Objective:

Examine the mental health burden of epilepsy in patients reporting FOS using a web-enabled survey. 

Background:

There remains a gap in our understanding of the real-world mental health burden of patients with FOS using validated patient-reported outcome measures (PROMs).

Design/Methods:

Eligible patients were 18 to 80 years, with a diagnosis of FOS for ≥1 year, ≥1 seizure per month, past/present use of >2 antiseizure medications (ASMs), and currently receiving an ASM for >1 month. Mental health data were collected via a questionnaire and validated PROMs for depression and anxiety. 

Results:

170 patients completed the survey; 66.5% (113/170) reported having >1 seizures a month, and 72.9% (124/170) reported ≥3 non-seizure-related symptoms despite ASM treatment. Mood issues (e.g., depression, anxiety) were the most common non-seizure symptoms, with 76.5% (130/170) reporting symptoms and 53.1% (69/130) indicating them to be highly severe. The mean (SD) Patient Health Questionnaire-9 (PHQ-9) depression severity score for all patients was 11.2 (5.2) out of 27. 63.5% (108/170) had a PHQ-9 score ≥10, suggestive of moderate-to-severe depression, although 52.8% (57/108) had no prior depression diagnosis. In addition, 20.6% reported having suicidal ideation or thoughts of self-harm on >7 days of the past 2 weeks; 4.7% had these thoughts daily. The mean (SD) Generalized Anxiety Disorder-7 score for all patients was 8.9 (4.8) out of 21. 46.5% (79/170) had a score of ≥10, suggestive of moderate-to-severe generalized anxiety, although 40.5% (32/79) reported no prior anxiety diagnosis. In addition, 37.7% reported that their anxiety symptoms made it very, or extremely difficult to work, take care of the home, or socialize. 

Conclusions:

Patients with FOS reported considerable mental health burden in addition to recurring seizure burden. The high rates of self-reported depression and anxiety, in contrast to lower rates of diagnosed depression and anxiety, suggest mental health burden may be under-recognized in patients with FOS.