Neurobiological mechanisms of psychosis in epilepsy: Findings from neuroimaging studies

Abstract

Despite the high prevalence and clinical importance of comorbid psychosis in epilepsy, its neurobiological mechanisms remain understudied. This narrative mini-review aims to provide an overview of recent updates in in vivo neuroimaging studies on psychosis in epilepsy, including structural and diffusion magnetic resonance imaging (MRI) and functional and molecular imaging, and to discuss future directions in this field. While the conventional morphological analysis of structural MRI has provided relatively inconsistent results, advanced methods, including brain network analysis, hippocampal subregion volumetry, and machine learning models, have recently provided novel findings. Diffusion MRI, for example, has revealed a reduction in white matter integrity mainly in the frontal and temporal lobes, as well as a disruption of brain white matter networks. Functional neuroimaging, such as perfusion single-photon emission computed tomography (SPECT) or fluorodeoxyglucose positron emission tomography (FDG-PET), often identifies hyperactivity in various brain regions. The current limitations of these more recent studies may include small and sometimes heterogeneous samples, insufficient control groups, the effects of psychoactive drugs, and the lack of longitudinal analysis. Further investigations are required to establish novel treatments and identify clinical diagnostic or disease-monitoring biomarkers in psychosis in epilepsy.

The Love Hormone and Seizure Control: A Review of Oxytocin’s Impact on Epilepsy Management

“…Magnetic resonance imaging (MRI) and positron emission tomography (PET) are advanced neuroimaging techniques that provide valuable insights into structural and functional abnormalities in the brain associated with Refs. [124][125][126][127]. Genetic profiling is increasingly utilised to identify specific gene mutations or genetic variants contributing to epilepsy susceptibility, allowing for more personalised treatment approaches [128][129][130][131][132].…”

Therapeutic applicability of cannabidiol and other phytocannabinoids in epilepsy, multiple sclerosis and Parkinson's disease and in comorbidity with psychiatric disorders

“…24 Indeed, neurological diseases, such as temporal lobe epilepsy, and psychiatric disorders, such as anxiety, psychosis and schizophrenia, were already reported in comorbidity. 25,26 Epigenetic modifications can be critical for the therapeutic efficacy of antidepressants and/or antipsychotic agents, 27 commonly prescribed for the treatment of patients with neurological diseases in comorbidity with psychiatric disorders, such as Parkinson's disease and depression, 28 epilepsy and psychosis, 29,30 multiple sclerosis and psychosis 31 and other comorbidities. The exposure of adolescents to psychotropic drugs, such as THC, during a "critical window" of enhanced neurophysiological vulnerability and chemical dependence causes long-term effects and contributes to the pathophysiology of schizophrenia and related primary psychotic disorders, 32 in which the clinical use of phytocannabinoids may be a useful therapeutic procedure.…”