EEG abnormality in first episode mania: remark of childhood trauma

Yıl 2013, , 100 - 6, 01.03.2013

Sermin Kesebir Sertaç Güven Özgür Bilgin Topçuoğlu Elif Tatlıdil Yaylacı

https://doi.org/10.5455/jmood.20130116052129

Öz

Objective: The aim of this study is to investigate the frequency of abnormal EEG findings in first episode mania and to compare cases with and without abnormal EEG findings with regard to their clinical characteristics of bipolar disorder. Method: In the present study, among the admissions to our outpatient clinic or emergency service within the last year 69 consecutive first attack mania cases, between the ages of 18-65, who were diagnosed with Bipolar Disorder Manic Episode according to the DSM-IV criteria and whose informed consent form was signed by first degree relatives were evaluated. Inclusion criteria were absence of any previous depressive episode neurologic disorder, history of head trauma and/or loss of consciousness and not any drug use at the enrollment which can influence electroencephalographic activity EEG (antiepileptic, anxiolytic, antidepressant and antipsychotics). Records of 50 patients who also did not met exclusion criteria have been evaluated. Diagnostic interviews were made by using SCID-I (DSM-IV Structured Clinical Interview). Information about then disease itself was recorded on SKIP-TURK (Mood Disorder Diagnosis and Following Form) and the severity of manic symptoms was determined by using YMRS (Young Mania Rating Scale). Childhood trauma was determined by using ETI (Early Trauma Inventory). EEG recordings were made with digital EEG device in 16 channels and 23 surface electrodes were placed according to international 10-20 system. Results: Epileptic EEG was found in 2 (4%) and nonepileptic abnormal EEG was found in 10 (20.8%) patients with first episode mania. Abnormal EEG in first episode mania was more frequent in females (p= 0.012). Childhood trauma, childhood history of psychiatric disorder, comorbid pshysical disease, history of suicide attempt and familiy history in first degree relatives were found to be more frequent in the group with EEG abnormality (p=0.016, 0.012, 0.001, 0.005 and 0.032). Childhood trauma was found to be a predictor of EEG abnormality in first episode mania cases as determined by regression analysis (p=0.004). Conclusion: In some bipolar cases, abnormal EEG is present from the onset of disease and is associated with clinical characteristics.

Anahtar Kelimeler

EEG, first episode, mania

İlk atak manide EEG Anormalliği: Çocukluk çağı travmalarının izi

Öz

Amaç: Bu çalışmanın amacı ilk atak manide EEG anormalliği sıklığını araştırmak, EEG anormalliği olan ve olmayan olguları, iki uçlu bozukluğun klinik özellikleri yönünden karşılaştırmaktır. Yöntem: Bu çalışmada, ayaktan tedavi merkezimize veya acil servisimize son bir yıl içerisinde başvuran, 18-65 yaş arası, bilgilendirilmiş onam formu birinci derece yakınları tarafından onaylanan, DSM-IV’e göre iki uçlu bozukluk, Manik Dönem olarak değerlendirilen, ilk dönem 69 olgu ardışık olarak değerlendirilmiştir. Olgularda öncesinde depresif dönem bulundurmama, herhangi bir nörolojik hastalığı, kafa travması ve/ veya bilinç kaybı öyküsü olmama, EEG çekimi öncesi, elektroensefalografik aktiviteyi etkileyecek ilaç (antiepileptik, anksiyolitik, antidepresan ve antipsikotik) almamış olma şartları aranmıştır. Dışlama ölçütleri haricinde 50 olguya ait veriler değerlendirmeye alınmıştır. Tanı görüşmeleri SCID-I (DSM-IV Yapılandırılmış Klinik Görüşmesi) ile yapılmış, hastalıkla ilgili bilgiler SKIP-TURK (Duygudurum Bozuklukları Tanı ve İzlem Formu) ile kaydedilmiş, manik belirtilerin şiddeti YMDÖ (Young Mani Derecelendirme Ölçeği) ile, çocukluk çağı travmasının varlığı ETI (Erken Travmatik Yaşantı Envanteri) ile belirlenmiştir. EEG çekimi digital EEG cihazı ile 16 kanal olarak yapılmış, 23 adet yüzey elektrodu uluslararası 10-20 sistemine göre yerleştirilmiştir. Bulgular: İlk manik dönem iki uçlu olgular arasında epileptik EEG 2 olguda (%4), epileptik olmayan anormal EEG 10 olguda (%20.8) saptanmıştır. İlk dönem manide EEG anormalliği kadın cinsiyette daha sıktır (p=0.012). Çocukluk çağı travması, çocukluk çağı psikiyatrik hastalık öyküsü, şimdiki fiziksel hastalık eştanısı, intihar girişimi öyküsü ve birinci derece yakınlarda aile öyküsü EEG anormalliği olan grupta daha sık bulunmuştur (p= 0.016, 0.012, 0.001, 0.005 ve 0.032). Çocukluk çağı travması, regresyon analizinde ilk atak mani olgularında EEG bozukluğunun öngörücüsü olarak saptanmıştır (p= 0.004). Sonuç: Bir kısım iki uçlu olguda anormal EEG, hastalığın başlangıcından itibaren mevcuttur ve klinik özellikler ile ilişkilidir.

Anahtar Kelimeler

EEG, ilk atak, mani

Kaynakça

• 1. Mula M, Marotta AE, Monaco F. Expert Rev Neurother. Epilepsy and bipolar disorders 2010;10:13-23.
• 2. Grunze HC. Anticonvulsants in bipolar disorder. J Ment Health 2010;19:127-41.
• 3. Cook BL, Shukla S, Hoff AL. EEG abnormalities in bipolar affective disorder. J Affect Disord 1986;11:147-9.
• 4. Hudson JI, Lipinski JR, Frankenburg FR. Electroencephalography in mania. Arch Gen Psychiatry 1988;45:267–73.
• 5. Kano K, Nakamura M, Matsuoka T. The topographical features of EEGs in patients with affective disorders. Electroencephalogr Clin Neurophysiol 1992;83:124–9.
• 6. Small JG, Milstein V, Mallory FW, Klapper MH, Golay SJ, Medlock CE. Topographic EEG studies of mania. Clin Electroencephalogr 1998;29:59-66.
• 7. Small JG, Milstein V, Mallory FW, Medlock CE, Klapper MH. Clinical and quantitative EEG studies of mania. J Affect Disord 1999;53:217-24.
• 8. Poyraz BÇ, Poyraz CA, Özdemir A, Özmen M, Arıkan MK. Psikiyatrik hastalıkların teşhis ve tedavisinde kantitatif EEG. Klinik Psikofarmakoloji Bülteni 2009;19:24-6.
• 9. First MB, Spitzer RL, Gibbon M. Structured Clinical Interview for DSM-IV Clinical Version (SCID-I / CV), Washington DC, American Psychiatric Press, 1997.
• 10. Özkürkçügil A, Aydemir Ö, Yıldız M. DSM-IV Eksen I bozuklukları için yapılandırılmış klinik görüşmenin Türkçe’ye uyarlanması ve güvenilirlik çalışması. İlaç ve Tedavi Dergisi 1999;12:233-6.
• 11. Özerdem A, Yazıcı O, Tunca Z, Mood Disorders Study Group, Psychiatric Association of Turkey and K Tırpan. Establishment of Computerized Registry Program for Bipolar Illnes in Turkey: SKIPTURK. J Affect Disord 2004;84:82-6.
• 12. Young RC, Biggs JT, Ziegler VE, Meyer DA. A Rating Scala for Mania: Reliability, validity and sensitivity. Br J Psychiatry 1978;133:429-35.
• 13. Karadağ F, Oral ET, Yalçın F. Young Mani Derecelendirme Ölçeği’nin Türkiye’de geçerlik ve güvenirliği. Türk Psikiyatri Dergisi 2001;13:107-14.
• 14. Bremner JD, Bolus R, Mayer EA.Psychometric properties of the Early Trauma Inventory-Self Report. J Nerv Ment Dis. 2007;195:211-8.
• 15. Centorrino F, Price B, Tuttle M, Bahk WM, Hennen J, Albert MJ, Baldessarini RJ. EEG abnormalities during treatment with typical and atypical antipsychotics. Am J Psychiatry 2002;159:109-15.
• 16. Fisch BJ. Fisch ve Spehlmann’dan EEG’ye Giriş: Dijital ve Analog EEG’nin Temel İkeleri. 3. Baskı. Şahiner T (Çev. ed). İstanbul:Turgut Yayıncılık; 2008.
• 17. Güven S, Kesebir S, Demirer RM, Bilici M. EEG Spectral Power Density in First Episode Mania: A comperative study with subsequent remission period. Klinik Psikofarmakol Bülteni 2012;22:30.
• 18. Small JG, Milstein V, Medlock CE. Clinical EEG findings in mania. Clin Electroencephalogr 1997;28:229-35.
• 19. Vaaler AE, Morken G, Iversen VC, Kondziella D, Linaker OM. Acute Unstable Depressive Syndrome (AUDS) is associated more frequently with epilepsy than major depression. BMC Neurol 2010;10:67.
• 20. Ekinci Ö, Toros F. Epilepsi tanılı çocuk ve ergenlerde ruhsal bozukluklar. Psikiyatride Güncel Yaklaşımlar 2013;5:60-77.
• 21. Cornelio-Nieto JO, Borbolla-Sala ME, Gallegos –Dimas A. Electroencephalographic alternations in children with attention deficity hyperactivity disorder. Rev Neurol 2011;1:97-101.
• 22. Hale TS, Smalley SL, Walshaw PD, Hanada G, Macion J, McCracken JT, McGough JJ, Loo SK. Atypical EEG beta asymmetry in adults with ADHD. Neuropsychologia 2010;48:3532-9.
• 23. Kawauchi A, Imada N, Tanaka Y, Minami M, Watanabe H, Shirakawa S. Changes in the structure of sleep spindles and delta waves on electroencephalography in patients with nocturnal enuresis. Br J Urol 1998;3:72-5.
• 24. McArthur G, Atkinson C, Ellis D. Atypical brain responses to sounds in children with specific language and reading impairments. Dev Sci 2009;12:768-83.
• 25. DePaskalis V, Varriale V, Rotonda M. EEG oscillatory activity associated to monetary gain and loss signals in a learning task: effects of attentional impulsivity and learning ability Int J Psychophysiol 2012:85;68-78.
• 26. Miller A, Fox NA, Cohn JF, Forbes EE, Sherrill JT, Kovacs M. Regional patterns of brain activity in adults with a history of childhood-onset depression: gender differences and clinical variability. Am J Psychiatry 2002;159:934-40.
• 27. Levitan RD, Parikh SV, Lesage AD, Hegadoren KM, Adams M, Kennedy SH, Goering PN. MD in individuals with history of childhood abuse: relationship to mania and gender. Am J Psychiatry 1998;155:1746-52.
• 28. Cook F, Ciorciari J, Varker T, Devilly GJ. Changes in long term neural connectivity following psychological trauma. Clin Neurophysiol. 2009;120:309-14.
• 29. Field T, Diego M. Maternal depression effects on infant frontal EEG asymmetry. Int J Neurosci 2008;118:1081-108.
• 30. Etain B, Henry C, Bellivier F, Mathieu F, Leboyer M. Beyond genetics: childhood affective trauma in bipolar disorder. Bipolar Disord 2008;10:867-76.
• 31. DeSantis H, Beker NL, Back SE, Spratt E, Ciolino JD, Moran M, Diparkar B, Brady KT. Gender difference in the effect of early trauma on HPA functioning. Depress Anxiety 2011;28:383-92.
• 32. Logemann HN, Lansbergen MM, Van Os TW, Böcker KB, Kenemans JL. The effectiveness of EEG-feedback on attention, impulsivity and EEG: a sham feedback controlled study. Neurosci Lett 2010;19:49-53.
• 33. Garno JL, Gunawardane N, Goldberg JF. Predictors of trait aggression in bipolar disorder. 2008;10:285-92.
• 34. Lim HW, Song HS, Hwang YH, Lee HW, Suh CK, Park SP, Kwon SH. Predictors of suicidal ideation in people with epilepsy living in Korea. J Clin Neurol 2010;6:81-8.
• 35. Brismar T. EEG physiological and clinical studies. Physiol Behav 2007;92:141-147.
• 36. Reeves RR, Burke RS, Struve FA. EEG does not predict response of manic patients to atypical antipsichotics. Clin EEG Neurosci 2011;42:25-29.