Authors :
Presenting Author: Churl-Su Kwon, MD, MPH – Columbia University
Ali Rafati, MD, M.P.H. – Iran University of Medical Sciences
Ruth Ottman, PhD – Columbia University
Jakob Christensen, MD, PhD – Aarhus University
Andres Kanner, MD – Miller School of Medicine, University of Miami
Nathalie Jette, MD, MSc – Cumming School of Medicine at the University of Calgary
Charles Newton, MD, MA – University of Oxford
Rationale:
Psychiatric conditions are more common in persons with epilepsy (PwE) than in the general population. We summarize the current evidence on the prevalence of 20 psychiatric comorbidities in PwE compared to persons without epilepsy.
Methods:
We systematically reviewed published epidemiological studies examining psychiatric comorbidity among PwE compared to persons without epilepsy. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. The search included data from January 1945-February 2024 in Ovid® MEDLINE. Embase®, and PsycINFO. Abstracts were reviewed in duplicate, and data were independently extracted using standard proforma. Articles were included if they met the following criteria: 1) original data, 2) investigating psychiatric comorbidities, 3) using a validated symptom measure (e.g., Neurological Disorders Depression Inventory in Epilepsy), clinical interview, or standardized interview (e.g., Mini International Neuropsychiatric Interview), or validated self-report questionnaires to determine the psychiatric diagnosis and/or symptoms, 4) studies with controls (epilepsy versus no epilepsy). Data describing psychiatric comorbidities in PwE compared to persons without epilepsy were recorded. Descriptive statistics and meta-analyses are presented.
Results:
A total of 10,392 records were identified from the systematic database search and 27 studies met eligibility criteria. The odds of most psychiatric comorbidities were significantly increased in PwE compared to those without epilepsy including: anxiety (8.4% vs. 5.7%; Odds Ratio (OR): 2.11, 95% Confidence Interval (95%CI): 1.73-2.58), depression (13.7% vs. 9.3%; OR: 2.45 95%CI: 1.94-3.09), bipolar disorder (1.2% vs. 1.0%; OR: 3.12 95%CI: 2.23-4.36), suicide ideation (20% vs. 11.7%; OR: 2.25 95%CI: 1.75-2.88), psychotic disorder (14.8% vs. 6.3%; OR: 3.98 95%CI: 2.57-6.15), schizophrenia (3.3% vs. 0.9%; OR: 3.72 95%CI: 2.44-5.67), obsessive compulsive disorder (0.4% vs. 0.1%; OR: 2.71 95%CI: 1.76-4.15), post-traumatic stress disorder (5.6% vs. 3.7%; OR: 1.76 95%CI: 1.14-2.73), eating disorders (1.2% vs. 0.7%; OR: 1.87 95%CI: 1.73-2.01), alcohol misuse (6.8% vs. 2.6%; OR: 3.64 95%CI: 2.27-5.83), and dependence (3.3% vs. 1.1%; OR: 4.94 95%CI: 3.50-6.96), substance use disorder (6.4% vs. 5.2%; OR: 2.75 95%CI: 1.61-4.72), autism spectrum disorder (10.9% vs. 1.0%; OR: 10.67 95%CI: 6.35-17.91), and attention deficit/hyperactivity disorder (13.0% vs. 3.4%; OR: 3.93, 95%CI: 3.80-4.08). (Figure 1)
Conclusions:
This is a comprehensive study looking at major psychiatric disorders in PwE compared to those without. All the psychiatric comorbidities examined were significantly more prevalent in PwE than in those without epilepsy. These findings underscore the importance of appropriately identifying and treating psychiatric comorbidity in epilepsy, given the significant association
[JC1] of psychiatric disorders with quality of life, morbidity, mortality and their negative impact on the course of epilepsy and tolerability of antiseizure medications.
Funding: None