Abstracts

Rationale: VWE are at increased risk of suffering psychiatric comorbidities as they often experience mood and anxiety including PTSD (Post Traumatic Stress Disorders). Chronic depression and anxiety disorders may often be unrecognized by patients or by providers if there is not appropriately addressed during the clinic visit. Failure to recognize and treat adequately these comorbidities will impact not only the quality of life but also seizure control. The lack of optimization dose due to misconception of lower seizure threshold and the lack of proper screening may facilitate the lack of recognition of these entities. Methods: We identified VWE followed in one of the outpatient epilepsy clinics at the Miami VA Medical Center from January 1st 2015 to January 1st 2016 who were diagnosed and treated for depression and/or anxiety disorders by the Psychiatry service. The pharmacologic treatment included SNRIs, SSRIs and mood stabilizer agents such as second-generation antipsychotics and / or antiepileptic drugs. Patients were asked to complete the two validated screening questionnaires. The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the Generalized Anxiety Disorder 7 (GAD 7). The former used to identify current major depressive episodes and the latter to identify an anxiety disorder. Patients were considered to be symptomatic if their score on the NDDI-E and /or the GAD-7 were >15 and >10, respectively. We also identified the maximal doses of the SSRI and SNRI used and compared them to the maximal dose that could have been given for each of the antidepressants. In addition, we identified the type of antiepileptic drug (AED) that the patient was taking in particular if they had enzyme inducing properties. Results: Charts of 48 patients were reviewed. 71% (n=34) patients scored in symptomatic range (with either NNDI or/and GAD 7 positive) after treatment. 56% (n=27) were symptomatic for both. About 29% (n=14) suffered from PTSD and 27% (n=13) were diagnosed with polysubstance abuse. Among the 34 patents that were symptomatic, 38% (n=9) had achieved maximal doses of the psychotropic drugs (p=0.04; Fisher Exact 2 tail) and 24 70.5% (n=24) were considered to be in remission in the psychiatry clinic visit (p=0.02; Fisher exact tail). Conclusions: This pilot study supported our hypothesis that failure to achieve remission of depression and anxiety disorder in VWE could be associated with the use of sub-therapeutic doses of antidepressant drugs and also failure of the treating psychiatrist to recognize that patients may still be symptomatic. Accordingly, the use of the NDDI-E and GAD-7 screening tools should be integrated as a part of the psychiatric evaluation in patient with epilepsy at the mental health clinic as well. Funding: none