Abstracts

Rationale: Postictal psychiatric symptoms are relatively frequent in patients with pharmaco-resistant epilepsy, with postictal symptoms of depression (PSD) and anxiety (PSA) being the most frequently recognized. We hypothesized that the presence of PSD and PSA would be associate with poor quality of life , independently of the presence of interictal depressive and anxiety disorders. Methods: Twenty four consecutive patients with pharmaco-resistant focal onset epilepsy underwent a structured interview with the MINI (MINI International Neuropsychiatric Inventory), designed to identify current interictal psychiatric disorder according to the DSM-IV criteria. Postictal psychiatric symptoms (PPS) were identified with the Rush Postictal Psychiatric Questionnaire. To be rated as positive, PPS and postictal cognitive symptoms (PCS) had to ocurr after more than 50% of seizures during the last three months. The postictal period was defined as the 72 hours following a seizure. Quality of life was measured with the Quality of Life in Epilepsy-89 (QOLIE-89). Data analysis consisted of univariate logistic regressions with the total QOLIE-89 score as the dependent variable and the presence of PSD, PSA, postictal neurovegetative symptoms (PNS), PCS, any DSM-IV diagnosis, any interictal depressive disorder and interictal anxiety disorder on the MINI as independent variables. Results: Among the 24 patients, 20 (83.3%) experienced a median of 2.5 categories of PPS (i.e., PSD, PSA, etc.), which included PSD in 14 patients (58%), PSA in 11 (46%),PSV in 19 (79%), postictal manic symptoms in 3 (12.5%) and postcital psychotic symptoms in 1 (4%) patient; 13 patients (54%) reported PCS. In six patients, PSA and PSD occurred together and postictal psychotic and manic symptoms always occurred in the presence of PSD and PSA. PSV occurred in combination with other types of PPS in 15 patients. A positive Axis I DSM-IV diagnosis was found in 15 patients, 11 of whom met criteria for an anxiety disorder and 8 for a depressive disorder. Five patients met criteria for mixed interictal depression / anxiety disorders. There was a significant association between PSA and an interictal anxiety Disorder (p = 0.038, Fisher Exact, two-tailed), but not between PSD and interictal depressive disorder. There was no correlation between the total QOLIE-89 score and the number of categories of PPS (p = 0.06). In univariate analysis, predictors of poor quality of life included the presence of PSA (p = 0.006), interictal anxiety (p = 0.03) and interictal depressive (p = 0.048) disorders. However, on multivariate analysis, only PSA remained as an independent predictor (p = 0.049). Conclusions: These data demonstrate that despite a higher frequency of PSD, PSA has a worse impact on quality of life, suggesting that patients may develop tolerance to PSD but not to anxiety symptoms. These data confirms the relatively high prevalence of PPS and the need to identify them in addition to the interictal psychiatric disorders.