Impact of a Free Anti-seizure Medication Intervention on Anxiety and Depression in People Living with Epilepsy in the Republic of Guinea
Dylan Rice1, Carlos Othon Guelngar2, Mohamed Traore2, Mohamed Lamine Conde2, Djenabou Diallo2, Nathanael Lee1, Fode Abass Cisse2, Farrah Mateen1
1Massachusetts General Hospital, 2Ignace Deen Hospital
Objective:
To quantify anxiety and depression in people living with epilepsy (PLWE) in Guinea before and after anti-seizure medication (ASM) intervention.
Background:
Little is known about mental health in PLWE in Sub-Saharan Africa and how seizure freedom could improve outcomes.
Design/Methods:
PLWE were prospectively recruited in Conakry (March 2022) to receive free clinical consultations with neurologists to implement/augment treatment regimens with free ASMs. Inclusion criteria were: >12 years old and >=2 unprovoked seizures. As part of a broader interview, participants reported seizure frequency and completed scales screening for depression (PHQ-9) and anxiety (GAD-7). 90-day follow-up assessed adherence to ASMs and re-assessed seizure frequency and mental health scales.
Results:
Of 148 participants enrolled (mean age=27.3 years, range 12–72; 45% female), 53.3% regularly took ASMs. Average seizure frequency over the 30 days pre-enrollment was 3.2 (SD=5.9; 28% seizure-free during this period).
Treatment regimens were modified for 95% of participants, mostly consisting of new levetiracetam provision (n=115). At 90 days, retention was 78.4% (n=116). Average adherence was 87.0%. Average seizure frequency over the prior 30 days was 1.5 (SD=5.7; 66% seizure-free during this period).
At baseline, average PHQ-9 score was 21.2 (95%CI [20.2,22.2]), indicating severe depressive symptoms, and average GAD-7 score was 16.5 [15.6,17.4], indicating severe anxious symptoms. At 90-days, average PHQ-9 was 17.5 [16.4,18.5] and significantly lower than baseline (p<.001). Average GAD-7 was 14.4 [13.6,15.3] and significantly lower than baseline (p=.002). Seizure frequency was not correlated with PHQ-9 (p=.50) nor GAD-7 (p=.10) scores at baseline but was at 90-days (PHQ-9: r=.24, p=.01; GAD-7: r=.22, p=.02).
Conclusions:
High levels of anxiety and depression occur in PLWE in Guinea, underscoring the unmet psychiatric needs in un- and under-treated epilepsy and the need for collaboration between neurologists and psychiatrists. Medication intervention may positively impact mental health, highlighting seizure control in addition to psychiatric intervention for this population.