Clinical correlates of memory complaints during AED treatment

Abstract

Objectives: To investigate clinical correlates of memory complaints (MC) during antiepileptic drug (AEDs) treatment in adults with epilepsy with special attention to the role of depression, using userfriendly standardised clinical instruments which can be adopted in any outpatient setting. Materials & methods:Data from a consecutive sample of adult outpatients with epilepsy assessed with the Neurological Disorder Depression Inventory for Epilepsy (NDDIE), the Adverse Event Profile (AEP) and the Emotional Thermometer (ET) were analysed.Results: From a total sample of 443 patients, 28.4% reported MC as "always" a problem. These patients were less likely to be seizure free (18.3% vs. 34.3%; p<0.001), had a high number of previous AED trials (4 vs. 3; p<0.001) and high AEP total scores (49 vs. 34.2; p<0.001). There was no correlation with specific AED type or combination. Depression was the major determinant with a 2-fold increased risk (95%CI 1.15-3.86; p=0.016). When depression was already known and under treatment, patients with MC were less likely to be in remission from depression despite antidepressant treatment (11.9% vs. 1.6% p<0.001). Among patients without depression, those reporting MC presented with significantly high scores for depression (3.3 vs. 2; t=3.07; p=0.003), anxiety (4.5 vs.2.7; t=4.43; p<0.001), anger (3 vs. 2; t=2.623; p=0.009) and distress (3.8 vs. 2.2; t=4.027; p<0.001) than those without MC.Conclusions: Depression has to be appropriately treated and full remission from depression should represent the ultimate goal as sub-threshold or residual mood and anxiety symptoms can contribute to MC.

Common psychiatric comorbidities in epilepsy: How big of a problem is it?

“…The problem of neuropsychological deficits in adult-onset epilepsies is quite complex. Several studies have clearly shown that subjective memory complaints do not correlate with formal neuropsychological deficits but are rather due to other factors, especially anxiety and depression (31,32). Antiepileptic drugs have a different propensity for cognitive side effects but a number of different variables, which are both patient-related and epilepsy-related, have to be taken into account in adults (30).…”

Anxiety disorders in people with epilepsy

“…A high level of anxiety is also associated with perceived stigma in persons with newly diagnosed epilepsy (Lee et al, 2015). Anxiety also contributes to memory complaints in persons with epilepsy (Mula et al, 2016).…”

Developments in depression in epilepsy: screening, diagnosis, and treatment

“…Finally, a number of studies are now pointing out that depression is a prognostic marker in epilepsy as it is associated not only with poor quality of life [16] but also with antiepileptic drug-resistance [17,18], increased seizure severity [19], increased side effects of antiepileptic drugs [20], increased risk of accident and injuries [21], poor outcome after epilepsy surgery [22] and increased mortality [23].…”