Cerebral metabolism and depression in patients with complex partial seizures
E. B. Bromfield, L. Altshuler, D. B. Leiderman, M. Balish, T. A. Ketter, O. Devinsky, R. M. Post and W. H. Theodore
Medical Neurology Branch, National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, Md.
Twenty-three patients with complex partial seizures were evaluated with
18F-2-deoxyglucose positron emission tomography and with the Beck
Depression Inventory. Five of 10 patients with left and zero of eight with
right temporal electroencephalographic foci had depressive symptoms; one of
five patients with poorly localized electroencephalographic foci also
scored in the depressed range. Temporal, frontal, caudate, and thalamic
normalized glucose metabolic rates among five patients with depressive
symptoms and well-localized left temporal epileptogenic regions were
compared with five patients without depressive symptoms but with similar
electroencephalographic characteristics. Multifactorial analysis of
variance yielded a significant nonlateralized mood by region interaction.
Of nine individual regions compared, only inferior frontal cortex showed a
significant difference in normalized regional metabolic rate between
depressed and nondepressed patients. Metabolism in this region also
distinguished patients with depressive symptoms from normal control
subjects. Depressive symptoms in patients with complex partial seizures are
associated with a bilateral reduction in inferior frontal glucose
metabolism, compared with patients without depressive symptoms and normal
control subjects. The frontal lobe hypometabolism observed in patients with
depressions associated with epilepsy, Parkinson's disease, and primary
affective disorder suggests that similar frontal lobe metabolic
disturbances could underlie these conditions.
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