Abstracts

Rationale: Depression and anxiety are among the most common comorbid conditions associated with epilepsy.  Up to one third of patients living with epilepsy spontaneously report mood as a “significant problem”. It is estimated that 20-55% of patients with epilepsy suffer depression, and the risk of suicide is 10 times higher in these patients than that for the general population. Mood change and depression have typically been studied in patients between seizures, and there appears to be a relationship between seizure frequency and levels of anxiety and depression. Few studies, however, examine the effect on mood hours or days after the seizure, during the “peri-ictal” period. While the occurrence of these conditions has been studied in the post-ictal and inter-ictal periods, little is understood about mood changes in the peri-ictal period. We hypothesize patients with baseline depressive moods will show improvements in mood scores in the peri-ictal period. We also examine the relationship between mood changes and seizure type and hypothesize patients with focal onset seizures are more likely to have mood improvements in the peri-ictal period than those with generalized onset seizures.  Methods: Subjects were adults enrolled from the Epilepsy Monitoring Unit (EMU) at the University of Maryland Medical Center.  They completed baseline psychological assessments at admission and at time points of 4, 12, and 24 hours and 2 weeks after a first seizure.  If a subsequent seizure occurred, the measures were readministered after that event and the schedule of assessments was reset.  Assessments included the Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI).  Seizures were analyzed by clinical semiology and EEG using video EEG monitoring by board-certified epileptologists.  Seizures were classified as epileptic (ES) or nonepileptic seizures (NES).  Seizure onset was classified as generalized or focal and then localized by region of onset if focal. Results: NES and ES patients had average BDI baseline scores categorized as mild depression (mean 14.3, 16.17). ES patients with generalized onset and focal onset seizures had mild depressive average BDI baseline scores (14.4, 16.54). Average BAI baseline scores for NES and ES (14.7, 10.89) were in the range of mild anxiety, as did ES patients, both with generalized and focal onset (7.25, 11.52) (Table 1).  BDI and BAI scores at baseline were not significantly different between generalized and focal onset ES patients, likely explained by the small sample of generalized onset patients.Our data suggest that patients with epilepsy show improvement in both mood and anxiety postictally, in which there was significant difference in 4-hour average BDI scores from baseline (p=0.0086) and 12-hour BAI scores (p= 0.0152). We also saw a significant average maximal change over 24 hours in focal and generalized onset epileptic patients (p=0.02), and significant anxiety improvement in focal onset patients (p=0.04) (Table 2).  Conclusions: Patients in the EMU showed, on average, mild depression and mild anxiety symptoms at baseline. Patients with epileptic seizures show a transient improvement in depression and anxiety, as hypothesized.  Patients with focal onset seizures did not show greater improvement in BAI and BDI scores when compared to generalized onset. Patients with focal onset seizures showed significant mood improvement at 24 hours compared to baseline and 2 weeks postictally.  Funding: Program for Research Initiated by Students and Mentors (PRISM) for University of Maryland Medical Students