metaanalysis
                Physical Sciences
                Mathematics
                Statistics
                Statistical Methods
                Metaanalysis
                Research and Analysis Methods
                Research Assessment
                Systematic Reviews
                Custom metadata
                All relevant data are within the article and its Supporting Information files.

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                Uncategorized

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