Abstract Details

Title Management of Refractory Epilepsy Patients with Symptoms of Anxiety or Depression

Topic Epilepsy

Presentation(s) P03 - (-)

Poster/Presentation
Number 130

Objective

Background BACKGROUND: In an unpublished series following patients with refractory localization-related epilepsy (LRE), those with psychiatric disease were less likely to undergo recommended surgery despite uncontrolled seizures. Our concern was that patients with symptoms of anxiety or depression receive less aggressive management due to avoidance of new therapies and invasive testing.

Design/Methods DESIGN/METHODS: This retrospective cohort study followed 81 patients with refractory LRE seen at the University of Pennsylvania. To determine active symptoms of depression or anxiety at baseline, all patients completed self-report scales (BDI, NDDI-E, PHQ-GAD 7) and a neuropsychiatric inventory (the MINI). Medical records of each patient were reviewed for up to 2 years following enrollment, noting outpatient management, i.e. addition of a new anti-epileptic drug (AED), and inpatient management, i.e. surgical procedure. Group comparisons were calculated using parametric and non-parametric tests, and linear regression models were constructed to determine independent associations.

Results RESULTS: 53% (n = 43) of patients endorsed symptoms of anxiety or depression and 47% (n = 38) served as controls. In terms of epilepsy management, anxious or depressed patients had a similar number of AED changes per month (0.207 vs. 0.206, p=0.99) and inpatient admissions or procedures (0.04 vs. 0.02, p=0.10) compared with controls. However, these patients were significantly more likely to have a missed visit (0.07 vs. 0.04, p=0.02) than patients not endorsing psychiatric symptoms even after controlling for age, gender, education, employment status, duration of epilepsy and current convulsions.

Conclusions CONCLUSIONS: Contrary to expectation, patients with symptoms of anxiety and depression did not receive a different level of epilepsy care as measured by AED adjustments and inpatient procedures; however, they were more likely to have missed outpatient appointments, which may affect long-term outcomes.

Authors/Disclosures
Katherine Hamilton, MD PRESENTER	Dr. Hamilton has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biohaven. Dr. Hamilton has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for BioDelivery Sciences International, Inc. Dr. Hamilton has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Woods Rogers Vandeventer Black. The institution of Dr. Hamilton has received research support from Abbvie. Dr. Hamilton has received personal compensation in the range of $500-$4,999 for serving as a Lecturer with Clinical ��ɫ�� Alliance. Dr. Hamilton has a non-compensated relationship as a Online Editor with Migraine Again that is relevant to AAN interests or activities.
Christopher Anderson, MD (Medical College of Wisconsin)	Dr. Anderson has nothing to disclose.
Cheryl Fitzer-Attas, PhD (ClinMed LLC)	Dr. Fitzer-Attas has received personal compensation for serving as an employee of Sage Therapeutics. The institution of Dr. Fitzer-Attas has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pharma Two B. The institution of Dr. Fitzer-Attas has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Golden Heart Flower. The institution of Dr. Fitzer-Attas has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Sage Therapeutics. Dr. Fitzer-Attas has stock in Golden Heart Flower. Dr. Fitzer-Attas has received intellectual property interests from a discovery or technology relating to health care.
Nabila Dahodwala, MD, FAAN (Parkinson's disease and Movement Disorders Center)	Dr. Dahodwala has received personal compensation in the range of $0-$499 for serving as a Consultant for Genetech. Dr. Dahodwala has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mediflix. Dr. Dahodwala has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acadia. Dr. Dahodwala has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Post and Schell. Dr. Dahodwala has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for O'Brien & Ryan, LLP. Dr. Dahodwala has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for MotleyRice. The institution of Dr. Dahodwala has received research support from AbbVie. The institution of Dr. Dahodwala has received research support from Medtronic.
	No disclosure on file
John R. Pollard, MD (Christiana Care Neurology)	No disclosure on file

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