Abstracts

Rationale: Insomnia symptoms in veterans with epilepsy are common and have been understudied. The purpose of this study is to characterize insomnia complaints and their association to epilepsy features, co-morbidities and treatments in an epilepsy clinic. Also, we want to identify the hypnotic selected prior to the first visit at the epilepsy clinic. Methods: We performed a cross-sectional analysis of consecutive patients attending initial evaluation at a VA epilepsy clinic. The inclusion criteria included patients with epilepsy who presented to the Veteran epilepsy clinic over a 18 months period. Patients complete a standardized interview including assessments of seizure and sleep history. Chronic use of sedative-hypnotics also satisfied insomnia diagnosis. Categorical and continuous data were compared among "insomniacs" versus "non insomniacs" groups using Chi-Square or ANOVA or Kruskal-Wallis test, respectively. Logistic regression modeling was used to explore the impact of measured variables on insomnia Results: One-hundred sixty-five participants (87% male, age 56 ± 15 years) were included: 66 insomniacs (40%). Insomniacs were more likely to have post-traumatic epilepsy and report smoking, pain, and psychiatric co-morbidities compared to non-insomniacs. Insomniacs were more commonly taking Gabapentin and Lamotrigine and less frequently Levetiracetam and Phenytoin. Our model used insomnia as the dependent variable and independent variables were those found to be significant in univariate analysis. Logistic regression demonstrated that male gender (OR 0.2, 95% CI 0.04-0.8), post-traumatic etiology (OR 3.5, 95% CI 1.3-9.5), mood disorder (OR 5.1, 95% CI 1.7-15.0), psychotic disorders (OR 9.3, 95% CI 2.0 -42.8), antipsychotics (OR 8.05, 95% CI 1.2-55.6), Lamotrigine (OR 4.5, 95% CI 1.2-16.1) and Levetiracetam (OR 0.3, 95% CI 0.1-0.9) were associated with insomnia. 31.8% of the insomniac patients were not treated with a sedative-hypnotic. Conclusions: Insomnia symptoms in veterans with epilepsy were associated with male-gender, post-traumatic epilepsy etiology, psychotic/ mood co-morbidities, and antiepileptic regimen using Lamotrigine and Gabapentin. Longitudinal studies are needed to clarify these associations.