Abstracts

Rationale: Psychiatric comorbidities are relatively frequent in patients with epilepsy (PWE), including patients with newly diagnosed focal epilepsy. Mood and anxiety disorders and suicidality are among the most frequent comorbidities, which often occur together. Mood and anxiety disorders have been found to drive the quality of life measures more than seizures in patients with treatment-resistant focal epilepsy. The purpose of this study was to establish whether the number of comorbid mood / anxiety disorders with and without suicidality correlated with the severity of Quality of Life measures. Finally, we investigated the existence of an association between an axis I diagnosis and the use of antiepileptic drugs (AED) with negative psychotropic properties. Methods: We used data from the Human Epilepsy Project obtained from 28 epilepsy centers, which included 369 consecutive patients with newly diagnosed non-lesional focal epilepsy (with the exception of mesial temporal sclerosis) with a duration of less than 4 months. Baseline psychiatric data, obtained at the time of enrollment, consisted of Axis I mood and anxiety disorders derived from the MINI International Neuropsychiatric Interview, suicidality derived from the Columbia-Suicide Severity Rating Scale (CSSRS) and Quality of Life measures, captured with the Quality of Life in Epilepsy-10 (QOLIE-10). Number of Axis I diagnoses were calculated for each patient (0 to 6). Current suicidality (last 6 months) was scored as present or absent. The total QOLI-E 10 score was compared among asymptomatic patients, patients with 1 or 2 diagnoses vs >2diagnoses with and without suicidality. T-Tests were used for statistical analyses. AEDs were classified into those with and without negative psychotropic properties. Results: Among the 369 patients, 221 (60%) were asymptomatic, 96 (26%) had one or two diagnoses and 43 (11.7%) had more than 2 diagnoses (3 to 6). Thirty-four patients (9.2%) met criteria for current suicidality. As expected, the QOLI-E 10 score was significantly higher (worse) in symptomatic vs asymptomatic patients (p <0.001). There was a significant difference between patients with (21.2+-6.5) and without (14.9+-5.7) current suicidality (p<0.001). Among patients without suicidality, there was a significant difference in QOLI-E 10 score among asymptomatic patients (13.5+-5.2), patients with 1 or 2 diagnoses (17.0+-5.8) and patients with >2 diagnoses (19.9+-5.7) (p< 0.001) and there was significant difference between patients with 1 or 2 diagnoses vs patients with more than 2 diagnoses (p<0.03). No association was found between the use of AEDs with negative psychotropic properties and an axis I diagnosis. Conclusions: Just as in patients with treatment-resistant focal epilepsy, the presence of mood and anxiety disorders have a negative impact on quality of life measures in patients with newly diagnosed focal epilepsy. This impact increases with the number of mood and anxiety diagnoses and with the presence of current suicidality. Of note, in this cohort, the presence of axis I diagnoses did not appear to be associated with the use of AEDs with negative psychotropic properties.  Funding: Funding supported by the Epilepsy Study Consortium (ESCI), a non-profit organization dedicated to accelerating the development of new therapies in epilepsy to improve patient care.The funding provided to ESCI comes from industry, philanthropy and foundations (UCB Pharma, Eisai, Pfizzer, Lundbeck, Sunovion, The Andrews Foundation, The Vogelstein Foundation, Finding a Cure for Epilepsy and Seizures (FACES), Friends of FACES and others.