Оценка эффективности таргетированной нейрофидбек-терапии в персонифицированной реабилитации депрессивных и тревожных расстройств у пациентов с фокальной эпилепсией

Abstract

Introduction. Depressive and anxiety disorders in patients with focal epilepsy are extremely common and significantly impair the quality of life, adherence to antiepileptic drug therapy and, as a result, the prognosis of the disease. Recurrent epileptic seizures, an imbalance of neurotransmitter systems and concomitant neurological symptoms create a favorable background for the development of affective disorders. The localization of the epileptic focus (right- or left–hemisphere) introduces additional variability into the clinical picture: right-sided foci are more often associated with severe anxiety and depersonalization, while left-sided foci are associated with apathy, anhedonia, and cognitive inhibition. Traditional clinical methods often do not detect subclinical manifestations, and EEG and MRI data without psychometric assessments do not reflect the completeness of the emotional state. To improve diagnostic accuracy, integration of three levels is necessary: psychometric feedback (HADS, BDI-II), neurophysiological feedback (EEG/qEEG). Only such a multi-level strategy makes it possible to reliably identify and stratify depressive and anxiety disorders, taking into account the lateralization of the focus, and to provide a personalized approach to rehabilitation.                                                                                                                                 

Purpose. To evaluate the severity of depressive and anxiety symptoms in right-handed patients with left-hemisphere (LPE) and right-hemisphere (PPE) focal epilepsy and to study the effect of a course of targeted neurofeedback (NFB) on the level of depression and anxiety.                                    

Materials and methods. The study conducted at the neurological department of the multidisciplinary clinic of Samarkand State Medical University involved 120 patients (58 – LPE, 62 – PPE), who had BDI-II and HADS-D scores before and after rehabilitation. Hardware and software: 21-channel EEG machine (standard "10-20"), Neuron Spectrum-4/VPM (Neurosoft, Russia). A software module for BOS (visual and sound stimulation).                                                   

Results. An intergroup cross-sectional analysis in 68 patients revealed moderate to severe levels of depression (BDI-II ≥ 20). The patients were randomized: group A (n=37) received NFB + cognitive behavioral therapy + the antidepressant Velaxine 75.0; group B (n=31) received only the antidepressant Velaxine 75.0. Before rehabilitation: BDI-II – PPE patients had higher scores – 24.1±6.8 versus 19.5±5.9 for PPE (p=0.002) and HADS-D – 11.3 ± 3.4 for PPE patients; 8.7 ± 2.9 for PPE (p < 0.001). After the rehabilitation course, the average decrease in BDI-II in group A was 8.2 (p<0.001) and HADS–D was 4.5 (p < 0.001), while in group B it was 4.1 (p = 0.005) and 2.3 (p = 0.012), respectively. The differences between the groups were statistically significant (p<0.01).                                                                                                                       

Conclusion. The data obtained indicate an additional effect of targeted NFB (neurofeedback) in reducing depressive and anxiety symptoms in patients with focal epilepsy.