Problems Regarding Comorbidity of Epilepsy with Depression in Children: A Literature Review

Review Article

Problems Regarding Comorbidity of Epilepsy with Depression in Children: A Literature Review

  • Sona E. Aliyeva *

*Corresponding Author: Sona E. Aliyeva, Azerbaijan Medical University, Department of Neurology, Baku City, Republic of Azerbaijan

Citation: Sona E. Aliyeva. (2022) Problems Regarding Comorbidity of Epilepsy with Depression in Children: A Literature Review. Psychology and Mental Health Care, 6(4): DOI: 10.31579/2637-8892/169

Copyright: © 2022 Sona E. Aliyeva, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 12 April 2022 | Accepted: 18 May 2022 | Published: 04 June 2022

Keywords: children; epilepsy; depression; comorbidity

Abstract

Objective: To review the literature on the comorbidity of epilepsy and depression in children.

Materials and methods: The following scientific research systems were used to achieve the set goal: MEDLINE; PreMEDLINE; PubMed Central (PMC); Cochrane Library; Scirus. http://www.scirus.com/; Google Scholar; FDA (U.S. Food and Drug Administration); EMA (European Medicines Agency); Rxlist; The New England Journal of Medicine; British Medical Journal; Ovid MD; Best Evidence; UpToDate; Internet Grateful Med; Scientific American Medicine; Clinical Evidence; Harrison’s Online.

Results: A search of the Internet and scientific journals revealed 21 sources directly or indirectly related to epilepsy and depression in children.

Conclusion: An analysis of the literature has shown that despite the literature on the comorbidity of epilepsy and depression, this problem has not been studied in children.

Review

Around 400 BC Hippocrates: “usually melancholy becomes epileptic, and epileptics – melancholic.” [1] Recurrent seizures are associated with a number of harmful effects. Seizure-related deaths can account for up to 40% of all deaths in patients with chronic epilepsy. The sudden mortality rate in patients with epilepsy is 7-17% and is reported to be 27 times higher than in patients without seizures. [2]

The neurological dysfunction inherent in epilepsy increases the patient's susceptibility to mental disorders, including depression and psychosis. Depression is the most common comorbid psychiatric disorder in people with epilepsy. However, it is especially difficult to diagnose depression in children. Doctors should consider not only classic depressive symptoms such as anhedonia, but less common symptoms such as unexplained irritability, lack of affection from family members, unfounded somatic complaints, trouble concentrating, and poor school behavior. Depression is more difficult to diagnose in children with epilepsy and mental retardation [3]

Depression and suicide rates increased significantly in patients with epilepsy. Both epilepsy and depression are associated with a decrease in hippocampal volume, but it is unclear if people with both conditions have more atrophy than those with epilepsy alone. Some researchers have linked depression to right ventricular epilepsy and hippocampal atrophy. At the same time, the author notes that this cannot be explained only by epilepsy. [4]

Depression was found to be most common in patients with epilepsy. These patients have lifelong depression between 30 and 35 years of age.

The variability of many factors plays a pathogenic role in the high comorbidity of both diseases. These variables were critically examined at an international symposium in Chicago in September 2010. Data from structural and functional neuroimaging studies in humans have provided a higher level of understanding of the common pathogenetic mechanisms of depression and epilepsy. The negative effects of depression on seizures have been documented in various studies. Contrary to previous views, the relatively high comorbidity of depression and epilepsy is not only a manifestation of a reactive process, but also leads to the fact that patients face multiple life obstacles with seizures. These data strongly suggest the existence of common neurobiological pathogenetic mechanisms that may play a key role in the high comorbidity of these two conditions. The effect of these pathogenic mechanisms is not limited to high comorbidity, but plays a decisive role in the deterioration of the pharmacological and surgical treatment of seizure disorders in patients with a lifelong history of depression. [5]

Cognitive problems in epilepsy can occur early in the disease. Modern technologies make it possible to discover the relationship between the structure and function of cognitive disorders in epilepsy. More and more people are learning about the connection between epilepsy, depression and anxiety. According to the patient, these two comorbid mental illnesses affect the risk of suicide, the side effects of antiepileptic drugs, and quality of life. Mental disorders are less common in patients with epilepsy and do not receive adequate treatment. Physicians treating patients with epilepsy should be aware that cognitive impairment and comorbid mental illness have a major impact on these patients.

In patients with epilepsy, identifying and treating these comorbidities is just as important as treating seizures [6]

Psychiatric disorders are more common in patients with epilepsy than in the general population. Although researchers have documented a strong link between epilepsy and comorbid mental illness, the nature of this link is still poorly understood. Therefore, mental illness in patients with epilepsy is often not diagnosed or treated, which leads to a further decrease in the quality of life of patients. The authors studied the comorbidity of epilepsy to better understand the relationship between the development of epilepsy and psychiatric disorders in adults and children. There is growing scientific interest in studying the relationship between epilepsy and comorbid mental illness in both adults and children, but they conclude that this is not enough. Further research is needed to create new and improved diagnostic tools for early detection of the onset of concomitant mental illness in adults and children and timely intervention to prevent their negative impact on real life activities. The authors note that physicians should be more careful about the risk of comorbid psychiatric illness in patients with epilepsy, especially the potential death and suicide risk associated with depression. [7]

Depression is a common medical condition that goes hand in hand with epilepsy. However, given the heterogeneity of epilepsy and depression, it is difficult to determine the etiology of depression. However, this overlap is so widespread that a two-way link has been proposed between depression and epilepsy. People with epilepsy and frequent seizures are more prone to depression. Depression varies across pediatrics, but it can be easily identified by understanding the nuances of mental health and the variability in neurovegetative symptoms. There are no clear guidelines for the treatment of epilepsy. Although there have been no clinical trials in pediatrics, anticonvulsants have been shown to improve symptoms of depression. Treating depression on your own can have a positive effect on epilepsy outcomes and quality of life. [8]

Despite the increased risk and prevalence of depression in young people with epilepsy, some researchers have found that only one third receive mental health services. Untreated depression leads to negative consequences and an increase in health care seeking and medical costs. Preventive screening behavioral medicine helps identify symptoms of depression and necessary interventions in efforts to optimize health-related quality of life (HRQOL). The main objectives of the study authors were: a) to study the degree of self-reported depression in young people with epilepsy, b) differences in demographic and medical indicators of depression, c) the effect of depression on HRQOL, and d) changes in subsequent depression and suicidal ideation. Depression was found in 23% of young people, and 14% of them confirmed suicidal thoughts. Depression is highly dependent on age, antiepileptic drugs, and insurance. Finally, the authors conclude that systematic assessment and early detection of depression or suicidal ideation in young people with epilepsy leads to a decrease in depression by improving the quality of life. [9]

Mood disorders, especially depression, are commonly associated with epilepsy. Mental health disorders were extremely common in epilepsy and are still more common than in other chronic diseases. Fortunately, both medical and non-medical treatments can be very effective. Although the evidence base for treatment is underdeveloped, small samples and observational studies hold promise for positive results. For groin seizures that are not accompanied by generalized seizures, be aware of the possibility of concomitant depression. As the evidence base grows, more information will become available about susceptible subtypes and the optimal use of anticonvulsants and antidepressants. In the meantime, it remains to be determined whether depression will go a long way in improving the quality of life of people with epilepsy and comorbid mood disorders. [10]

Depression is one of the most common mental disorders due to its chronic nature and economic costs associated with society. Several studies have shown that early childhood depression prevention programs are beneficial for healthy children and adolescents.

However, the study notes this. There are still several comparable programs for children and adolescents with chronic conditions. This article discusses the comorbidity of depression with three conditions found in pediatric psychosomatic medicine: diabetes, epilepsy, and inflammatory bowel disease. The authors discuss the situation of adolescents who are chronically ill and at risk of developing depressive symptoms. Each patient group is familiar with specific risk factors and is associated with depression. It also presents existing individual programs and related research on depression prevention. After a literature review, it was shown that research on risk factors and depression prevention for these three patient populations is still in its infancy. While new risk factor models and biomarker approaches for depression prevention are emerging as a promising foundation, research highlights the importance of achieving better tailored preventive interventions for children and adolescents with chronic diseases. [11]

The author investigates some aspects of the relationship between epilepsy and depression, which have recently attracted increasing attention and may become a major research topic in the near future. Epidemiological studies show that in some cases, depression and suicide are premorbid symptoms before the onset of epilepsy. The suicide rate in epilepsy is three times higher than in the general population. Reliable tools already exist for detecting depression and suicide in patients with epilepsy, but real data are needed to develop common clinical pathways between neurology and psychiatry.

Data on children with epilepsy are still limited, although, in addition to epilepsy, about 50% of children with adults with mood and anxiety disorders have a history of mood and anxiety disorders. Despite the increased attention to the problem, the additional stigma associated with mental health problems remains one of the main obstacles to timely diagnosis and treatment. The new research will focus on developing common clinical pathways in neurology and psychiatry for treating mental illness and preventing suicide. New global campaigns to combat double stigma will support the disease in regions where it is still equally ill and poorly treated. [12].

Anxiety and depression in children and adolescents with epilepsy is a common comorbid condition that places a serious burden on patients and their families and complicates the clinical management of epilepsy. In this study, the authors provided an analytical review of the etiology, phenomenology, assessment, and treatment of depression and anxiety in pediatric patients with epilepsy. Recognition of effective comorbidities in childhood epilepsy is currently limited, and clinicians must consider the adjuvant role of antiepileptic drugs in such comorbidities. Recognition of comorbid mental illness in children and adolescents with epilepsy remains limited. Although rarely a single cause, the effects of anticonvulsants must be considered by clinicians in this context and appropriately addressed. [13]

Researchers have found that epilepsy is associated with a significantly increased risk of depressive disorders during adolescence. On the other hand, depression is more common in adolescents with epilepsy. These results highlight the importance of early detection and appropriate treatment of depression in adolescence. The prevalence of depressive episodes in adolescents with epilepsy is 8-35% higher than in the population of the same age. The relationship between epilepsy and depression is complex and potentially two-way, indicating a common pathophysiological mechanism between the two diseases. In addition, failure to identify and treat depressive disorders, especially during adolescence, leads to a number of negative consequences, such as increased suicidal ideation or behavioral risk and decreased quality of life. It is important to use psychiatric or psychological ratings, structured or semi-structured rating scales to identify depressive disorder. According to the authors, physicians should be able to regularly check for signs of depression in young people with epilepsy. The first step to consider when treating adolescent epilepsy depressive disorder is to consider possible reversible causes of anxiety and depression (i.e., controlling seizures with anticonvulsants). On the other hand, great attention should be paid to the education of children and adolescents and their families, and efforts should be made to improve knowledge about epilepsy, while reducing parental stress and increasing the competence of the child. Consideration should also be given to medical treatment for adolescents diagnosed with depression. [14]

In this presentation, the authors discuss specific and general risk factors for epilepsy in childhood epilepsy, prevention, clinical symptom assessment, and suicide risk and treatment. Epidemiological data on the detrimental effect of depression on the course of epilepsy and its long-term consequences are presented. Depression is an important risk factor for long-term negative outcome of epilepsy, regardless of the frequency of seizures, the type of epilepsy and the amount of antiepileptic drugs used. Despite a decrease in the number of epileptic seizures and an improvement in diagnosis and treatment, the incidence of comorbid psychopathology has not changed over the past 30 years. Patients with epilepsy have a higher risk of depression than patients with diabetes and asthma. The comorbidity of epilepsy and depression increases the risk of suicide compared to the general population: 20% of children with epilepsy commit suicide. Patients with epilepsy should have a mental health screening as part of their daily epilepsy treatment. Depression is common in childhood epilepsy and is associated with a high risk of suicide, severe epilepsy, and long-term sequelae. [15]

The fact that epilepsy goes hand in hand with a wide range of diseases is already accepted as a fact. Although epileptic seizures are an important element of epilepsy in children, there are a number of neurological, mental and cognitive disorders that lead to a decline in quality of life, which increases the burden of epilepsy in childhood. The most common comorbid conditions of childhood epilepsy include depression, anxiety, autism spectrum disorders, sleep disturbances, attention deficit disorder, cognitive impairment, and migraine. Although epilepsy can lead to comorbidities, many childhood illnesses have a two-way relationship, and the risk of epilepsy and epilepsy increases. The dual nature of epilepsy and comorbidities is likely to be a common pathophysiological mechanism of both seizures and comorbidities. While the recognition of co-morbid conditions in childhood epilepsy is increasing, the development of effective treatments has been delayed by concerns that drugs used to treat co-morbid conditions may increase the susceptibility to seizures. There is now some evidence that most drugs used for comorbid conditions are safe and do not relieve seizures. Unfortunately, data on medications for many diseases associated with epilepsy in children are very limited. There is a great need for randomized, placebo-controlled trials of drugs for efficacy and safety in the treatment of childhood epilepsy-related diseases. [16]

Depression is common and negatively affects the quality of life of patients with epilepsy. While many studies have looked at relevant predictors, the results are mixed. The goal of this meta-analysis is to examine risk factors that may increase the likelihood of depression in this population. The search was conducted by Medline, The Cochrane Library, Web of Science and Embase for a comprehensive study of the incidence of epilepsy and depression.

The results of the meta-analysis showed that several factors were associated with an increased risk of depression in epilepsy. This can help develop more effective strategies for prevention and selection of group depression. In addition, the mechanisms underlying these diseases require further study to determine appropriate and targeted interventions on a case-by-case basis. [17]

The authors used the following search methods: Cochrane Epilepsy Group Specialized Registry; Cochrane Central Registry for Controlled Trials (CENTRAL 2014 Issue 5), MEDLINE (Ovid), SCOPUS, PsycINFO, www.clinicaltrials.gov.

Research findings: There is very limited evidence that antidepressants are effective in treating depressive symptoms associated with epilepsy. Results from only a small randomized controlled trial show that venlafaxine has a statistically significant effect on symptoms of depression. No high quality evidence was found for the choice of antidepressants or drug class in the treatment of depression in patients with epilepsy. The review presents evidence of the low quality of security in terms of escalating tensions with the SSRI. However, I have no comparative data on antidepressant classes and seizure safety. There are no comparative data on antidepressants and psychotherapy in the treatment of depression in epilepsy. The researchers believe that comparative clinical trials of antidepressants in large populations of epilepsy and depressed patients are needed to better inform future treatment strategies. [18].

L.R. Zenkov [19] notes that depression requires special attention in epilepsy. According to the author, 10-30% of patients with epilepsy suffer from depression. This is primarily due to brain dysfunction in epilepsy and limited stigmatization of educational, professional and social contacts.

Review

Around 400 BC Hippocrates: “usually melancholy becomes epileptic, and epileptics – melancholic.” [1] Recurrent seizures are associated with a number of harmful effects. Seizure-related deaths can account for up to 40% of all deaths in patients with chronic epilepsy. The sudden mortality rate in patients with epilepsy is 7-17% and is reported to be 27 times higher than in patients without seizures. [2]

The neurological dysfunction inherent in epilepsy increases the patient's susceptibility to mental disorders, including depression and psychosis. Depression is the most common comorbid psychiatric disorder in people with epilepsy. However, it is especially difficult to diagnose depression in children. Doctors should consider not only classic depressive symptoms such as anhedonia, but less common symptoms such as unexplained irritability, lack of affection from family members, unfounded somatic complaints, trouble concentrating, and poor school behavior. Depression is more difficult to diagnose in children with epilepsy and mental retardation [3]

Depression and suicide rates increased significantly in patients with epilepsy. Both epilepsy and depression are associated with a decrease in hippocampal volume, but it is unclear if people with both conditions have more atrophy than those with epilepsy alone. Some researchers have linked depression to right ventricular epilepsy and hippocampal atrophy. At the same time, the author notes that this cannot be explained only by epilepsy. [4]

Depression was found to be most common in patients with epilepsy. These patients have lifelong depression between 30 and 35 years of age.

The variability of many factors plays a pathogenic role in the high comorbidity of both diseases. These variables were critically examined at an international symposium in Chicago in September 2010. Data from structural and functional neuroimaging studies in humans have provided a higher level of understanding of the common pathogenetic mechanisms of depression and epilepsy. The negative effects of depression on seizures have been documented in various studies. Contrary to previous views, the relatively high comorbidity of depression and epilepsy is not only a manifestation of a reactive process, but also leads to the fact that patients face multiple life obstacles with seizures. These data strongly suggest the existence of common neurobiological pathogenetic mechanisms that may play a key role in the high comorbidity of these two conditions. The effect of these pathogenic mechanisms is not limited to high comorbidity, but plays a decisive role in the deterioration of the pharmacological and surgical treatment of seizure disorders in patients with a lifelong history of depression. [5]

Cognitive problems in epilepsy can occur early in the disease. Modern technologies make it possible to discover the relationship between the structure and function of cognitive disorders in epilepsy. More and more people are learning about the connection between epilepsy, depression and anxiety. According to the patient, these two comorbid mental illnesses affect the risk of suicide, the side effects of antiepileptic drugs, and quality of life. Mental disorders are less common in patients with epilepsy and do not receive adequate treatment. Physicians treating patients with epilepsy should be aware that cognitive impairment and comorbid mental illness have a major impact on these patients.

In patients with epilepsy, identifying and treating these comorbidities is just as important as treating seizures [6]

Psychiatric disorders are more common in patients with epilepsy than in the general population. Although researchers have documented a strong link between epilepsy and comorbid mental illness, the nature of this link is still poorly understood. Therefore, mental illness in patients with epilepsy is often not diagnosed or treated, which leads to a further decrease in the quality of life of patients. The authors studied the comorbidity of epilepsy to better understand the relationship between the development of epilepsy and psychiatric disorders in adults and children. There is growing scientific interest in studying the relationship between epilepsy and comorbid mental illness in both adults and children, but they conclude that this is not enough. Further research is needed to create new and improved diagnostic tools for early detection of the onset of concomitant mental illness in adults and children and timely intervention to prevent their negative impact on real life activities. The authors note that physicians should be more careful about the risk of comorbid psychiatric illness in patients with epilepsy, especially the potential death and suicide risk associated with depression. [7]

Depression is a common medical condition that goes hand in hand with epilepsy. However, given the heterogeneity of epilepsy and depression, it is difficult to determine the etiology of depression. However, this overlap is so widespread that a two-way link has been proposed between depression and epilepsy. People with epilepsy and frequent seizures are more prone to depression. Depression varies across pediatrics, but it can be easily identified by understanding the nuances of mental health and the variability in neurovegetative symptoms. There are no clear guidelines for the treatment of epilepsy. Although there have been no clinical trials in pediatrics, anticonvulsants have been shown to improve symptoms of depression. Treating depression on your own can have a positive effect on epilepsy outcomes and quality of life. [8]

Despite the increased risk and prevalence of depression in young people with epilepsy, some researchers have found that only one third receive mental health services. Untreated depression leads to negative consequences and an increase in health care seeking and medical costs. Preventive screening behavioral medicine helps identify symptoms of depression and necessary interventions in efforts to optimize health-related quality of life (HRQOL). The main objectives of the study authors were: a) to study the degree of self-reported depression in young people with epilepsy, b) differences in demographic and medical indicators of depression, c) the effect of depression on HRQOL, and d) changes in subsequent depression and suicidal ideation. Depression was found in 23% of young people, and 14% of them confirmed suicidal thoughts. Depression is highly dependent on age, antiepileptic drugs, and insurance. Finally, the authors conclude that systematic assessment and early detection of depression or suicidal ideation in young people with epilepsy leads to a decrease in depression by improving the quality of life. [9]

Mood disorders, especially depression, are commonly associated with epilepsy. Mental health disorders were extremely common in epilepsy and are still more common than in other chronic diseases. Fortunately, both medical and non-medical treatments can be very effective. Although the evidence base for treatment is underdeveloped, small samples and observational studies hold promise for positive results. For groin seizures that are not accompanied by generalized seizures, be aware of the possibility of concomitant depression. As the evidence base grows, more information will become available about susceptible subtypes and the optimal use of anticonvulsants and antidepressants. In the meantime, it remains to be determined whether depression will go a long way in improving the quality of life of people with epilepsy and comorbid mood disorders. [10]

Depression is one of the most common mental disorders due to its chronic nature and economic costs associated with society. Several studies have shown that early childhood depression prevention programs are beneficial for healthy children and adolescents.

However, the study notes this. There are still several comparable programs for children and adolescents with chronic conditions. This article discusses the comorbidity of depression with three conditions found in pediatric psychosomatic medicine: diabetes, epilepsy, and inflammatory bowel disease. The authors discuss the situation of adolescents who are chronically ill and at risk of developing depressive symptoms. Each patient group is familiar with specific risk factors and is associated with depression. It also presents existing individual programs and related research on depression prevention. After a literature review, it was shown that research on risk factors and depression prevention for these three patient populations is still in its infancy. While new risk factor models and biomarker approaches for depression prevention are emerging as a promising foundation, research highlights the importance of achieving better tailored preventive interventions for children and adolescents with chronic diseases. [11]

The author investigates some aspects of the relationship between epilepsy and depression, which have recently attracted increasing attention and may become a major research topic in the near future. Epidemiological studies show that in some cases, depression and suicide are premorbid symptoms before the onset of epilepsy. The suicide rate in epilepsy is three times higher than in the general population. Reliable tools already exist for detecting depression and suicide in patients with epilepsy, but real data are needed to develop common clinical pathways between neurology and psychiatry.

Data on children with epilepsy are still limited, although, in addition to epilepsy, about 50% of children with adults with mood and anxiety disorders have a history of mood and anxiety disorders. Despite the increased attention to the problem, the additional stigma associated with mental health problems remains one of the main obstacles to timely diagnosis and treatment. The new research will focus on developing common clinical pathways in neurology and psychiatry for treating mental illness and preventing suicide. New global campaigns to combat double stigma will support the disease in regions where it is still equally ill and poorly treated. [12].

Anxiety and depression in children and adolescents with epilepsy is a common comorbid condition that places a serious burden on patients and their families and complicates the clinical management of epilepsy. In this study, the authors provided an analytical review of the etiology, phenomenology, assessment, and treatment of depression and anxiety in pediatric patients with epilepsy. Recognition of effective comorbidities in childhood epilepsy is currently limited, and clinicians must consider the adjuvant role of antiepileptic drugs in such comorbidities. Recognition of comorbid mental illness in children and adolescents with epilepsy remains limited. Although rarely a single cause, the effects of anticonvulsants must be considered by clinicians in this context and appropriately addressed. [13]

Researchers have found that epilepsy is associated with a significantly increased risk of depressive disorders during adolescence. On the other hand, depression is more common in adolescents with epilepsy. These results highlight the importance of early detection and appropriate treatment of depression in adolescence. The prevalence of depressive episodes in adolescents with epilepsy is 8-35% higher than in the population of the same age. The relationship between epilepsy and depression is complex and potentially two-way, indicating a common pathophysiological mechanism between the two diseases. In addition, failure to identify and treat depressive disorders, especially during adolescence, leads to a number of negative consequences, such as increased suicidal ideation or behavioral risk and decreased quality of life. It is important to use psychiatric or psychological ratings, structured or semi-structured rating scales to identify depressive disorder. According to the authors, physicians should be able to regularly check for signs of depression in young people with epilepsy. The first step to consider when treating adolescent epilepsy depressive disorder is to consider possible reversible causes of anxiety and depression (i.e., controlling seizures with anticonvulsants). On the other hand, great attention should be paid to the education of children and adolescents and their families, and efforts should be made to improve knowledge about epilepsy, while reducing parental stress and increasing the competence of the child. Consideration should also be given to medical treatment for adolescents diagnosed with depression. [14]

In this presentation, the authors discuss specific and general risk factors for epilepsy in childhood epilepsy, prevention, clinical symptom assessment, and suicide risk and treatment. Epidemiological data on the detrimental effect of depression on the course of epilepsy and its long-term consequences are presented. Depression is an important risk factor for long-term negative outcome of epilepsy, regardless of the frequency of seizures, the type of epilepsy and the amount of antiepileptic drugs used. Despite a decrease in the number of epileptic seizures and an improvement in diagnosis and treatment, the incidence of comorbid psychopathology has not changed over the past 30 years. Patients with epilepsy have a higher risk of depression than patients with diabetes and asthma. The comorbidity of epilepsy and depression increases the risk of suicide compared to the general population: 20% of children with epilepsy commit suicide. Patients with epilepsy should have a mental health screening as part of their daily epilepsy treatment. Depression is common in childhood epilepsy and is associated with a high risk of suicide, severe epilepsy, and long-term sequelae. [15]

The fact that epilepsy goes hand in hand with a wide range of diseases is already accepted as a fact. Although epileptic seizures are an important element of epilepsy in children, there are a number of neurological, mental and cognitive disorders that lead to a decline in quality of life, which increases the burden of epilepsy in childhood. The most common comorbid conditions of childhood epilepsy include depression, anxiety, autism spectrum disorders, sleep disturbances, attention deficit disorder, cognitive impairment, and migraine. Although epilepsy can lead to comorbidities, many childhood illnesses have a two-way relationship, and the risk of epilepsy and epilepsy increases. The dual nature of epilepsy and comorbidities is likely to be a common pathophysiological mechanism of both seizures and comorbidities. While the recognition of co-morbid conditions in childhood epilepsy is increasing, the development of effective treatments has been delayed by concerns that drugs used to treat co-morbid conditions may increase the susceptibility to seizures. There is now some evidence that most drugs used for comorbid conditions are safe and do not relieve seizures. Unfortunately, data on medications for many diseases associated with epilepsy in children are very limited. There is a great need for randomized, placebo-controlled trials of drugs for efficacy and safety in the treatment of childhood epilepsy-related diseases. [16]

Depression is common and negatively affects the quality of life of patients with epilepsy. While many studies have looked at relevant predictors, the results are mixed. The goal of this meta-analysis is to examine risk factors that may increase the likelihood of depression in this population. The search was conducted by Medline, The Cochrane Library, Web of Science and Embase for a comprehensive study of the incidence of epilepsy and depression.

The results of the meta-analysis showed that several factors were associated with an increased risk of depression in epilepsy. This can help develop more effective strategies for prevention and selection of group depression. In addition, the mechanisms underlying these diseases require further study to determine appropriate and targeted interventions on a case-by-case basis. [17]

The authors used the following search methods: Cochrane Epilepsy Group Specialized Registry; Cochrane Central Registry for Controlled Trials (CENTRAL 2014 Issue 5), MEDLINE (Ovid), SCOPUS, PsycINFO, www.clinicaltrials.gov.

Research findings: There is very limited evidence that antidepressants are effective in treating depressive symptoms associated with epilepsy. Results from only a small randomized controlled trial show that venlafaxine has a statistically significant effect on symptoms of depression. No high quality evidence was found for the choice of antidepressants or drug class in the treatment of depression in patients with epilepsy. The review presents evidence of the low quality of security in terms of escalating tensions with the SSRI. However, I have no comparative data on antidepressant classes and seizure safety. There are no comparative data on antidepressants and psychotherapy in the treatment of depression in epilepsy. The researchers believe that comparative clinical trials of antidepressants in large populations of epilepsy and depressed patients are needed to better inform future treatment strategies. [18].

L.R. Zenkov [19] notes that depression requires special attention in epilepsy. According to the author, 10-30% of patients with epilepsy suffer from depression. This is primarily due to brain dysfunction in epilepsy and limited stigmatization of educational, professional and social contacts.

Conclusion

Depression is one of the mechanisms explaining the comorbidity of epilepsy. Post Author: R.M. theory. Kindling in the classical sense is a gradual increase in sensitivity to intermediate repetition of stimulation of the same subelectric neuron over time. In this sense, the amygdala has been studied in more detail. This is due to the stimulation of repetitive excitation: a decrease in the seizure threshold after an electrical discharge; high blood pressure; progression of the seizure phase, ending with full-scale tonic-clonic seizures of the forelimbs with raising and lowering; it is a manifestation of evolutionary stimuli for spontaneous seizures. This evolving process is immediately accompanied by changes in the spatio-temporal expression of early genes, neurotrophic factors, and late-acting genes, as well as changes in the model of the effectiveness of various pharmacological interventions in time and space. Since remembering this pattern is a paradigmatic manifestation of behavior, some pharmacological seizures result from local anesthesia such as cocaine and lidocaine, and some epileptic syndromes are likely homologous modeled by this phenomenon. However, since non-epileptiform syndromes such as recurrent episodes of affective disorders and some pain syndromes contain heterogeneous evolutionary elements similar to sedation, some of the principles involved in the burning sensation may be related to the understanding and treatment of these syndromes. For example, one can try to distinguish between secondary and adaptive genes involved in the initial pathological processes in the evolution of the syndrome. This differentiation can have a significant impact on the development of therapeutic approaches to suppress or enhance changes, respectively. In these cases, the results obtained using the kindling model are necessarily indirect and limited, since various neuroanatomical and biochemical processes can influence the development of each neuropsychiatric syndrome. Given the limitations of well-known non-homologous models, relapse can provide information on the longitudinal course, progression, and treatment of several neuropsychiatric syndromes that can be clinically tested directly [20]. The great Russian scientist I.P. When examining patients, Pavlov once used the following phrase about a patient with alcoholic delirium: “This is not a state of drowsiness, the hallucinations observed in a patient are a manifestation of neuronal awakening” [20]. Thus, the study of the comorbidity of epilepsy and depression in children is of great theoretical and practical importance. First, it will help identify depression early. Second, it can prevent suicide. Third, the number of resistant forms of epilepsy treatment will decrease. Finally, it will have a positive effect on improving the quality of life of patients with epilepsy.

References

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Prof Sherif W Mansour

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

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Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

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Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

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Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

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Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

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Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

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Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

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Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

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Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

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Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

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Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

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Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

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Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

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S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

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Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

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Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

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Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

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Maria Dolores Gomez Barriga

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

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Dr Maria Dolores Gomez Barriga

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

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Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.

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Dr Marcelo Flavio Gomes Jardim Filho

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

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Zsuzsanna Bene

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

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Dr Susan Weiner

My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.

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Lin-Show Chin

My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.

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Sonila Qirko

My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.

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Luiz Sellmann