Abstracts

Rationale: The risk of suicide in patients of epilepsy has been reported to be up to 5-fold higher than the general population. The risk can be attributed to epilepsy (seizures), antiepileptic drugs (AEDs) that are known to affect mood, and the many psychiatric conditions that are comorbid with epilepsy (anxiety, depression and bipolar disorder). On 1/31/2008, the Food and Drug Administration (FDA) alerted physicians and health care professionals that patients receiving antiepileptic drugs had approximately twice the risk of suicidal behavior or ideation compared to patients receiving placebo. [http://www.fda.gov/Cder/Drug/InfoSheets/HCP/antiepilepticsHCP.htm]. Since there are no guidelines on how to manage psychiatric conditions and suicide in patients with epilepsy, it is not clear how the FDA alert would affect daily clinical practice. We developed a survey to determine if there is a consensus on how to deal with depression in patients with epilepsy, and to determine practitioners’ reaction to the FDA alert. Methods: A 22-question survey was developed. Data was collected through an online survey tool (Zoomerang). Eligible practitioners were contacted via email addresses. Attempts were made to send invitations only to neurologists and neurology nurse practitioners. Results: Demographics: Ninety-four participants (8%) completed the survey, 71% are men. Most participants are; practicing in academic institutions (51%), have a comprehensive epilepsy program (65%), and have been in clinical practice for more than 10 years (58%). Nearly half (49%) devote the majority of clinical practice time (>75%) to epilepsy. Screening for depression: Only 16% screen all epilepsy patients for comorbid depression using a metric scale. More than half (51%) do not use any metric scales for depression. The most commonly used scales are Beck Depression Inventory (22%), Hamilton Depression Rating Scale (8%), and Neurological Disorders Depression Inventory for Epilepsy (6%). More than half (56%) feel comfortable initiating treatment for depression when needed. Discussing behavioral problems and suicide: Most participants (97%) warn patients about behavioral side effects of AEDs (56% for all AEDs, 41% for certain AEDs). About 56% do not warn about suicidal thoughts when starting AEDs (14% warn for all AEDs and 16% warn for certain AEDs). Only 16% ask all patients routinely about suicidal thoughts during visits. About 38% of participants reported that they had patients who had attempted suicide, and 23% reported that they had patients who had committed suicide. FDA Alert: On a scale from 1-10, the mean score of the FDA alert clarity (10 is very clear), appropriateness (10 is very appropriate) and its impact on clinical practice (10 is significant impact) were 5.2, 4.1 and 3.3 respectively. The alert will not change the practice of 47% of participants. Any change of practice will by done through face to face counseling by 86% of participants. Conclusions: The epilepsy community needs to have better guidelines regarding how to address mood problems, behavioral side effects and suicide in patients with epilepsy.