Abstracts

Rationale: The epilepsies are a significant contributor to the global burden of neuropsychiatric disease. Disability in epilepsy is multifactorial, modulated by seizure frequency/recency, anticonvulsant side effects, and the burden of comorbid psychiatric symptoms. In this study, we utilized wrist actigraphy to explore how objective, continuous and in situ assessments of rest and activity patterns correlate with epilepsy-specific variables and psychometric scales of emotional wellbeing and somatic symptoms.

Methods: Our study protocol was approved by the Baylor College of Medicine Institutional Review Board. Adults aged 18-75 with focal epilepsy were enrolled during routine clinic visits. We excluded pregnant patients, those with co-existing motor impairments (e.g., stroke-related hemiparesis) or with moderate-severe intellectual disability. Subjects were instructed to (i) wear a widely utilized FDA-approved wrist-worn device (Actigraph 2) on their non-dominant wrist continuously for at least 7 days, (ii) maintain a log of seizure events, and (iii) complete a series of standardized questionnaires: the Adverse Event Profile [AEP], Quick Inventory of Depressive Symptomatology – Self Report [QIDS-SR], Epworth Sleepiness Scale [ESS], and Patient Health Questionnaires for Somatic [PHQ15], Anxiety [GAD7], and Depressive [PHQ9]. Cosinor analysis was applied to derive measures of circadian behavior (mesor, amplitude, acrophase). Quantitative accelerometry data were examined for active state morphology, as well as actigraphically defined putative measures of “sleep.”

Results: 29 patients have been enrolled so far (41% male, 68% intractable), taking a median of 2 daily anticonvulsants, with a mean age of 39.5 (18-72). Circadian amplitude was directly proportional to self-reported measures of anxiety (GAD7, r = +0.517, p< 0.01) but not depressive symptoms (QIDS-SR or PHQ-9, p >0.5). Higher AEP scores were associated with a delay in acrophase (r = +0.373, p< 0.05). Intractability was associated with significantly lower mesor values, without notably altered psychometric profiles. Sleepiness, as captured by the ESS, was directly proportional to daily “sleep” bouts (r = +0.39, p < 0.05). Consistent with total daily sleep inversely varied with age (r = +0.59, p< 0.001).