Abstracts

Rationale: The objective of this study is to measure post-ictal mood changes. Depression and anxiety are some of the most common comorbid conditions in patients with epileptic seizures (ES). A variety of mood changes are reported by patients in the peri-ictal period but little is known about the immediate effects of a seizure on mood and how long mood changes last. Electroconvulsive Therapy (ECT) is used to treat depression by creating seizure activity and may be an important model to study mood in patients with ES. We hypothesize that patients with ES and depressive mood will experience greater improvement in symptoms post-ictally compared to those with non-epileptic seizures (NES).Methods: Subjects enrolled (n=50) from the Epilepsy Monitoring Unit at the University of Maryland Medical Center completed Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventories (BAI), and the Montgomery Asberg Depression Rating Scale (MADRS). These scales were completed prior to seizures and post-ictally within a 1-4 hour interval, at 12 hours, 24 hours, 48 hours and 2 weeks. Testing was performed based on the first seizure. Mood changes were averaged across patients for each questionnaire and compared between patients with ES (n=14) and patients with NES (n=11) with standard deviations. Data were compared with standard t-tests.Results: Both the ES and NES groups had similar baseline levels of depressive mood measured with BDI (mean 18.07 and 17.09, p=0.82), and MADRS (mean 17.00 and 18.00, p=0.93). Anxiety levels were different at baseline though not statistically significant (mean 13.71 and 18.09, p=0.30). ES patients showed an initial improvement in mood while NES patients had a worsening of mood (-5.75 and 0.80, p=0.02) within 4 hours post-ictally. ES patients had a sustained improvement in mood at 12 hours, (-6.78 and -6.83, p=0.99), 24 hours, (-5.20 and -3.80, p=0.71) and 2 weeks (-3.00 and 3.00, p=0.65) while NES patients had mood improvement after their initial worsening. ES patients also demonstrated an improvement in mood with MADRS scores at 4 hours (-6.2 and -3.9, p=0.51), 12 hours (-5.86 and -4.83, p=0.89), 24 hours (-8.50 and -6.80, p=0.82) that was greater than NES patients but this did not reach statistical significance. ES patients showed an improvement in anxiety greater than NES patients at 4 hours (-1.82 and -0.20, p=0.66), 12 hours (-7.00 and -4.6, p=0.56), and 24 hours (-6.83 and -1.00, p=0.49) but this did not reach statistical significance. Data were not significant at 2 weeks for MADRS and BAI due to lack of patient response.Conclusions: Patients with ES and NES have similar levels of depressive symptoms before seizures but only ES patients show mood improvements within 4 hours post-ictally. ES patients appear to have a more sustained improvement in mood after seizures though this finding is not statistically significant. ES patients may have mood improvements post-ictally due to similar physiologic changes as in patients undergoing ECT. Future study may help to understand the effects of seizures on mood and guide management strategies in these common comorbid conditions.