Abstracts

Rationale: Postictal psychiatric symptoms are defined as symptoms that occur within 120 hours of a seizure. Often there can be a symptom-free period between the seizure and the onset of psychiatric symptoms. Symptoms identified in the postictal period can be restricted to the postictal period or can represent an exacerbation in severity of interictal symptoms. Whether having interictal symptoms only, postictal symptoms only or postictal exacerbation of interictal symptom affect differently the quality of life of patients with epilepsy is not known. The purpose of this study is to answer this question. Methods: 50 consecutive patients with pharmaco-resistant partial epilepsy were included in the study. The postictal period was defined as the 72 hours following a seizure. Interictal psychiatric disorders were identified with the structured psychiatric interview MINI International Neuropsychiatric Interview developed to generate DSM-IV current diagnoses. During the previous 3 months, we established the presence of: (1) postictal psychiatric symptoms only: (2) interictal symptoms only; (3) interictal symptoms with postictal exacerbation in severity. To that end, we used a structured interview, the Rush Postictal Psychiatric Symptoms Questionnaire (RPPSQ). Only postictal symptomatology that occurred after more than 50% of seizures was included. The quality of life was measured with the Quality of Life in Epilepsy Inventory-89 (QOLIE-89). Statistical analyses consisted of ANOVA and linear logistic regression. Results: 34 patients had a DSM-IV diagnosis, 30 of whom met criteria for a depressive (n =6), anxiety (14) or both (n =10) disorders. 35 patients (70%), reported interictal symptoms with postictal exacerbation in severity with or without other postictal symptoms, while six patients (12%) had only postictal symptoms. The mean ( SD) total QOLIE-89 score dropped from 53.6( 7.4) among patients without interictal or postictal psychiatric phenomena to 39.5( 10.9) among patients with interictal symptoms with postictal exacerbation in severity with or without other postictal symptoms, while there was no difference in the scores of patients with only postictal symptoms [53.5( 6.1)] (F = 10.9, df = 2, p<0.0001). The logistic regression model identified two independent predictors of poor quality of life: 1) The presence of an interictal mood and/or anxiety disorder (p = 0.017) and (2) the presence of interictal symptoms of depression, anxiety and neurovegetative symptoms with postictal exacerbation in severity with or without other postictal symptoms (p < 0.0001).