Peri-Ictal Changes in Depression and Anxiety in Persons With Epileptic and Non-epileptic Seizures

Abstract

ObjectiveWe tested the hypothesis that epileptic, but not non-epileptic, seizures would produce an improvement in comorbid depression and anxiety symptoms in the peri-ictal period, much like the antidepressant effects of electroconvulsive therapy.MethodsWe examined depression and anxiety symptoms in patients admitted to an inpatient unit for continuous video electroencephalography as part of routine clinical care. Patients completed three questionnaires that included the Beck Depression Inventory-II (BDI), Montgomery Asberg Depression Rating Scale (MADRS), and Beck Anxiety Inventory (BAI) after admission, in the 24 h following a seizure, then again 2 weeks after the last seizure.ResultsIn patients with epilepsy, depression and anxiety scores improved in the 24 hrs following a seizure (change in BDI = 24%; change in MADRS = 19%; change in BAI = 21%) but returned toward baseline after 2 weeks. In patients with non-epileptic seizures, depression and anxiety scores also improved in the 24 hrs following a psychogenic non-epileptic seizure (change in BDI = 17%, change in MADRS = 27%, change in BAI = 36%). There was a greater improvement in depression and anxiety scores in patients with focal-onset epilepsy (BDI = 30%, MADRS = 22%, BAI = 30%) compared to generalized seizure onset (BDI = 6%, MADRS = 12%, BAI = 8%).ConclusionWe conclude that single seizures can result in transient improvements in mood. Because seizures need not be generalized or epileptic to exert this effect, the underlying mechanisms are uncertain.

An update on psychogenic nonepileptic seizures

“…A study by Gargiulo et al [28] comparing the levels of perceived stress, resilience, and stress-coping levels and the relationship with psychiatric symptoms to identify psychopathological patterns in patients with PNES, drug resistant epilepsy (DRE) and controls identified higher levels of perceived stress with lower levels of resilience in the PNES cohort than the controls. Hopp et al [29] observed that seizures produce a significant improvement in mood scores within a 24-h period in patients with both ES or PNES. The improvement in mood after seizures appeared transient and depression and anxiety scores trended back toward the baseline when assessed 2 weeks after the seizure.…”