Abstracts

Rationale: Even though anxiety disorders, along with mood disorders, are the most frequent psychiatric comorbidities of patients with epilepsy (PWE), they are usually underdiagnosed and undertreated. Up to the moment, few studies addressed the impact of clinical epilepsy variables on subsyndromic anxiety. Moreover, some demographical factors have a recognized impact on anxiety symptoms in non-neurological subjects. It is still unclear if these variables have the same influence on PWE. Objectives: To investigate (i)  the presence and severity of subsyndromic anxiety in patients with a pharmaco-responsive and pharmaco-resistant epilepsies; (ii) the impact of clinical epilepsy variables, other than pharmaco-resistance, on anxiety symptoms; (iii) if age and gender have similar effects on anxiety symptoms in PWE as observed in non-neurological subjects.  Methods: We evaluated 81 patients with Juvenile Myoclonic Epilepsy (JME) (mean age 27.3 [±8.4]; 43.2% male); and 58 patients with Temporal Lobe Epilepsy related to Hippocampal Sclerosis (TLE-HS) (mean age 39.4 [±11.8]; 41.4% male). Patients were assessed with the State-Trait Anxiety Inventory, in which values under 33 are related to low/absent levels of anxiety, 33 to 48 to moderate and over 49 to severe anxiety symptoms. Clinical epilepsy variables (pharmaco-response, age at seizure onset, epilepsy duration and number of antiepileptic drugs) and demographical information (age and gender) were obtained with the patient and an informant. Statistical analysis was performed using Pearson’s chi-square, Student’s t test and linear regression analysis. Results: The majority of patients showed some level of trait (JME: 77.8% and TLE-HS: 93%) and state (JME: 61.7% and TLE-HS: 81%) anxiety symptoms. Patients with TLE-HS typically showed higher levels of anxiety, with up to 40% and 44.8% of them having severe levels of state and trait anxiety, respectively (x2=29.48; p2=0.14; F=3.95; p=0.026) influenced by the number of AEDs (i.e. polytherapy) and gender (i.e. female). State anxiety was significantly (r2=0.31; F=2.82; p=0.016) influenced by age (i.e. younger patients), lesion location, number of AEDs (i.e. polytherapy), IQ score (i.e. higher IQs), gender (i.e. female), epilepsy duration (i.e. longer duration), and age at onset (i.e. older). Female patients hat higher trait (t=2.01; p=0.008) and state (t=2.69; p=0.047) anxiety than males. Age was positively correlated to both trait (r=0.20; p=0.018) and state (r=0.23; p=0.008) anxiety. Pharmaco-response did not influenced trait (t=0.85; p=0.398) nor state (t=1.44; p=0.153) anxiety. Conclusions: Anxiety symptoms are prevalent in patients with epilepsy, irrespective of pharmaco-responsiveness. Some clinical epilepsy variables such as age at onset, epilepsy duration and laterality of TLE-HS impact STAI results only of patients with TLE-HS. Other variables such as number of AEDs, age and gender impacted STAI scores in both types of epilepsies. Female and older patients are more prone to higher levels of anxiety.  Funding: We state that there are no conflicts of interest. This work was supported by a grant from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, Foundation for the Support of Research in the State of São Paulo; Grant nos. 12/09025-3 and 13/11361-4), as well as by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, Office for the Advancement of Higher Education), and the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, National Council for Scientific and Technological Development Grant No. 307262/2011-1).