2024 American Academy of Neurology Abstract Website

Objective:

To characterize changes in mood in epilepsy patients admitted to the Epilepsy Monitoring Unit (EMU) after experiencing a seizure.

Background:

One third of patients with newly diagnosed epilepsy have a mood disorder. Yet, the impact of seizures themselves on mood are unknown. Investigating this link may provide insights into mechanisms of depression as a comorbidity of epilepsy.

Design/Methods:

Upon admission to the NYU Langone EMU, patients with epilepsy completed the Beck Depression Inventory-II (BDI-II) and a trained assessor administered the Montgomery-Asberg Depression Rating Scale (MADRS). The MADRS was repeated 4-24 hours and 2-7 days after a seizure. Those who did not have a seizure served as controls and the MADRS was repeated from 2 days after admission to day of discharge and 2-7 days after discharge.

Results:

Out of fifty-one total subjects (Male=29; Age: M=36.4, SD=11.3), thirty-six had a seizure and fifteen were controls. There was a trend to a change in mood (measured by MADRS) in either direction post-seizure compared to post-admission for controls (Fisher’s, p=0.144). Clinically significant postictal changes in MADRS were more likely to be an improvement in mood (Fisher’s, p=0.014). Those with higher BDI-II scores were more likely to experience mood improvement 4-24 hours after a seizure (r=-0.66, p=0.0004). Conversely, controls with higher BDI-II scores were more likely to experience worsening of mood acutely post-admission (r=0.63, p=0.015). Furthermore, those with postictal mood improvement had higher BDI-II scores (M=19.6, SD=2.14 – i.e. mild depression) compared to those whose mood worsened (M=10.5, SD=2.35 – i.e. minimal depression) (One-way ANOVA, p=0.019; Tukey’s HSD, p=0.019). Nine relevant covariates (ex: inpatient therapy, length of stay, medication tapering etc.) had a lack of effect.

Conclusions:

Seizures are associated with improvement and worsening of mood. Pre-ictal depressive symptoms predict postictal mood improvement, indicating that a subset of patients with epilepsy may experience a therapeutic effect from seizures.