Concurrent depression and anxiety, psychiatric history linked to worse seizure control in MTLE

The co-occurrence of mood and anxiety disorders and the existence of a family psychiatric history are associated with pharmacoresistant seizures in patients with mesial temporal lobe epilepsy (MTLE), a cross-sectional study has found.

The population comprised 144 consecutive MTLE patients, among whom 82 were pharmacoresistant and 62 were treatment-responsive. All underwent psychiatric evaluations, including the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) Axis I, Beck Depression Inventory, Beck Anxiety Inventory, Neurological Disorders Depression Inventory for Epilepsy and Interictal Dysphoric Disorder Inventory.

Based on the results of the evaluations, patients were divided into four groups: psychiatric negative (group 1; n=61), current subsyndromic depression episodes and anxiety episodes (group 2; n=26), current mood disorder (MD) or anxiety disorder (AD; group 3; n=25), and current mixed MD/AD (group 4; n=32).

Among patients with pharmacoresistant MTLE, 68.3 percent were found to have symptoms of depression and/or anxiety (groups 2, 3 and 4; odds ratio [OR], 2.8; 95 percent CI, 1.41 to 5.53; p<0.01). Compared with psychiatric asymptomatic patients (group 1; n=26/61), those with mixed MD/AD (group 4; n=24/32) were more likely to have pharmacoresistant MTLE (OR, 4.04; 1.57 to 10.42; p<0.01) and significantly higher seizure frequency (p<0.01).

Additionally, pharmacoresistant patients were 2.28 (1.02 to 5.05) times as likely as treatment-responsive patients to be positive for family psychiatric history (p=0.04). There were 31.6 percent of patients with MD and or AD who were not receiving psychiatric treatment.

The present data highlight the importance of recognizing and treating psychiatric disorders in patients with epilepsy, researchers said. This is because depression, for example, is an independent predictor of increased suicidal risk, poor quality of life, greater medical costs associated with psychiatric treatment, higher use of health services and social disability. [Epilepsy Curr 2006;6:141–146; Acta Neurol Scand 2004;110:207–220]

Additional research is warranted to further examine the relationship between psychiatric disorders and epilepsy, as well as to determine whether psychiatric disorders are comorbidities merely associated with treatment-resistant seizure or are directly involved in induction/facilitation of treatment-resistance.