PHILADELPHIA—Mood improves within 24 hours after a seizure in patients with epilepsy and depression, according to data described at the 69th Annual Meeting of the American Epilepsy Society. The improvement is transient, however; mood returns to baseline level within two weeks. Greater improvements in mood occur among patients with focal-onset seizures, compared with patients with generalized-onset seizures.
Anecdotal patient reports of significant postictal mood improvement prompted several medical students, including Maureen Cassady, a second-year student at the University of Maryland School of Medicine and Medical Center in Baltimore, to study peri-ictal mood in patients with epilepsy in their university’s epilepsy monitoring unit (EMU). The researchers hypothesized that because epileptic seizures are similar to the activity that electroconvulsive therapy induces in the brain, mood in patients with epilepsy would improve in the postictal period. They also sought to determine whether seizure onset localization is related to peri-ictal mood.
Maureen Cassady
An Ongoing Study in the EMU
Jennifer Hopp, MD, Associate Professor of Neurology, and Scott Thompson, PhD, Chair of Physiology, both at the University of Maryland School of Medicine, led the study. The researchers began enrolling participants in the ongoing study in June 2014. Eligible participants are adults with adequate cognitive function, as assessed by Mini-Mental Status Examination. Patients undergo continuous EEG monitoring in the University of Maryland Medical Center EMU, and the EEGs are read by epileptologists, who provide diagnoses. The investigators are collecting data about participants’ medications, particularly antiepileptic and antidepressant drugs, and these data will be analyzed in a future phase of the study.
At the time of admission to the EMU, researchers establish patients’ baseline mood using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory. If a patient has a seizure in the EMU, he or she responds to the same two questionnaires at several time points within 24 hours after the seizure. Finally, the investigators are conducting a two-week follow-up by phone.
As of September 2015, 76 patients had been enrolled in the study. Of this population, 35 patients had seizures in the EMU. Fifteen patients had nonepileptic seizures, and 20 patients had epileptic seizures. Of the 20 patients with epileptic seizures, 15 had a seizure with focal onset, and five patients had a generalized-onset seizure.
In patients with nonepileptic seizures and patients with epileptic seizures, average mood was within the range of mild depression, according to the BDI scale. Baseline mood was within the range of mild depression and did not differ significantly between patients with generalized-onset seizures and those with focal-onset seizures. In addition, all patients with seizures had a low level of anxiety, regardless of area of seizure onset.
Greatest Improvement in Frontal Lobe Epilepsy
Within 24 hours following a seizure, anxiety and depression improved, and average mood returned to approximately baseline levels by two weeks. On average, participants’ depression had improved significantly at four hours after the seizure, and anxiety had improved significantly at 12 hours after the seizure.
When the investigators examined the data by seizure-onset localization, they found that patients with focal-onset epilepsy had a greater improvement in depression in the 24 hours after the seizure, compared with patients with generalized-onset seizures. In addition, patients with focal-onset seizures had improvement in anxiety within 24 hours of the seizure, while patients with generalized-onset seizures did not experience a significant change in anxiety.
Furthermore, of two patients with frontal lobe epilepsy, both reported a severe level of starting depression scores and experienced the greatest mood improvement within this 24-hour postictal period. This improvement was much greater than that in patients with temporal lobe epilepsy. The difference in anxiety symptoms between groups was not as pronounced.
In the future, Ms. Cassady and colleagues plan to examine whether changes in medication dosages are correlated with changes in mood. They also intend to investigate whether patients with hippocampal volume loss are more likely to show worse symptoms of anxiety and depression at baseline and less likely to show improvements in mood after a seizure. Finally, the group also will study peri-ictal mood among patients with nonepileptic seizures.
—Erik Greb
