Abstracts

Rationale: Major depressive episodes (MDE) and generalized anxiety disorder (GAD) are the most frequent psychiatric comorbidities in patients with epilepsy (PWE) which have a very negative impact on their quality of life, increased mortality risk, tolearnce of AEDs and response to the treatment of the seizure disorder. To identify PWE with these comorbidities in the outpatient clinic, clinicans have started to use screening instruments such as the Neurologic Disorders Depression Inventory in Epilepsy [NDDI-E] for MDE and the Generalized Anxiety Disorder -7, for GAD Yet, whether screening for these conditions translate into their remission or improvement remains to be proven. This study was developed to address this question. Methods: Every English speaking adult aged >18 years-old seen in the outpatient Epilepsy Clinic of the Rush Epilepsy center were asked to complete the NDDI-E and the GAD-7 at each visit. Only those who were able to complete these instruments independently and understand their items were included in the study. Those with an NDDI-E total score >15 were considered to have a probable MDE (PMDE), while those with a GAD-7 total score >10 were considered to be suffering from a probable GAD (PGAD). Five treating epileptologists had to make a decision on how to intervene with these symptomatic patients. The interventions included referral to a mental health professional, start or modify a pharmacologic regimen with psychotropic drugs, maintain on the same regimen or other intervention. The type of intervention was at the discretion of each epileptologist. Out of 615 outpatients who completed these instrument, 115 had been seen twice during the period of this study. We identified the number of PWE who met criteria for PMDE, PGAD and PMDE+PGAD on visit 1 and had become asymptomatic on visit 2. We also identified how many patients who were not symptomatic on visit 1 had become symptomatic on visit 2. Results: Among the 115 patients, 40 (34.7%) were symptomatic on visit 1, 10 with PMDE only, 13 with PGAD only and 17 with both. Visit 2 occurred after a mean period of 122 days (±77 days). Among the 40 symptomatic patients on visit 1, 25 (62.5%) were not symptomatic any more on visit 2; this included 6 patients with only PMDE (60%), 7 (47%) with only PGAD and 12 (66%) with PMDE + PGAD. In addition, 12 of the 115 PWE (10.5%) who were asymptomatic on visit 1, became symptomatic on visit 2: 3 patients with PMDE, 5 with PGAD and 4 with PMDE+PGAD. Conclusions: Screening for MDE and GAD can translate into improvement of these psychiatric conditions when epileptologists make some type of intervention that may include start pharmacotherapy or refer for treatment. By the same token, our data suggests that screening for MDE and GAD should be done at every visit, as these conditions are likley to recur in the course of the seizure disorder.