Management of Refractory Epilepsy Patients with Symptoms of Anxiety or Depression (P03.130)

OBJECTIVE: To determine if symptoms of anxiety or depression serve as a barrier to optimal care in medication-resistant epilepsy patients. BACKGROUND: In an unpublished series following patients with refractory localization-related epilepsy (LRE), those with psychiatric disease were less likely to undergo recommended surgery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: 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: 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: 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. Disclosure: Dr. Hamilton has nothing to disclose. Dr. Anderson has received personal compensation for activities with Cyberonics for consulting services. Dr. Dahodwala has nothing to disclose. Dr. Lawler has nothing to disclose. Dr. Pollard has received personal compensation for activities with H. Lundbeck Inc. Dr. Pollard has received research support from H. Lundbeck Inc, Vertex Pharmaceuticals, SK Pharmaceuticals, Pfizer, Eisai, Cyberonics, Upsher-Smith Labs, Medtronic, and GlaxoSmithKline.