Mood Disturbances, Anxiety, and Impact on Quality of Life in Patients Admitted to Epilepsy Monitoring Units

Abstract

Introduction: The overall combined prevalence of anxiety and depression in patients with epilepsy has been estimated at 20.2 and 22.9%, respectively, and is considered more severe in drug-refractory epilepsy. Patients admitted to epilepsy monitoring units constitute a particular group. Also, patients with psychogenic non-epileptic seizures can reach more than 20% of all admissions. This study aims to characterize these symptoms in a large cohort of patients admitted for evaluation in a tertiary epilepsy center.Materials and Methods: The study was conducted among 493 consecutive patients (age: 38.78 ± 12.7, 57% females) admitted for long-term video EEG from January 2013 to February 2021. Demographic, clinical, and mood disorder patients' data were collected. Anxiety and depression symptoms were assessed through the Hospital Anxiety Depression Scale (HADS-A and HADS-D), the State Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI-II). Quality of life was determined using the QOLIE-10. Patients were divided into three groups: patients with epilepsy (n = 395), psychogenic non-epileptic seizures (PNES) (n = 56), and combined (n = 33). A univariate and multivariate regression analysis was performed for variables associated with quality of life.Results: Of 493 patients, 45.0% had structural etiology, and considering epilepsy classification, 43.6% were of temporal lobe origin. In addition, 32.45% of patients had a previous psychiatric history, 49.9% of patients had depressive symptoms in BDI, and 30.9% according to HADS-D; 56.42 and 52.63% of patients presented pathological anxiety scores in STAI-T and STAI-S, respectively; and 44.78% according to HADS-A. PNES and combined groups revealed a higher incidence of pathologic BDI scores (64.29 and 78.79%, p < 0.001) as well as pathologic HADS-A scores (p = 0.001). Anxiety and depression pathologic results are more prevalent in females, HADS-A (females = 50.7%, males = 36.8%; p = 0.0027) and BDI > 13 (females = 56.6%, males = 41.0%; p = 0.0006). QOLIE-10 showed that 71% of the patients had their quality of life affected with significantly higher scores in the combined group than in the epilepsy and PNES groups (p = 0.0015).Conclusions: Subjective anxiety, depression, and reduced quality of life are highly prevalent in patients with refractory epilepsy. These symptoms are more evident when PNES are associated with epilepsy and more severe among female patients. Most of the cases were not previously diagnosed. These factors should be considered in everyday clinical practice, and specific approaches might be adapted depending on the patient's profile.

Influence of sleep disturbance, depression, anxiety, and stress on quality of life in people with epilepsy

“…These psychiatric comorbidities are associated with increased adverse reactions related to ASM 25 . There are reports of depression and anxiety independently affecting QOL in PWE 22,26,27 . We found significant negative associations between depressive and anxious symptoms and QOL in PWE (Figure 1Ab,c,Bb,c) similar to those of Johnson et al 9 …”

“…25 There are reports of depression and anxiety independently affecting QOL in PWE. 22,26,27 We found significant negative associations between depressive and anxious symptoms and QOL in PWE (Figure 1Ab,c,Bb,c) similar to those of Johnson et al 9 Stress can be a precipitating factor for developing seizures. However, reports are scanty on the effect of subjective stress on QOL in epilepsy.…”

Optimization of Therapy in Patients with Epilepsy and Psychiatric Comorbidities: Key Points

“…Available literature data indicate that psychiatric disorders occur in a higher percentage in PWE than in the general population with an increased risk of 2 to 5-fold [ 1 , 4 , 27 - 29 ]. One out of three PWE has a diagnosis of a psychiatric disorder over lifetime [ 4 ].…”

“…In another review, anxiety was more prevalent than depressive symptoms (44.8-52.9% vs . 30.8-49.9%) [ 29 ]. High prevalence values have been also reported for sleep disturbances, especially insomnia (61.4%) followed by excessive daytime sleepiness (EDS) and restless leg syndrome (RLS) (35.7% and 28.6%, respectively) [ 34 ].…”

Self-perceived burden and associated factors in Chinese adult epilepsy patients: A cross-sectional study

“…Epilepsy often causes physical and psychological harm to patients, such as sudden unexpected death in epilepsy, status epileptics, falls, sleep disorder, social maladjustment, etc ( 4 – 10 ). These symptoms have seriously affected epilepsy patients' quality of life ( 11 ), thereby resulting in a Self-Perceived Burden (SPB). Adults are the backbone of the family and society, and adult epilepsy patients need to bear greater psychological, emotional, economic and social pressure than minors and elderly patients and are more likely to develop SPB.…”