Anticipatory anxiety of epileptic seizures: An overlooked dimension linked to trauma history. (February 2021)

• Record Type: Journal Article
• Authors: Ertan, Deniz; Hubert-Jacquot, Caroline; Maillard, Louis; Sanchez, Stéphane; Jansen, Claire; Fracomme, Léa; Schwan, Raymund; Hopes, Lucie; Javelot, Hervé; Tyvaert, Louise; Vignal, Jean-Pierre; El-Hage, Wissam; Hingray, Coraline
• Is Part Of: Seizure. Volume 85(2021)
• Page Start: 64
• Page End: 69
• Publication Date: 2021-02
• Subjects: Drug-resistant focal epilepsy -- Anxiety -- Trauma -- Psychiatric comorbidities -- Anticipatory anxiety of seizures; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2020.12.006
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: Over half (53 %) of our patients with refractory focal epilepsy suffered from anticipatory anxiety of seizures (AAS). AAS, a debilitating condition leading to avoidance behavior and poor quality of life, is overlooked in people with epilepsy. AAS was strongly linked to subjective ictal anxiety but not to objective severity of seizures or frequency. Patients with AAS experienced more trauma and reported more frequently a feeling of danger during their seizure. A simple question could improve screening: "In your everyday life, are you afraid of having an epileptic seizure?". Abstract: Objective: Fear of having a seizure called anticipatory anxiety of epileptic seizure (AAS), constitutes a daily life burden but has been rarely studied. Our aim was to assess the prevalence and the determining factors of AAS in patients with drug-resistant focal epilepsy, a dimension that has not been thoroughly investigated before. Methods: We conducted an observational, prospective study enrolling patients with drug-resistant focal epilepsy. The psychiatric assessment aimed to evaluate psychiatric comorbidities, trauma history, and quality of life using hetero-evaluation and self-assessment tools. Dimensions of anxiety specifically related to epilepsy (peri-and-inter-ictal) were explored as exhaustively as possible. Results: AAS was found in 53 % of the 87 patients. We compared the two groups of patients: with or without AAS. Patients with AAS had a significantly shorter duration of epilepsy (p = 0.04). There was no difference between groups with respect to psychiatric disorders, except for cannabis dependence, more frequent in patients with AAS (p = 0.02). Compared to patients without AAS, those with AAS presented more subjective ictal anxiety (p = 0.0003) and postictal anxiety (p = 0.02), were more likely to avoid outdoor social situations due to seizure fear (p = 0.001), and had a poorer quality of life (QOLIE emotional well-being; p = 0.03). Additionally, they had experienced more traumatic events in their lifetime (p = 0.005) and reported more frequently a feeling of being unsafe during their seizures (p = 0.00002). Significance: AAS is a specific dimension of anxiety, possibly linked to trauma history. AAS is strongly linked to subjective ictal anxiety but not to the objective severity of seizures or frequency.