Abstract

Most people with epilepsy experience anxiety, depression, or both. The existing evidence showed that anxiety and depression were detected to a higher degree in people with TLE than in people with FLE. Either in TLE or in FLE anxiety and depression affect the subject’s Quality of Life. Side effects of previous and current antiepileptic drugs and irregular use of them could deteriorate anxiety and depression. Aura, a common feature of epilepsy interacts with anxiety and depression. Other factors related to anxiety and depression were memory impairment, concentration difficulties, age, brief seizures, and gender. The present research was focused on anxiety and depression in adults with TLE and FLE and the impact of the aforementioned factors on these psychic disorders.
There was an online participant recruitment process. The participants were classified by the author according to the type of epilepsy. From the SPSS-ANOVA application it resulted that gender, concentration abnormality, and dizziness affected anxiety to a significant degree. Concentration disturbance, dizziness, and memory impairment proved to have a significant impact on depression state. There were participants that presented no traces of anxiety and depression. The type of epilepsy didn’t affect anxiety and depression to a significant degree. Memory impairment, age, missing an AEDs dose, aura, brief epileptic seizures, AEDs number, substance and dose had an insignificant impact on anxiety. Depression was not affected by gender, age, aura, brief epileptic seizures, missing AEDs dose, AEDs number, substance and dose.

Keywords: TLE; FLE; Epilepsy; Anxiety epilepsy; Depression epilepsy; Epileptic aura; Seizures; Antiepileptic drugs

Abbreviations: PWE: People with Epilepsy; AEDs: Antiepileptic Drugs; ToE: Type of Epilepsy; TLE: Temporal Lobe Epilepsy; FLE: Frontal Lobe Epilepsy; HRQOL: Health-r\Related Quality of Life; QOL: Quality Of Life; DD-RIS: Demographic and Disease-Related Information Sheet; HADS: Hospital Anxiety and Depression Scale

Introduction

Nowadays 70 million people internationally have epilepsy [1]. In many cases it could claim the life of the subject [2,3]. Anxiety and depression comprise two common psychic disorders present to the majority of people with epilepsy (PWE) [1,4,5,6]. Recent studies defined them as the two most common psychiatric disorders in PWE [5,7,8,9]. It has also been suggested that PWE living with depression had at least 3 times less probabilities to be seizure free with Antiepileptic Drugs (AEDs) [7]. Previous studies proved that people with Temporal Lobe Epilepsy (TLE) and people with Frontal Lobe Epilepsy (FLE), have 2–3 more probabilities in comparison with healthy people to suffer from anxiety and depression [5,6,9-13]. There was identified a bidirectional impact between psychic disorders, including anxiety and depression, and epilepsy: PWE had higher tendencies to develop psychic disorders and patients with psychic illnesses had higher possibilities to have epilepsy [14-17].

Someone with depression had at least 4 times more probability of being epileptic than a healthy person [7]. Psychic disorders could increase the probabilities of seizure occurrence [17], frequency [13], and severity [1], rising AEDs’ dose, adverse reactions [1], and lead to multitherapy [18]. As a result, the psychic disorders could raise the probabilities of having epilepsy [17] and even irritate the existing epilepsy [10,18]. On the other hand, the evidence that a seizure is coming [9], the number, the duration, and the type of seizures e.g. tonic-clonic or partial, could have a significant impact on the deterioration of anxiety [10,13,19,20] and depression [2,9,13]. Thus, according to the existing literature the development of anxiety and depression in PWE was estimated to be something mathematically expected. There was a distinct comorbidity between depression and anxiety, independently if being present in PWE or in any other person [8,21].

In many cases anxiety was linked to epilepsy [12]. It was defined as more common than depression [4,9]. Previous researchers have found that it was a disorder present in different stages of seizures [20,22], as well as in the everyday life of PWE. In most cases it was treated as psychiatric disorder [23]. It was classified into 4 categories: preictal anxiety [12,15], ictal anxiety [6,10,12,15,24], postictal anxiety, and interictal anxiety [12]. Preictal anxiety could be a warning symptom that a seizure is coming [10,12,20]. It occurred hours or even days before seizure occurrence [22]. Ictal anxiety [12,24], was related to frontal lobe seizures [6,15,25], specifically anterior cingulate or orbito-frontal cortex [25]. It accompanied seizures [6,12,20]. Partial seizures [20] were more frequent in TLE [20]. They comprise a predictor of ictal anxiety [20]. Thus, ictal anxiety was frequent even in people with TLE [10,12,25].

Postictal anxiety occurred after seizure and independently of epileptic discharges [12]. Interictal anxiety, was the most common form of anxiety in PWE [12]. Interictal anxiety was affected by neurobiological, and psychological factors too. A common definition of it could be “the presence of anxiety symptoms without temporal relationship with seizures” [Hermann and Chhabria, 1980 in [22]. People with TLE have more possibilities to experience interictal anxiety in comparison with people suffering from other types of epilepsy [12]. Despite its definition as a comorbid disorder in PWE [10,12,20], anxiety in many cases might not be aetiologically related to epilepsy [12]. In some cases, anxiety could be a depression symptom [7]. In other cases, it was depression that predicted anxiety [22]. Certain indications that warn the coming of a seizure were related to depression [9].

Research has shown that depression could be more common than anxiety in PWE [7,8,9,17,26]. PWE have higher percentage to present depression than people with anxiety do [4]. There were recognized four types of depression: preictal depression [7,8], ictal depression [7], postictal depression [7], and interictal depression [7]. Preictal depression occurs before seizures [8]. Its presence could vary between many hours and many days before seizure occurrence [7]. Ictal depression was more frequent in TLE [7]. Postictal depression was accompanied by anxiety [7]. It could be presented even 5 days after the end of a seizure [7]. Interictal depression comprises the more frequently recognized depression [7]. It was proved to be independent of seizure’s presence [7]. Anxiety and depression might start as psychological disorders and stimulated by the side effects of AEDs [2,11,13,20,23], number of AEDs [6,23], age [11], gender [23], and type of epilepsy (ToE) [15] could be transformed into psychiatric disorders.

It was proved that not only the deterioration of anxiety and depression, but even their presence could be followed by a lower health-related quality of life (HRQOL) [7] and thus a minimized Quality of Life (QoL) on its all [1,2,7-10,12,14,15,17,19,23,26,27]. There were not few cases of adults with TLE and FLE that have reached the stage of suicidal tendencies [7,19]. Indeed, the presence of these disorders in PWE could cause death, including suicide [1,3,4,7,9,17,26]. PWE that suffer from anxiety and depression have higher suicidality tendencies compared with PWEdiagnosed only with anxiety or depression [7,10,19,20,22]. A major part of deaths in PWE was because of suicide [17]. Suicide comprised not less than 32% of deaths of PWE and 13.5% of all suicides were PWE suicides [17]. Furthermore, because PWE are part of society, there should not be neglected various external factors which can affect the level of anxiety and depression in PWE.

The main factors are the risk of death [12] and the fear of experiencing uncontrollable epileptic seizures [10,23,28]. The idea of the possibility to have seizures in the presence of strangers [22], while being out [20,23,29], without the presence of a friend or another person who can support the subject while having seizures increases the subject’s anxiety and depression level [22,23]. In addition, stigma [3,8-10,12,15,17,26,30,31], which can lead to embarrassment [9], unemployment [3,12,26,29], and to a racist behaviour [3,8,30], was proved to be another factor which could have a deteriorative effect on anxiety [15,19,20], and depression in PWE [6,19,22]. As a result, epilepsy is not less than a disabling and stigmatizing disease [17]. Although anxiety and depression are two factors the deterioration of which can enhance to a high degree the worsening of epilepsy [7,18], of QoL [4,7,10,12,14,17,23], and cause death they are still underestimated and as a consequence underdiagnosed and undertreated [3,4,8,9,10,17].

Type Of Epilepsy

TLE was more resistant to AEDs in comparison with FLE [24,29]. Furthermore, people with FLE had more intellectual abilities than people with TLE did [20]. Someone diagnosed with TLE could have higher tendencies to experience anxiety [20,25,31,32] and depression [25,31] by comparison with an FLE case [15]. In certain cases, anxiety in TLE was an epileptic seizure by itself [32]. Temporal lobe and frontal lobe interact between them. As a result, a seizure of TLE could cause function impairment on frontal lobe and vice versa [29]. However, in other cases depression between FLE and TLE did not have a significant difference [5,15] and there were even TLE cases without depression [17]. As TLE has been the most common type of epilepsy [6,31] there were abundant studies on people with TLE and therefore even on TLE anxiety and depression.

The high percentage of people with TLE might be since TLE could be detected more often through electroencephalography (EEG) than FLE [25]. There were done few scientific studies on FLE [25], particularly about anxiety and depression in people with FLE [25]. It might be a consequence of the fact that in many cases FLE was not detected through EEG [25] and anxiety and depression didn’t have all the evidence of being caused by FLE [25]. As a result, FLE anxiety and depression were treated as psychiatric disorders on their own, independently of FLE [25]. However, as FLE has been defined as the second most common kind of epilepsy treated with epilepsy surgery [20,25,31], recent studies have been paying attention even to FLE [25] and consequently even on anxiety and depression in cases of FLE [25].

Gender

Many researchers have found that gender comprise an important predictor of anxiety [16] and depression [16,23]. The existing data show that females are more likely to be more depressive and anxious than males [14-16,23], independently of epilepsy’s presence [14]. However, in certain cases, the percentage of women with anxiety and depression compared with the percentage of men suffering from anxiety and depression were not significantly different [16,23]. Currently, there are few studies on the gender’s impact on anxiety and depression [16].

Age

Although the effect of gender on anxiety and depression was higher than the effect of age [23], the latter affected the level of anxiety and depression to a quite significant degree. The data of previous studies proved that older ages received higher dose of AEDs [33], experienced more seizures [33], and therefore even higher levels of anxiety. Existing research proved that older people experience milder depression stage than younger people [34].

Memory Impairment

Memory impairment was a common cognitive disorder in PWE [25,29]. It was defined as evidence of anxiety [25] and depression [35]. It has been suggested that people with TLE were more vulnerable to it [5,20,25,29,31]. People with FLE have milder memory impairment compared with TLE [20,25,29]. Memory impairment accompanied the interictal anxiety [12]. Even the fear of memory impairment could affect the anxiety state [12]. However, it was not something found in all PWE [24].

Concentration Difficulties

Concentration abnormality was a usual cognitive disorder in PWE [29]. Moreover, low concentration comprised part of the post ictal period [31] as well as an important symptom of anxiety and depression [21]. If not treated it could be deteriorated [21]. Its development corresponded to anxieties and depression’s aggravation [21] and thus to stimulation of epilepsy. Albeit its importance as a diagnostic symptom, there was an unexplained small number of research on concentration difficulties [21].

Aura

Another factor interacting to a significant degree with anxiety and depression was aura [9,32]. Preictal and ictal anxiety caused aura [6,12,20,22]. Except of aura, there was detected the presence of aura continua. Aura continua in clinical terminology are defined as a simple partial status epilepticus [32,36] that can last even for years [32]. According to the father of the modern epilepsy, Hughling Jackson, status epilepticus is every attack that lasts for more than 1 hour [37]. There were several cases of aura continua, especially in TLE, resistant to AEDs and as a result in many cases the only solution was an epilepsy surgery [32,38]. A continuous aura raises the fear and anxiety of having seizures [24]. This means by itself, that there is an increased probability of inducing seizure frequency.

Dizziness

Dizziness was present in FLE as a form of aura [25,36] and related to anxiety [25]. It was presented before seizures and raised the risk of anxieties and depression’s development [9]. Yet, it comprised a side effect of AEDs [32].

Finding difficulties in understanding the content of Demographic and Disease-Related Information Sheet (DD-RIS)

Not all PWE have knowledge of all kinds of seizures. Some seizures that are synonyms of epileptic aura, last not more than a minute and are accompanied by confusion and disorientation. These seizures, in many cases were not diagnosed by the doctors and were not declared by the patients, because they don’t recognize them as epileptic seizures [36]. Furthermore, patients didn’t declare them, because of the fear of stigma [3] to be diagnosed with psychiatric disorders due to the presence of these seizures [36]. All these factors led the author to ask about the presence of any difficulties in understanding the DD-RIS content.

AEDs

Valproate [25] and carbamazepine [25] had a mood stabilizing effect on PWE [25]. As carbamazepine is the first line therapy for FLE [25] it might be another factor that explains the lower rates of anxiety and depression in FLE [25]. Lamotrigine could lead to depression and anxiety melioration of PWE [9,25]. It was proved that some AEDs could cause and deteriorate anxiety and depression in PWE independently of the ToE [8,14,23]. According to previous studies levetiracetam [8,10,25], vigabatrin [8], perampanel [8], barbiturate [8,25], and topiramate [8,25] deteriorated anxiety [10] and depression [9]. Previous studies suggest that several AEDs like pregabalin [10,12], and barbiturates which increase GABA [6], as well as gabapentin [10,12], valproate [23], carbamazepine [25], and benzodiazepines [10,24,25] can work as anxiolytics [6,12,13,24,25]. Many AEDs which have the property to increase activity of GABA [6,24], can cause cognitive impairment [24] in FLE [25] when used as anxiolytics [24,25].

Considering that the cognitive part affects anxiety and depression state and the two latter’s aggravation could lead to epilepsy deterioration it gets obvious that there was created a vicious circle: the AEDs that is destined to treat epilepsy deteriorates epilepsy and even the basic cognitive abilities [39]. Thus, when the side effects are not defeated, they would lead to an everyday more deteriorated epilepsy, HRQOL and as a result QoL. There were recorded cases of PWE that continued to experience the side effects of an AED even after stopping it [39]. The multitherapy by itself, could cause allergies and was defined as a strong factor which stimulates the aggravation of anxiety, depression and epilepsy [18,19,23].

Prior studies classified the dose of AEDs amongst the important factors that affected the cognitive abilities [39]. When AEDs wouldn’t meliorate anxiety and depression, doctors prescribe psychiatric drugs to control anxiety and depression in PWE. As in many cases psychiatric drugs decline the effect of AEDs, this fact led to more and longer seizures [8,12,25]. As a result, providing psychiatric medicines to PWE not only does not decline anxiety and depression levels, but it was proved to be a stimulus of vital importance for the deterioration of these psychiatric disorders. That is not an unquestionable fact. In other cases, antidepressants did not always induce seizure frequency [8].

This study was conducted to explore anxiety and depression in TLE and FLE. The danger of losing the lives of PWE because of these psychic disorders and their underestimation stimulated the author’s decision to investigate the possible triggers for these psychic disorders in TLE and FLE. The author was interested in the influence of Toe in anxiety and depression’s development and which of the previous and current AEDs related factors – substance, dose, number, or missing a dose in the last 48 hours – could affect anxiety and depression to a significant degree. Another goal was to add another study to the few existing studies about the impact of previous and current AEDs’ dose, gender and concentration on these psychic disorders and try to clarify if age, memory impairment, aura, dizziness and brief epileptic seizures could be significant predictors of anxiety and depression. The researcher intended to demonstrate that there could be epileptic people who do not experience anxiety and depression at all.

Methods and Materials

Participants

The eligible population that could participate should have the following characteristics:
Be at least 18 years old
Choose only the option male or female
Being diagnosed only with TLE or FLE.
Receive only AEDs or not recive AEDs.
There were excluded:
People younger than 18 years old.
People at least 18 years old that had both types of epilepsy – TLE and FLE.
People at least 18 years old that had another type of epilepsy.
People at least 18 years old that had epilepsy surgery.
Citizens that were receiving other pharmaceutical therapy, i.e., psychiatric drugs.
Anyone who had other comorbid diseases, i.e., autism.
Someone who would not choose either male or female.

Ethical Policy

The present study followed the ethical policy of University of Central Lancashire, United Kingdom and of Epilepsy Action.

Consent Form

Written – direct and indirect – consent form was obtained from all the participants. Filling a Consent Form was obligatory before beginning to provide any detail. No detail was provided before filling the Consent Form and clicking the red button with an arrow on it at the bottom right of the screen to open the next document. Filling the Consent Form meant ticking the statements of the Consent Form. There was no time limit for the Consent Form. Someone wishing to fill the Consent Form could take all the required time till the clear understanding of the Consent form’s content, ticking its statements and its confirmation. If someone did not tick all the statements, it was equal to not consenting to share the data for the purpose of this study, not be allowed to provide any data and tick the button with an arrow on it to see what is next, and thus, not accepting to be a participant of this study. That was the direct consent.

The indirect consent was the clicking of the red button every time that the citizen would like to continue with the next paper. The subject had the right to throw out all the data declared till the moment of clicking the red button with the word “SUBMIT” on it at the right bottom of the screen after reading the Debrief sheet. Thus, by clicking the red button with an arrow on it, was equivalent to consent to continue the participation, while clicking the red button with the word “SUBMIT” on it was the final consent to submit the data declared during the participation time. If someone did not click the red button with the word “SUBMIT” on it, none of the data submitted till that moment will be holded. All the data submitted till that moment will be deleted and it will be like the participant never clicked the link, never participated and thus, never submitted a single data.

Procedures

The participant recruitment process was anonymous. No one gave name, passport number, photography, handwriting or any other identifiable data. It was neither required nor asked. Even the people that shared the link, did not declare that they have epilepsy or someone they knew had epilepsy. The citizens that contacted the author for more information and/or specifications did not declare either if they participated or what the details they provided were, in case of being a participant of the study. The data were collected, analyzed and interpreted only by the author. Noone else got access to the data. The participants were informed about everything. They were from several countries and continents. Someone could participate via the following online link: https://qtrial2018q1az1.az1.qualtrics.com/jfe/form/ SV_02FSnAhF9gUVCYd

Clicking the link provided all the required papers of this study – Brief, Participant Information Sheet, Consent Form, DD-RIS, Hospital Anxiety and Depression Scale (HADS) and Debrief Paper. The papers where the subject had to add information in order to continue with the next paper, were Consent Form – to tick the statements – DD-RIS – to provide information about the factors that might affect depression and anxiety development – and HADS – to assess the self-perceived levels of anxiety and depression.

The main groups that published it were:Epilepsy Action (The biggest organization for epilepsy in Europe. It has many branches worldwide, in and out of Europe and has account on many social media): https://www.epilepsy.org.uk/

Epilepsy Education and support: https://www.facebook. com/profile.php?id=100068712697083

Coping with epilepsy: https://www.coping-with-epilepsy. com/

The link and some information about the study were uploaded with the author’s consent by the group’s administrator, or by the author with the group administrator’s consent.

When the post did not include enough information about the study many people contacted the researcher through email, about any further information and/or specification. Although it was estimated that it will take up to 20 minutes till the successful participation accomplishment, it was not time limit for the participants.

To the author’s knowledge many physicians and other citizens voluntarily shared the publication on their Instagram, Facebook and other (social) media accounts.

Materials

For the participants’ assessment of anxiety and depression state was chosen the HADS. It was estimated to be a reliable and well-established anxiety and depression self-reported assessment patient subscale [10,16,20]. It was made up by seven statements for anxiety and seven items for depression [20]. Each statement had four options. Every option corresponds to a point varying between zero and three. The stages of anxiety and depression were rated from 0-21. If the total score of anxiety was between 0 and 7 it meant a normal level of anxiety. If the total score varied between 8 and 10 there was a borderline abnormal anxiety condition and when the score varied between 11 and 21 it was an abnormal case of anxiety. The measurement was valid in depression assessment too.

The DD-RIS was used to collect information about ToE, age, gender, current AEDs name, number of current AEDs per day, dose of current AEDs, name of previous AEDs, the number of previous AEDs per day, dose of previous AEDs, any missing dose of AEDs in the last 48 hours, and the existence or absence of aura, memory impairment, concentration difficulties, dizziness and any difficulty in understanding the content of DD-RIS.

The information about the ToE and Gender was a choice of two versions: Temporal Lobe epilepsy, Frontal Lobe Epilepsy, and Male, Female respectively. The pre-defined option Yes, No was applied in the following independent variables: if there was any of the current medicine’s dose missed in the last 48 hours, the presence or absence of epileptic aura, memory impairment, concentration difficulties, dizziness, and any difficulty understanding the DDRIS.

Statistical Analysis

Statistical analysis was performed using IBM SPSS Statistics 2016. There was chosen the LEVENE’S TEST Homogeneity of Variance for Between-Subjects ANOVA to assess if one group’s data dominates over the other or if there was an equal distribution of both groups’ data. If LEVENE’S TEST was less than .05 (sig<.05), it meant that the data of one group dominated and the final data were not reliable for sure. If sig≥.05 then there was an equal distribution of both groups’ data and consequently the results’ reliability was unquestionable. Descriptive-Frequency option was chosen to calculate the percentage of male, female, FLE and TLE participants. Graphs-Bar was preferred for a more detailed image of the statistics i.e., how many people had zero anxiety score. Descriptive-Minimum-Maximum-Standard Deviation-Standard Error-Mean was applied to all the other factors.

Results

The participants

The recruitment process began at March 16th, 2018, and finished at May 31st, 2018. 47 of 48 participants were selected. A male of 19 years old was excluded because his father contacted the author and informed her about the data that his son declared and that his son was receiving even psychiatric drugs. This fact broke the ethical policy of anonymity and the study’s standards that someone should not receive any other medicine except of antiepileptic drugs. Among the participants 12 (25.5%) were males and 35 (74.5%) were females (N=47) (Table 1). The youngest participant, independently of the type of epilepsy, was 22 years old and the oldest participant was 73 years old (Table 2). The mean age of the participants, independently of any other factor, was 41 years old (M=41.26, SD = 13.752) (Table 2). The youngest participant diagnosed with TLE was 22 years old, while the oldest one was 73 years old (Figure 1). The youngest participant diagnosed with FLE was 25 years old, while the oldest participant diagnosed with FLE was 52 Years old (Figure 1).

Anxiety

Anxiety and type of epilepsy: TLE was present in 42 participants and only 5 patients had FLE

(Table 3). The evidence showed non-significant impact of ToE on anxiety [F (1) = .516, p= .476] (Table 4). However, it should not be ignored that the TLE was associated with higher mean anxiety score that corresponds to borderline abnormal case (M = 9.43, SD = 4.72), compared to the FLE mean anxiety score which corresponds to the normal case (M = 7.80, SD = 5.45) (Table 3). Contrary to that the zero-anxiety score corresponds to TLE (Table 3).

Anxiety and age: Age had a non-significant effect on anxiety development [F (26) = 1.084, p = .432] (Table 5).

Anxiety and gender: Gender had a significant impact on anxiety condition [F (1) = 4.476, p <.05]

(Table 6). While in male group the anxiety score was zero (Min = 0), in female participants the minimum anxiety score was three (Min = 3). Additionally, albeit in both cases the maximum anxiety score corresponds to the abnormal case, in male participants it was at the first stages of abnormal case category (Max = 12), whilst in female participants it reached the advanced stage of abnormal case (Max = 19) (Table 7). Moreover, contrary to the mean anxiety score of female group that has reached the peak of borderline abnormal case (M = 10.09, SD = 4.72), the mean anxiety level of male participants was quite normal (M = 6.83, SD = 4.17) (Table 7).

Anxiety and Current Antiepileptic Drugs’ Name: Based on the inspection of the descriptive

statistics it seems likely that CAEDs substance comprises a non-significant predictor of the anxiety stage [F (25) = .813, p = .693] (Table 8).

Anxiety and Current Antiepileptic Drugs’ Therapy: It appears that anxiety didn’t depend upon

the CAEDs therapy [F (3) = .462, p = .710] (Table 9).

Anxiety and Current Antiepileptic Drugs’ Dose per day: The data revealed that CAEDs dose

wasn’t among the predictors that could have a significant impact on anxiety [F (30) = 1.312, p = .362] (Table 10).

Anxiety and Concentration Abnormalities: Concentration difficulties were a factor that affected

significantly the anxiety’s development [F (1) = 23.979, p = .000] (Table 11). Its existence means higher anxiety scores, while its absence means disappearance of anxiety. The mean score made it more obvious: the mean score of anxiety in the absence of concentration difficulties corresponded to the normal stage (M = 7.26, SD = 3.77), while the mean score of abnormal anxiety stage (M = 13.13, SD = 4.11) corresponded to concentration difficulties’ presence (Table 12).

Anxiety and Aura: Aura did not comprise a factor that affects the anxiety to a significant degree [F (1) = .304, p = .584] (Table 13).

Anxiety and Dizziness: Dizziness was amongst the factors that affected anxiety’s development to

a significant degree [F (1) = 11.039, p = .002] (Table 14). The absence of dizziness could lead even to disappearance of anxiety (Min = 0). While the mean score of anxiety in the absence of dizziness was at the beginning of the borderline abnormal (M = 8.24, SD = 4.21), the presence of dizziness corresponded to a mean score of anxiety that comprised a significant abnormal case (M = 13.56, SD = 4.77) (Table 15,16).

Anxiety and Memory Impairment

Anxiety and Missing Any AEDs Dose

Missing any of the CAEDs’ dose during the last 48 hours didn’t comprise a significant predictor of anxiety [F (1) = .281, p = .599] (Table 17).

Anxiety – Difficulties to understand the DD-RIS: Finding it difficult to understand the DD-RIS

content was an insignificant predictor of anxiety condition [F (1) = .864, p = .358] (Table 18).

PAEDs Name: Substance/s of the previous pharmaceutical therapy did not impact anxiety to a

significant degree [F (20) = 1.435, p = .192] (Table 19).

Paeds Therapy: The number of antiepileptic drugs received in the past by epileptic people, affected anxiety’s development to a non-significant degree [F (3) = .581, p = .631] (Table 20).

Paeds Dose: The dose of previous antiepileptic drugs didn’t affect anxiety condition to a significant degree [F (12) = 1.557, p = .561] (Table 21).

Depression

Depression and ToE: The statistics declared that ToE didn’t have a significant impact on depression [F (1) = 2.051, p = .159] (Table 22).

Depression and Age: Age was proved to have an insignificant effect on depression [F (26) = 1.587, p = .146] (Table 23).

Depression and Gender: Gender could not be ranged among the factors that had a significant impact on depression development [F (1) = .972, p = .329] (Table 24).

Depression and CAEDS Name: CAEDS name had an insignificant impact on depression [F (25) = .948, p = .555] (Table 25).

Depression and CAEDS Therapy: The statistical evidence revealed that the number of current antiepileptic drugs didn’t have a significant impact on depression [F (3) = .806, p = .498] (Τable 26).

Depression and CAEDS Dose: CAEDS dose does not affect the depression’s development to a significant degree [ F (30) = 1.582, p = .256] (Table 27).

Depression and Concentration Abnormalities: Concentration difficulties were amongst the factors that had a significant impact on depression [F (1) = 17.588, p = .000] (Table 28). All the participants that had no depression were not experiencing concentration difficulties. Albeit the participants that didn’t have concentration difficulties were more than those who declared the presence of concentration difficulties, the mean depression score of those not experiencing concentration abnormalities was at the normal level (M = 4.74, SD = 4.02), while the mean depression score of the participants that submitted the presence of concentration difficulties reached the latest stage of borderline abnormal case (M = 10.44, SD = 5.11) (Table 29).

Depression and Aura: Aura could not affect the depression’s stage to a significant degree [F (1) = .055, p = .815] (Table 30). However, these results should be interpreted with caution, because the Levene’s Test coefficient was significant (Sig.<.05) (Table 31), which means that the data of one group predominates compared to the other group.

Depression and Dizziness: Dizziness was proved to be a significant predictor of depression’s development [F (1) = 4.323, p = .043] (Table 32). All the participants that hadn’t depressive health condition hadn’t dizziness (Table 33). Furthermore, the mean depressive condition in the absence of dizziness was at normal level (M = 5.95, SD = 4.7) (Table 33). Contrary to that, the mean depression score of the group experiencing dizziness was at the advanced borderline abnormal stage (M = 9.8, SD = 6.14) (Table 33).

Depression and Memory Impairment: The results verified that memory impairment could have a significant impact on depression [F (1) = 6.561, p = .014] (Table 34). All the participants with no depressive condition did not declare memory impairment (Table 35). Moreover, the mean depression score of those not experiencing memory impairment was lower than the last score of the normal case (M = 5.44, SD = 4.90) (Table 35). It does not match the mean depression level of people experiencing memory impairment which has reached the borderline abnormal scores (M = 9.33. SD = 4.82) (Table 35).

Depression and Missing AEDS in the last 48 hours: The data confessed that missing to receive the dose of an antiepileptic drug in the last 48 hours impacts depression to an insignificant degree [F (1) = .948, p = .336] (Table 36).

Depression and difficulties to understand the content of the DD-RIS: The data determined the existence of difficulties to understand the content of DD-RISas a non-significant predictor of depression [F (1) = 1.431, p = .238] (Table 37).

Depression and PAEDs Names/Substances: Depression’s development was independent of any of the previous antiepileptic drug’s substance [F (20) = 1.103, p = .401] (Table 38).

Depression and PAEDs Therapy: Statistical digital explored the non-significant impact of PAEDS’ number on depression [F (3) = .105, p = .956] (Table 39).

Depression and PAEDs Dose: The total dose of PAEDS comprised a factor that had an insignificant impact on depression [F (12) = 8.245, p = .266] (Table 40).

Discussion

ToE

After the conduction of this study, it resulted that not always adults with TLE experience higher levels of anxiety and depression than adults with FLE. There were found FLE casesthat experienced higher levels of anxiety and depression in comparison with TLE cases. All the evidence of the present study confirmed the hypothesis that ToE did not affect anxiety and depression to a significant degree. Albeit the minimum, maximum, and mean anxiety and depression score in TLE were higher compared with FLE the only person with no anxiety scores had TLE, the three of the five participants that hadn’t depression were diagnosed with TLE, and 28 of the 42 TLE participants had normal depression scores.

AEDs

The substance, the dose and the number of AEDs had an insignificant impact on anxiety and depression in PWE. Despite that, there was paid attention to some AEDs’ substances mentioned in the literature. Contrary to previous research PWE receiving topiramate and levetiracetam had normal anxiety level. Corresponding to normal and distorted anxiety condition when receiving barbiturates was in line with the existing findings. The findings of the study agree with prior studies in that valproate, gabapentin, carbamazepine, benzodiazepine, and lamotrigine were part of the medical therapy of those that had normal anxiety condition. Affirming the data of the presented research the participants receiving carbamazepine as monotherapy, 2 AEDs therapy or multi-therapy had normal depression score. The present study confirmed the data that receiving levetiracetam, barbiturate and topiramate corresponds to deteriorated depression state. Verifying the chosen references, the participants receiving lamotrigine had normal depression rates.

The other factors that had an insignificant effect on anxiety and depression in PWE.

Age, aura and brief seizures (DD-RIS comprehension) were proved to have a non-significant impact on the psychic disorders in PWE.

Factors that affected anxiety and depression to a significant degree

Verifying the results of prior research, the present study explores the significant impact of gender, dizziness, and concentration disturbances on anxiety. Consistently with existing studies, concentration disturbances, dizziness and memory distortions affected depression to a significant degree.

Limitations

The most obvious limitation was the number of participants: 47 PWE amongst the 70 million PWE worldwide could not be considered a remarkable sample. Some participants wrote the dose of previous AEDs, but not the name. Additionally, the HADS was filled subjectively by the participants without a doctor’s estimation. However, HADS was defined as a reliable assessment scale. A positive factor of this study was the non-existence of time limit. The participant had all the time needed to send any query, as well as to understand and add the data when having them and feeling ready to do it. Another strength of the current study was online recruitment. An online recruitment process had therefore less stress to provide sensitive personal data, especially about an illness with such a burden as stigma of epilepsy.

Its explanation of less stress could be that behind a screen without a video or any other recording, being anonymous, encourages someone to be more open and honest when providing sensitive personal data. Moreover, this small sample gave several novel evidence. To the author’s knowledge it is the first study that investigated 15 independent variables on anxiety and depression and proved the existence of different epileptic people with no anxiety, no depression, and free of pharmaceutical therapy for 30 years. The present study added to the existing literature that someone using valproate, gabapentin, carbamazepine, benzodiazepine, and lamotrigine could reach abnormal anxiety stage and that people who received perampanel had normal anxiety scores.

Other factors that enriched the literature were that people having levetiracetam, barbiturates and topiramate could have normal depression scores, that someone receiving lamotrigine could have deteriorated depression score, a citizen having perampanel could have normal depression score, and that while some people having pregabalin, gabapentin, valproate and benzodiazepine had normal depression rates, some other having gabapentin, valproate, and benzodiazepine had non-normal depressive condition. More studies should take place about anxiety and depression and focus on several external and internal factors that affect these detrimental psychic disorders. Longitudinal studies with a large sample size would be more enlightening on how to treat and even disappear the psychic disorders, the disappearance of which in many cases could stop AEDs and even epileptic seizures. Therefore, prevention and disappearance of these disorders would be imperative to meliorate health, the QoL, and even save the lives of PWE.

Conclusion

Epilepsy is a widespread neurological illness. Anxiety and depression prevalence in PWE, had a significant negative impact on health and QoL of PWE, and a harmful impact on these people. The existence of these psychic disorders could be an important factor that ranked the suicides in PWE as the major part of all suicides. Thus, the prevention and cure of these abnormalities could save the summum bonum. AEDs dose; substance and number could not affect anxiety and depression to a significant degree. Anxiety was affected to a significant degree by concentration disorders, dizziness, and gender, while dizziness, concentration and memory distortions had a significant impact on depression. More studies are required to have a more explicit substantiation of the factors that stimulate birth and the development of anxiety and depression.

Acknowledgments

Many thanks to all the participants for their decision to participate in the study, to every individual, to Epilepsy Action and all the groups for sharing the participant recruitment’s content of this study.

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