Abstracts

Patients with epilepsy have a significantly higher suicide rate than that expected in the general population.Suicide attempts have been reported during the postictal period but the prevalence and risk factors of postictal suicidal ideation have yet to be established. The purposes of this study were to identify the prevalence of postictal suicidal ideation (PSI) occurring as a habitual phenomenon, (that is, after more than 50% of seizures) in a group of 100 consecutive patients suffering from pharmaco-resistant partial epilepsy, as well as to identify any psychiatric and neurologic risk factors. We defined the postictal period as the 72 hours following a seizure or cluster of seizures.
Using a 42-item questionnaire, we identified the presence and clinical characteristics of postictal psychiatric symptoms which included symptoms of depression, anxiety, psychosis, hypomanic and neurovegetative symptoms and postictal cognitive symptoms that occurred in the previous three months. For each symptom we established the prevalence, frequency of occurrence, median [quot]estimated[quot] duration, and concurrent occurrence during the interictal period. We only included symptoms that occurred after [gt]50% of seizures. Symptoms reported during interictal and postictal periods were not included. None of the patients were on psychotropic drugs. All patients underwent a psychiatric evaluation to identify any past psychiatric history of mood, anxiety, psychotic and attention deficit disorders as well as past hospitalizations. All patients underwent as well a prolonged video-EEG monitoring study, high resolution MRI and neuropsychological studies.
Among the 100 patients, 13 experienced PSI with a median estimated duartion of 24 hours (range: 1 to 240 hours). All patients reported passive PSI but eight also experienced active PSI. Among the psychiatric variables significantly associated with PSI, we identified a past history of depression ([chi]² = 7.6, p[lt] 0.0001) and a previous history of psychiatric hospitalization ([chi]² = 13.1, p[lt]0.0001). The occurrence of PSI significantly correlated with that of the following [italic]postictal[/italic] [italic]symptoms of depression[/italic]: hopelessness (r = 0.4, p[lt]0.0001), helplessness (r=0.55, p[lt]0.0001), crying bouts(r=0.3, p[lt]0.0001), feelings of self-depreciation (r=0.55, p[lt]0.0001) and guilt (r=0.46, p[lt]0.0001), all of which also had a median estimated duration of 24 hours, except for crying bouts, which had a median duration of 6 hours. On the other hand, none of the neurologic and epilepsy related variables (location of seizure focus, type of seizures, seizure frequency, seizures in clusters, neuroradiologic abnormalities) were significantly associated with the occurrence of PSI.
Postictal suicidal ideation can be part of the clinical semiology of habitual seizures in 13% of patients with pharmaco-resistant partial epilepsy. A past history of depression and previous psychiatric hospitalizations should prompt clinicians to suspect the presence of PSI.