Abstracts

Rationale: Inpatient video-electroencephalography is widely used by epilepsy centers as a component in the comprehensive evaluation of patients with epilepsy. The current literature defines potential physical risks that an admission to the Epilepsy Monitoring Unit (EMU) poses, such as status epilepticus, injury, and cardiac arrhythmia. However, aside from the small risk of provoking postictal psychosis, there is minimal research studying the emotional impact that these inpatient evaluations may have on patients. We investigated the psychological burden that an admission to the EMU has on epilepsy patients by prospectively assessing a variety of emotional and cognitive symptoms during their hospital stay and after discharge. Methods: We recruited 74 patients with probable or definite epilepsy diagnosis who were being admitted to the EMU. Patients with a suspected or proven diagnosis of PNES diagnosis were excluded. Participants were asked to complete five questionnaires assessing for current psychiatric symptoms– the Positive and Negative Affect Scale (PANAS), the Profile of Mood States (POMS), the State-Trait Anxiety Inventory-State (STAI-S), the Fenigstein and Vanable Paranoia Scale (PS), and a hallucinations survey – on a daily basis during their inpatient stay and seven additional times as an outpatient during the first month following discharge. To ensure that the study sample included only patients with definite epilepsy, patients who did not have at least one inpatient electroclinical seizure were excluded. Among the remaining patients, the 31 who completed at least three outpatient and three inpatient assessments were analyzed.  Here we report an analysis of the POMS scores. The primary outcome of interest was a within-subject difference between mean inpatient and mean outpatient POMS total mood disturbance (TMD) score, as assessed with a two-sample t-test. As a secondary analysis, POMS subscores were also assessed. Results: Across subjects, the mean number of inpatient assessments was 6.58 (range 3-13) and the mean number of outpatient assessments was 6.32 (range 3-11). POMS TMD was significantly worse while patients were in the hospital (mean difference of 17.4192 points, p<0.001). All POMS subscores were also significantly worse during the inpatient portion of the study (tension p=0.002, depression p<0.001, anger p=0.003, fatigue p =0.003, confusion p<0.001, and vigor p<0.001). Conclusions: Admission to the EMU for long-term monitoring can cause significant mood disturbance for epilepsy patients. Clinicians should be aware of this potential, and should consider a patient’s ability to cope with the stressful hospital experience when making referral to the EMU. Increased attention to patients’ emotional experience during their stay may be warranted.   Funding: The Endowed A.J. Trustey Epilepsy Research Fund Award