Seizure control and anxiety: Which factor plays a major role in social adjustment in patients with Juvenile Myoclonic Epilepsy?

Abstract

This study aimed to determine the presence of anxiety disorder and severity of anxiety symptoms in an extensive series of consecutive patients with JME and its association with epilepsy-related factors. In addition, we evaluated the impact of anxiety and clinical variables on social adjustment. Methods: We prospectively evaluated 112 (56.2 % females, mean age 27.2 years) patients with an electroclinical diagnosis of JME and 61 (52.4 % females, mean age 29.3 years) healthy controls. Anxiety symptoms were assessed by the State and Trait Anxiety Inventory (STAI). Social functioning was addressed with Self-Report Social Adjustment Scale (SAS). The patient group was also evaluated with a psychiatric interview. Results: Patients with JME presented more severe anxiety symptoms and worse social adjustment compared with controls. The presence of anxiety disorder and the severity of anxiety symptoms was associated with frequent seizures -generalized tonic-clonic seizures (p = 0.008) and drug-resistant epilepsy (p = 0.021). Regarding social adjustment, the severity of anxiety symptoms was associated with lower economic adjustment (p = 0.039), while the presence of anxiety disorder impacted family relationships (p 0.025). The presence of hard-to-control myoclonic seizure was associated with lower scores on work (p = 0.019), leisure activities (p = 0.008), family relationship (p = 0.022) and overall social adjustment (p = 0.038). Conclusion: Patients with JME have severe anxiety symptoms and worse social adjustment. Anxiety disorder and symptoms were associated with frequent seizures and drug-resistant epilepsy. Epilepsy-related factors and anxiety impaired distinct aspects of social functioning.

Psychiatric comorbidities in adult patients with epilepsy (A systematic review)

“…Duration of epilepsy (mean/median) was less than 10 years in three studies (16,18,28), between 10 and 20 years in six studies (18,20,(24)(25)(26)(27) and longer than 20 years in three studies (20)(21)(22). Three research articles did not contain clear information on epilepsy duration.…”

“…We included data obtained from one randomized controlled trial (assessing depression and anxiety improvement in epilepsy patients when multidisciplinary management was applied) because the severity of the psychiatric disorders in the control group was assessed after 12 months (16), two cohort studies [one designed to detect depression disorders and anxiety disorders in adult patients with childhood onset epilepsy (17) and the other one analyzing psychotic disorders in idiopathic focal epilepsy (18)], one case-control study that evaluated specifically the psychiatric outcome in drug-resistant epilepsy patients who underwent surgery vs. patients that were considered non-eligible for the procedure (because baseline data on psychiatric disorders diagnosed was solid and because the patients in the control group were re-assessed by psychiatrist at 6 months, thus providing information about the time evolution of psychiatric disorders in people with epilepsy) (19), four studies with a cross sectional design [first assessing interictal personality in patients with juvenile myoclonic epilepsy (JME) and in patients with mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE/HS)] (20), second one analyzing interictal dysphoric disorder and interictal personality in drug-resistant temporal lobe epilepsy (TLE) ( 21), the third one evaluating depressive symptoms and executive functions in patients with TLE ( 22) and the last one on white matter changes in patients with TLE and depression (23). We selected for this analysis five studies that assessed the relation between interictal dysphoric disorder and other psychiatric disorders in patients with epilepsy (24), the association between childhood trauma and psychiatric comorbidities in epilepsy (25), social adjustment determinants in JME (26), possible phenotypes of depression in epilepsy (27) and brainstem sonographic changes in patients with idiopathic generalized epilepsy (IGE) (28). Importantly, we identified two studies having the same first author (24,25) and two studies performed by the same research team (22,23) that had different research questions, but used a shared sample population of epilepsy patients that was compared with a different control group in the first case and with the same control group (but fewer subjects) in the second case.…”

“…Psychiatric disorders were confirmed according to the DSM IV criteria in eight studies, using different structured or semi-structured clinical interviews such as Structured Clinical Interview for DSM IV Axis I disorders (SCID I) (two studies) (20,27) (28). DSM IV-TR criteria were used for diagnosis in two studies: In one study Diagnostic Interview Survey (DIS-IV) was applied by phone in subjects and in one control group, while the Composite International Diagnostic Interview (CIDI) was used for the second control group (17); in the second study SCID for Axis I and II was applied (26). Finally, DSM-5 criteria for diagnosis were utilized in one study only (the method used for diagnosis was standard psychiatric assessment, without a formal standardized interview) (21).…”

“…The professional confirming the psychiatric diagnosis was a psychiatrist in two studies (19,20) and psychologist in two studies (22,23). The remaining seven --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- (17,21,(24)(25)(26)(27)(28).…”

“…The prevalence of any psychiatric disorder was high for all epilepsy types: 43 and 51%, respectively, in two populations with JME (20,26), 33% in patients with MTLE/HS that underwent surgery (20), 43.1% in patients with pharmacoresistant TLE-MTS (21) and 43.3% in a sample of patients with epilepsy from a tertiary referral centre (24,25). A summary of the psychiatric disorders characteristics is shown in Table III.…”