Abstracts

This abstract has been invited to present during the Broadening Representation Inclusion and Diversity by Growing Equity (BRIDGE) poster session.

Rationale: Adolescents with epilepsy are at increased risk of suicidal ideation (SI) when compared to the general population. Prior studies have noted one in five adolescents report SI at the time of focal epilepsy diagnosis, yet limited data exist on the role played by seizure type and anti-seizure medications (ASMs) in the risk of SI in this age group. In this study, we sought to identify characteristics associated with suicidal ideation in adolescents with newly diagnosed focal epilepsy by evaluating seizure characteristics and ASMs selected.

Methods: This was a retrospective analysis using adolescent enrollment data from the Human Epilepsy Project, an international study that collected data from 34 sites in the USA, Canada, Europe and Australia between 2012 and 2017. Participants used for this analysis were 11 to 17 years old and diagnosed with focal epilepsy within 4 months of enrollment. We used data from the Columbia Suicide Severity Rating Scale (C-SSRS), medical records, treatment logs, and seizure diaries to identify SI, as well as characteristics of seizures and pre-enrollment ASMs. Univariable tests (chi-square and t-tests; non-parametric tests where appropriate) assessed the significance of group differences.

Results: A total of 67 adolescents were enrolled. Of these, 14 (20.9%) endorsed any lifetime SI at enrollment. No difference was observed in semiology at seizure onset, psychiatric ictal phenomena, seizure awareness, or frequency of seizures between patients with and without SI (p >0.05). However, youth with a delay to epilepsy diagnosis of ≥ 1 year were 2.5x more likely to endorse any lifetime SI, and were 5x more likely to endorse lifetime suicidal behaviors (p < 0.05). They also had a longer overall median time to diagnosis than those without SI (385 vs. 136 days; p=0.03, Figure 1A). While no difference was observed in onset seizure semiology, participants with SI were 2.5x more likely to experience non-motor seizures with conversion to motor than those without SI (57.1% vs 22.6%; p=0.01, Figure 1B). A majority (86%) of participants with SI and delays ≥ 1 year had non-motor seizures that went undiagnosed until conversion to motor symptoms (Figure 1C). No difference in ASM selection was noted between groups (p >0.05). Furthermore, there was no difference in the prescription of ASMs with negative psychotropic properties in patients with and without SI (57% vs 58%, p=0.93). SI secondary to adverse effects of ASMs occurred in 3 of the 14 (21%) patients who developed SI; all 3 occurred after starting levetiracetam.

Conclusions: This study shows new evidence linking increased delays to epilepsy diagnosis and suicidal ideation in adolescents with focal epilepsy supporting the bidirectional relationship between these conditions. Suicidality in this group is likely multifactorial, with contributions from the underlying CNS disease, ASM side effects, and psychosocial factors. Our findings emphasize the critical need for prompt diagnosis and the importance of mental health evaluation in guiding the comprehensive care of youth with new-onset epilepsy.

Funding: None