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Commission on Psychobiology

Commission Members

Frank Besag
Bedford, England
Cesare Cornaggia
Milano, Italy
John Gates
Minnesota, USA
Kousuke Kanemoto
Aichi-gun, Japan
Steffi Koch-Stoecker
Bielefeld, Germany
E.S. Krishnamoorthy
Chennai Tamil Nadu, India
John Moriarty
London, England
Michael Trimble
London, England

The Commission on Psychobiology was chaired by Michael Trimble during the term of the previous presidency. The current chair took over in 2003. A number of subcommissions were continued; some were newly established.

Aims

  • To enhance research in and awareness of the behavioral and cognitive consequences of epilepsy
  • To understand the mechanisms of these problems
  • To enhance management of patients

Summary of Activities
The main Commission and Subcommissions have met regularly, often at international meetings, and research plans, position papers and possible symposia have been discussed. Several of these have come to fruition.

Two major international meetings have taken place, and the proceedings have been published or will be published as supplements of Epilepsia.

Several sessions and symposia were in place at the international meetings in Lisbon, Vienna and Paris.

Two position papers are in preparation (Psychiatric Care in Epilepsy Surgery, Behavioral Effects of AEDs).

Four projects were conducted (standards of psychiatric care in epilepsy surgery, international attitudes toward psychiatric comorbidity in epilepsy, psychopathology of affective disorders in epilepsy (Blumer Syndrome) and postictal psychoses in epilepsy).

Future Plans
The Commission has been very productive with respect to various activities, including meetings, projects and publications. I am particularly pleased that during the last ILAE meetings neuropsychiatric issues have been increasingly discussed and I would hope that this increased awareness will continue. I have not laid out any future plans with the exception of a meeting that was proposed by Dr Krishnamoorthy on transcultural perspectives, which I hope will be supported by the ILAE in the next term. The Commission has now ended, and I would like to say that I am very proud to have worked with my international colleagues on the Commission.

If you wish to continue the Commission, I suggest that Dr Krishnamoorthy would be an excellent choice for chair.

2005 Meetings

  1. ILAE Paris: Psychiatry was one of the main topics. Psychiatric sessions were organized by Y Inoue together with B Schmitz.
    Topics:      
    Main Session: Affective Disorders in People with Epilepsy.
    Post Main Session: Anxiety Disorders in People with Epilepsy.
    Parallel Session 2: Psychiatric Issues in Epilepsy Surgery.
    Parallel Session 3: Epilepsy and Autism Spectrum Disorders.
    Breakfast Seminar: Cognitive and Behavior Disturbances in Children with Epilepsy.

2004 Meetings

  1. The Subcommission on Learning Disability organized a two-day meeting on Behavioral Outcomes of Epileptic Syndromes, which was held in Bologna, 8-9 October 2004 (organized by C Cornaggia, G Gobbi and F Besag). With financial support from the ILAE, proceedings from this meeting will be published as a supplement of Epilepsia.
  2. There was a roundtable discussion organized by the Subcommission on Affective Disorders (MR Trimble, B Schmitz) on 17 July 2004 in Berlin bringing together psychiatrists working with antiepileptic drugs in bipolar disorder and epileptologists with a special interest in affective disorders. The topic was Links Between Affective Disorders and Antiepileptic Drugs in Epilepsy. The meeting was sponsored by GlaxoSmithKline with a $37,000 grant. The proceedings from this meeting were published as a supplement of Epilepsia. The publication was supported by an unrestricted grant by GlaxoSmithKline ($20,000).
  3. Several sessions were organized by the Commission at the last European League meeting in Vienna 2004 including a main session and several parallel sessions (psychiatric aspects was a main topic of this meeting).

Surveys

  1. Subcommission on Epilepsy Surgery (Koch-Stöcker):
  2. The survey on neuropsychiatric care in epilepsy surgery centers has been analyzed by S Koch-Stöcker and E Krishnamoorthy; results were presented in Vienna. Final results will be published in Epilepsia as a Commission report together with recommendations for minimum psychiatric standards in epilepsy surgery centers.
  3. Main Commission Ongoing Research Project:
    Attitudes toward psychiatric complications and the role of psychiatrists in epilepsy centers worldwide: With support from the ILAE we have started a survey on psychiatric care in epilepsy centers worldwide. A standardized questionnaire has been developed and sent to all sections of the ILAE with the request that this questionnaire be forwarded to the most significant national epilepsy centers. The questionnaire is adapted from the one used in the epilepsy surgery survey and will focus on estimates of psychiatric complications (frequency, type, severity), use of psychiatric treatments (medical or psychotherapeutic) and availability of psychiatric services or cooperation with psychiatrists (J Moriarty, B Schmitz). Based on this survey the Commission will develop recommendations on standards of psychiatric care in epilepsy. Results will be presented in Helsinki 2006 and published as a Ccommission report in Epilepsia. Because of the initially unsatisfying response rate via email, we hope to increase the compliance by using the ILAE Website for online responses.
  4. Subcommission on Affective Disorders (M Mula, B Schmitz):
    The Subcommission has started a multicenter study on epilepsy specific affective syndromes, called the Blumer Syndrome. This study was supported by the ILAE. In this study we screened consecutive epilepsy patients for affective symptoms in two epilepsy outpatient clinics in Germany and Italy. Patients with significant depressive symptomatology were interviewed in detail with respect to affective symptomatology with a particular focus on symptoms described by Dietrich Blumer. The control group consists of patients with migraine. Results will be presented in Helsinki.
  5. Subcommission on Postictal Psychoses (Kanemoto): 
    An international prospective controlled survey on the characteristics of postictal psychoses is being conducted.

Subcommissions
The following Subcommissions have continued their work:

  1. Epilepsy Surgery.
  2. Affective Disorders.
  3. Transcultural Aspects.
  4. Dissociative Seizures.
  5. Learning Disability.
  6. Periictal Disorders.
  7. Behavioral Side Effects of Anticonvulsants.
  1. Epilepsy Surgery (Koch-Stöcker): The survey on neuropsychiatric care in epilepsy surgery centers has been analyzed by Koch-Stöcker and Krishnamoorthy. Results were presented in Vienna and will be published as a Commission report together with recommendations for psychiatric standards. The manuscript will be discussed with the Commission on Epilepsy Surgery.
  2. Affective Disorders (Trimble):
    • Meetings (see above): Roundtable discussion in Berlin 2004 on affective disorders in epilepsy, anticonvulsants and bipolar disorders.
    • Research Project: A multicenter study on the Blumer Syndrome (see above).
  3. Transcultural Affairs (Krishnamoorthy):
    E Krishnamoorthy planned a meeting on transcultural aspects of psychiatric comorbidity in epilepsy (for  program, see next page).
  4. Dissociative Disorders (Gates)
    J. Gates organized a session on transcultural aspects of dissociative seizures in Lisbon 2003. He had planned to submit a manuscript to Epilepsy & Behavior summarizing the Lisbon program. Unfortunately Prof Gates died in 2005 and could not complete his aims. The Commission on Psychobiology is very sad to have lost a good friend and inspiring colleague.
  5. Learning Disabilities: See 2004 Meetings, above Cornaggia)
  6. Postictal Psychosis (Kanemoto): An international prospective controlled survey on the characteristics of postictal psychoses is being performed.
  7. Psychiatric Adverse Events of AEDs (Besag): The task of this Commission was a report on psychiatric side effects of old and new antiepileptic drugs and a recommendation for appropriate instruments to evaluate these effects. A report on the new AEDs has already been published. A report on the older AEDs is in preparation.

Publications
Supplement: Neurobiological Links of Epilepsy, Bipolar Disorder and Anticonvulsants
Editors: Schmitz, Trimble
Epilepsia. 2005; 46 Suppl 4.

Supplement: Cognitive and Behavioral Outcomes of Epileptic Syndromes
Editors: Cornaggia, Gobbi, Schmitz
Supplement for Epilepsia, in preparation.

Review: Besag FM. Behavioral Effects of the Newer Antiepileptic Drugs: An Update.
Expert Opin Drug Saf. 2004 Jan;3(1):1-8.

Future Projects
Preliminary program for a symposium on Transcultural Perspectives in the Neuropsychiatry of Epilepsy proposed by E Krishnamoorthy.

ILAE Workshop
Transcultural Perspectives in the Neuropsychiatry of Epilepsy

18-19 November 2005, Chennai, India

Chairperson: Bettina Schmitz
Convener: Ennapadam S Krishnamoorthy
Hosts: ILAE Commission on Psychobiology and Neurosciences India Group

Background
The neuropsychiatry of epilepsy is a poorly researched area and one of great emerging interest. Over the past decade there has been convergence of data from multiple avenues, emphasizing the importance of neuropsychiatric disorders in epilepsy, both in the interest of providing better care for epilepsy, and as a paradigm to understand brain-behavior relationships. However, the vast majority of research in this area comes from the developed world, Europe, USA and Japan being predominant. The contributions that have emerged from developing countries have been few and far between. This symposium focuses on transcultural aspects of neuropsychiatry of epilepsy and aims to compare and contrast developed and developing nations and set an international research development agenda in this area, for the future.

Program Day 1
0830: Neuropsychiatric Epidemiology in Epilepsy
Chair: V Patel
0830-0915:   Transcultural Psychiatry: Evolution of a Concept
D Bughra
0915-0945:  Transcultural Issues in the Epidemiology of Epilepsy
N Bharucha
0945-1015:  Neuropsychiatric Epidemiology in Epilepsy: Current Status
ES Krishnamoorthy
1015-1100:  Panel Discussion on Transcultural Research in the Neuropsychiatry of Epilepsy and Development of an International Research Agenda
Lead Discussants: Cesare Cornnagia and representative of ILAE Epidemiology Commission
1100-1130: Coffee
1130: Neuropsychiatric Disorders in Epilepsy: Toward an International Classification
Chair: D Bughra
1130-1200: The Case for an Etiological Approach: Views from a Developed Nation
K Kanemoto
1200-1230: The Case for a Phenomenological Approach: Views from a Developing Nation
ES Krishnamoorthy
1230-1300: Discussion
Lead Discussants: L Tebartz van Elst and representative of Classification Subcommission
1300-1400:  Lunch
1400: Neuropsychiatric disorders in Epilepsy: Phenomenology and Diagnosis of Epilepsy Specific Neuropsychiatric Disorders
Chair: B Schmitz
1400-1445: Common Mental Disorders: Evolution of a Concept and Transcultural Perspectives Thereof
V Patel
1445-1530: Epilepsy Specific Syndromes of Depression and Anxiety: Where Are They? What Are They?
B Schmitz
1530-1615:  Psychoses of Epilepsy (POE): How Does It Differ from Schizophrenia?
A Kanner
1615-1645: Coffee
1645-1730: Transcultural Descriptions of Episodic Mental Disorders and their Relevance to Our Understanding of Psychiatric Phenomenology
D Bughra
1730-1830: Panel Discussion on Transcultural Issues and Development of an International Research Agenda
Lead Discussant:  J Moriarty
Program Day 2
0800: Transcultural Aspects of Epilepsy Neuropsychiatry - I
Chair: B Schmitz
     A. Cognitive and Behavioral Syndromes in Children
0800-0830:  The Global Perspective
F Besag
0830-0850:  Transcultural Perspectives in a Developing Nation
P Singhi
     B. Learning Disability and Epilepsy
0850-0920: The Global Perspective
S Brown
0920-0940:  Transcultural Perspectives in a Developing Nation
P Singhi
0940-1020:  Panel Discussion on Transcultural Issues and Development of a Research Agenda
1020-1050:  Coffee
1050:

Transcultural Aspects of Epilepsy Neuropsychiatry - II                        
Chair: B Schmitz
     C. Epilepsy Surgery

1050-1120: The Global Perspective                        
S Koch-Stoecker
1120-1140:  Issues Relevant in a Developing Nation
K Radhakrishnan 
     D. Non-Epileptic Seizures
1140-1210:  The Global Perspective:
J Gates
1210-1230: Issues Relevant in a Developing Nation
ES Krishnamoorthy
      E. The Role of Antiepileptic Drugs
1230-1300: The Global Perspective
M Mula
1300-1320:  Issues Relevant in a Developing Nation
K Radhakrishnan
1320-1400: Discussion
Discussants: Representatives from Epilepsy Surgery, Non-Epileptic Seizures and Antiepileptic Drugs Subcommissions
1400:  Lunch and Close
1530: Public Symposium on Neuropsychiatry of Epilepsy

Plan for Workshop
All invited speakers will be requested to prepare and submit a PowerPoint presentation of their lecture by 31 May 2005 to the workshop secretariat. Speakers will also have to submit a draft manuscript of their lecture subject following Epilepsia guidelines for submission of manuscripts by 31 July 2005. The presentations and manuscripts will be circulated among the discussants for that session, who will in response prepare a short PowerPoint to present during the workshop and a draft commentary for that session. All manuscripts and presentations will be circulated in advance of the workshop to all participants (by 31 August 2005). The proceedings of the workshop will be recorded and transcribed and the relevant transcripts circulated among workshop attendees.

External Delegates
Twenty international epileptologists and neuropsychiatrists chosen in competition (based on submissions of original research) by Neurosciences India Group and the ILAE Commission on Psychobiology will be invited to attend this workshop and to participate from the floor. The invitation will be widely publicized together with the announcement of this workshop. The hosts undertake to give free registration to these international delegates; provision of a bursary toward travel and accommodation arrangements will however be subject to the receipt of grants toward this meeting.

Output from Workshop

  • A supplement to Epilepsia entitled Transcultural Issues in the Neuropsychiatry of Epilepsy is proposed. This will include a white paper on research priorities for developing nations.
  • A multicenter, cross-cultural research protocol involving centers from around the world for a comprehensive study of neuropsychiatric disorders in epilepsy including the development and validation of an epilepsy specific battery of assessment tools is expected to evolve from the workshop.

Funding
Neurosciences India Group and K Gopalakrishna Department of Neurology, Voluntary Health Services, Chennai-600113, the hosts of this workshop, have committed to raise limited funding that will cover the organizational costs (conference secretariat, communications, audio-visual arrangements, conference hall, food and beverages) of this closed door meeting and local travel for Indian faculty.

Funding is requested in order to cover:

  1. Economy class travel for 10 workshop faculty.
  2. Funding to cover two nights accommodation (room and breakfast) of 10 workshop faculty @ $200 per head.
  3. Funding to cover an 80 page academic supplement to Epilepsia.

Other sources of funding:
As this workshop has a strong academic/research development content and agenda, an application for support is being made to the Wellcome Trust in London.

Bettina Schmitz, Chair
Berlin, Germany
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