Authors :
Presenting Author: Jessica Niskanen, BS – Queens University
Caitlin Barry, MA, MS – Queen's University
Ada Mullett, MA, CPsych – Kingston Health Sciences Centre
Ron Levy, MD, PhD – Queen's University
Gavin Winston, MD/PhD – Queen's University
Lysa Boissé Lomax, MD, MSc – Queen's University
Garima Shukla, MD – Kingston Health Sciences Centre
Rationale: Substance use has been reported to be highly prevalent among persons with epilepsy (PWE), with cannabis use, alcohol consumption and tobacco/nicotine use being the commonest. There is paucity of literature on impact of effective treatment of pharmacoresistant epilepsy on substance use. The primary objective of this study is to assess the impact of successful epilepsy surgery on substance use and the correlation with change in sleep quality and mood (among PWE with refractory focal epilepsy).
Methods: Consecutive patients undergoing evaluation for surgical treatment for refractory focal epilepsy at the Kingston Health Sciences Centre (KHSC) (District Epilepsy Center in the Ontario province of Canada) over a 3-year period, were included. Detailed self-reported sleep data and mood scores (on the Beck Depression Inventory [BDI], Beck Anxiety Inventory [BAI]), quality of life (Quality of Life in Epilepsy [QOLIE-31]), and substance-use-related data were collected. Descriptive statistics were run to report pre-operative and post-operative individual sleep- and substance-related parameters. A McNemar’s test was conducted to analyze changes in individual binary parameters, and paired t-tests used for non-binary parameters. A Pearson correlation matrix was generated, followed by pairwise Pearson correlation analyses. Corrections for multiple comparisons were applied.
Results:
38 patients underwent evaluation for resective epilepsy surgery between 2021-2024. Among these, 60.5% patients reported use of cannabis, 52.6% reported use of alcohol, and 40% smoked tobacco/nicotine products regularly. Criteria for a substance use disorder were fulfilled by 31%; 29.6% specifically for AUD. Twenty-five of the 37 patients underwent surgical resection, 13 among which, had a modified Engel class I surgical outcome, 4 had class II, and 3 had a class III outcome.
Among the 18 with class-I or II outcomes, two patients reported significant reduction in daily cannabis use, two reported significant reduction in weekly alcohol intake, one reported reducing tobacco consumption by half and one reported quitting nicotine. Two patients reported significant increase in their weekly alcohol intake.
A positive correlation was found between the change in total substance use and the change in anxiety scores (pre- to post-operatively) (r = 0.59, p=0.02), however, after conducting a multiple comparisons correction, this did not remainstatistically significant.
Conclusions:
This prospective study demonstrates substance use prevalence before and after epilepsy surgery for pharmacoresistant epilepsy, along with changes in sleep, mood and overall quality of life in this population. A trend towards reduction in substance use and its correlation with reduced anxiety scores was observed, although not statistically significant.
Funding: PSI Foundation Ontario