Citing Hippocrates on depression in epilepsy

Depression and anxiety among patients with epilepsy: A cross-sectional study from Riyadh, Saudi Arabia

Background

It is well established that epileptic disorders are associated with a wide range of psychosocial issues that overburden the affected individuals and limit their lifestyle. This study aimed to determine the commonalities between depression and anxiety symptoms among patients with epilepsy (PWE). In addition, we assessed whether depression and anxiety rates varied depending on factors related to the disease.

Materials and Methods

A cross-sectional study was conducted between October 2021 and March 2022 among all PWE at Prince Mohammed bin Abdulaziz Hospital, and 147 patients who responded to the questionnaires were included for analysis (65.6% response rate). Depression was measured using the Patient Health Questionnaire depression scale (PHQ-9), while anxiety levels were measured using the Generalized Anxiety Disorder scale (GAD-7). Demographic variables such as sex, age, marital status, and factors related to epilepsy were also recorded.

Results

The results showed that 39.5% and 27.9% of participants had major depressive disorder (MDD) and generalized anxiety disorder (GAD), respectively. The presence of factors that increased susceptibility to seizures was associated with a greater expression of depression (P = 0.035) and anxiety (P = 0.002) symptoms. The presence of symptoms/signs that precede seizures was associated with a higher risk of moderate and severe depression (P = 0.001) and moderate and severe anxiety (P < 0.001). Irregular use of medications was associated with a higher risk of moderate and severe depression (P = 0.037); however, lamotrigine was associated with lower rates of depression among the participants (P = 0.023).

Conclusion

This study found that PWE had a higher prevalence of MDD and GAD than the general population. However, this accepted paradigm has yet to reflect a meaningful change in constructing condition-specific recommendations for PWE. Our study revealed that the presence of subjectively recognized signs of an impending ictal episode was significantly associated with a higher risk of moderate and severe depression and anxiety. Furthermore, factors that increase the susceptibility to seizures were associated with a higher risk of depression and anxiety. Irregular medication use was associated with a higher risk of moderate and severe depression. However, lamotrigine was associated with lower rates of depression among participants.

Epilepsy - from mysticism to science

The understanding of epilepsy has been in progressive evolution since Antiquity, with scientific advances culminating in the last few decades. Throughout history, epilepsy was plagued by mystical misconceptions involving either demonic possessions, witchcraft, or divine interventions. This has frequently altered or even halted any real progress in its scientific understanding or its social perception. This metaphysical context is also at the core of the stigma revolving around this condition, some of which still lingering today. This review explores the origins of these mystical beliefs, and describes the chronological evolution of epilepsy from mysticism to science across different civilizations and eras.

Epilepsy in the Hippocratic collection: Seizures and syndromes

Despite extensive scholarship, several questions on the view of seizures and epilepsy in the Hippocratic collection have not been answered. The book 'On the Sacred Disease' contains descriptions of focal and generalized tonic-clonic seizures, understands the stigma attached to epilepsy, its association with depression, and probably describes auras. Remarkably, the collection presents a physiologic theory of 'mental' disease. Other parts of the collection suggest recognition of syndromes such as childhood febrile seizures. Non-motor seizures are not clearly described. There may be a distinction between 'acute symptomatic' and recurrent seizures or 'epilepsy.' Analysis of the relative occurrence of terms related to 'epilepsy' or 'spasms' in an online text collection shows a significant difference: 'epilepsy' terms are more frequent when seizures are described alone, while 'spasm' terms are more frequent in the context of systemic diseases or injuries. This dichotomy suggests, in contrast to previous accounts, possible understanding of the distinction between 'idiopathic' and 'symptomatic' seizure disorders.