Abstracts

Rationale: Psychiatric comorbidity, including anxiety, is increasingly recognized as an important determinant of quality of life in epilepsy. Nevertheless, little is known regarding the association between anxiety symptoms and epilepsy related factors, including lateralization and localization of epileptogenic foci. Methods: A cohort of 500 adults with epilepsy (mean age: 39.3 years) who underwent neuropsychological evaluation at the Columbia Comprehensive Epilepsy Center between 1999 and early 2012 was identified, using a clinical database derived from medical records. Anxiety symptoms were assessed using the anxiety subscale of the Symptom Checklist 90-R (SCL-90-R), a validated self-report instrument, with T score of >60 corresponding to the 84th centile of anxiety symptoms among an adult non-patient normative group. The cohort was divided into 2 groups by reported anxiety symptoms: high anxiety (SCL-90R anxiety T score >= 60) and lower anxiety (anxiety T score <60). The association of anxiety group with demographic and epilepsy related factors was assessed using chi square and two-sample t tests. The association of anxiety group with lateralization and localization of epileptogenic foci was also assessed within focal epilepsy and temporal lobe epilepsy (TLE) subgroups. Results: The overall prevalence of high anxiety symptoms (SCL-90R T score >= 60) was 46%. There was no significant association between anxiety group and age, gender, education level, seizure frequency, age of epilepsy onset, presence of epilepsy causing lesion, or presence of mesial temporal sclerosis. High anxiety was more common among noncaucasians than caucasians(p=0.025). Also, the number of current antiepileptic drugs (AEDs) was associated with anxiety group(p=0.018, chi square), with more patients on AED polytherapy in the high anxiety group, though test for trend was not statistically significant (p=0.075). Epilepsy type (focal vs. generalized) was significantly associated with anxiety (p=0.021), as 47% of focal epilepsy patients (N=362) reported high anxiety symptoms, in contrast to 31% of generalized epilepsy patients (N=58). TLE (N=313) was also associated with high anxiety symptoms compared to non-TLE (N=98) (p=0.008). Among focal epilepsy patients, lateralization of seizure focus was not associated with anxiety group. However, among TLE patients, there was a nonsignificant trend toward patients with left foci reporting high anxiety symptoms (p=0.082), as 52% of patients with left TLE reported high anxiety(N=177), while only 41% of right TLE patients reported high anxiety(N=111). Among TLE patients, there was no association between anxiety group and mesial versus lateral temporal focus. Conclusions: Anxiety symptoms are highly prevalent among epilepsy patients in this sample, particularly among those with TLE and other focal epilepsies. AED polytherapy and noncaucasian race may be risk factors for comorbid anxiety in epilepsy, though these findings require further study. Screening for anxiety symptoms may be useful in the clinical setting, especially among those with focal epilepsy.