Abstracts

Rationale: Post-ictal aggression and confusion can be a debilitating problem for patients, caregivers and their families. Despite the relative frequency of the phenomenon, there is a paucity of literature addressing this issue. The purpose of this study was to describe the characteristics and impact of the post-ictal state in people presenting to a tertiary care epilepsy centre. Methods: We used the prospective comprehensive Calgary Epilepsy Programme database to identify all consecutive first presentations to the clinic. Standardised forms are used to collect patient data at first presentation. Information pertaining to demographics, seizure characteristics, investigations, and treatment was collated. We defined the post-ictal state as a prolonged period of confusion or aggression following a seizure. We used the χ² test for comparisons of categorical variables. Parametric statistics were used for continuous variables with approximately normal distributions and non-parametric statistics were used for those without normal distributions. We used a two-tailed alpha level of significance of 0.05. Results: We identified 2094 patients with data on post-ictal confusion. A total of 1486 (71%) reported problems with post-ictal confusion or aggression. Patients with a post-ictal state tended to be younger (median age 20 versus 23; p=0.01) and a greater proportion were male (48% versus 43%; p=0.03). A lower proportion of people with a post-ictal state were married (31% versus 39%; p=0.005). Furthermore, controlling for seizure type, fewer patietns with post-ictal confusion or aggression had a paid job (47% versus 53%; p=0.02), and a greater proportion required social services (6% versus 3%; p=0.001). More patients with post-ictal state are referred for psychiatric assessment (13% versus 9%; p=0.01) and receive psychiatric treatment (16% versus 11%; p=0.004). A greater percentage of these patients report an aura (50% versus 40%; p<0.001), generalised tonic-clonic seizures (77% versus 47%; p<0.001), focal dyscognitive seizures (37% versus 28%; p<0.001), and are diagnosed with temporal lobe epilepsy (31% versus 24%; p<0.001). Patients with post-ictal confusion were more likely to be currently taking anti-epileptic drugs at the time of first assessment (81% versus 71%; p<0.001). They are also more likely to report a history of depression (12% versus 9%; p=0.001) and lifestyle restrictions such as a revoked licence to drive (68% versus 59%; p<0.001). Conclusions: This exploratory analysis reveals that post-ictal confusion and aggression is associated with the socioeconomic wellbeing of people with epilepsy. Differing treatment and management strategies may be required for this population who, independent of seizure type, are less likely to have acquired gainful employment and are more reliant on social services. This likely represents a unique population with epilepsy and further research designed to improve their quality of life is warranted.