Alan B. Ettinger

Symptoms of Depression and Anxiety in Pediatric Epilepsy Patients

Summary: Purpose: We assessed rates of symptoms of anxiety and depression among pediatric patients with epilepsy.

A comprehensive profile of clinical, psychiatric, and psychosocial characteristics of patients with psychogenic nonepileptic seizures

Summary: Purpose: To attain a comprehensive profile of clinical, psychiatric and psychosocial characteristics of patients with psychogenic nonepileptic seizures (NESs), and to assess the relation of these factors to NES outcome.

Two cases of nonconvulsive status epilepticus in association with tiagabine therapy.

Summary: We report two patients with intractable partial seizures who developed generalized nonconvulsive status epilepticus (NCSE) after receiving tiagabine (TGB). Neither had a history of absence seizures or generalized epileptic discharges on prior EEG monitoring. Clinicians need to be aware of a possible association between TGB and NCSE.

Positive and Negative Psychotropic Effects of Lamotrigine in Patients with Epilepsy and Mental Retardation

Summary: Purpose: To describe significant positive or negative psychotropic effects of lamotrigine (LTG) observed in epilepsy patients with mental retardation (MR).

Fatigue and Depression in Epilepsy

Fatigue is commonly reported as an adverse effect of antiepileptic drugs. In other disorders, fatigue has been closely correlated with depression. We examined the frequency of fatigue in epilepsy patients, the contribution of depression to fatigue, and the impact of fatigue upon quality of life. We measured fatigue and depression with the Fatigue Severity Scale (FSS) and Center for Epidemiological Studies-Depression scale (CES-D), respectively in 89 patients with epilepsy at an epilepsy center, 26 depressed controls (DC), and 30 normal health adults (NHA). Patients with epilepsy also completed the Quality of Life in Epilepsy (QOLIE-10) scale. Forty-four percent of epilepsy patients met criteria for severe fatigue, while 52% were depressed. The correlation between fatigue and depression was high among epilepsy patients (r = .60, p = .0001). Both fatigue and depression had an inverse relationship with quality of life in epilepsy (p < .0001). Fatigue in epilepsy is common and is closely associated with depression. Fatigue is associated with significant impairment in quality of life in epilepsy.

Postictal symptoms help distinguish patients with epileptic seizures from those with non-epileptic seizures

The aim of the study was to assess whether post-ictal symptoms can help distinguish patients who have epileptic seizures from those with non-epileptic seizures (NES). We reviewed the spontaneous responses to the question What symptoms do you have after a seizure? in 16 patients with epileptic seizures (predominantly focal with secondary generalization or generalized tonic-clonic) and 23 NES patients. Six of the 16 patients (38%) vs. only one of 23 NES patients (4.3%) noted post-ictal headache (P = 0.008). Nine epilepsy patients (56%) vs. three NES patients (13%) reported post-ictal fatigue (P = 0.004). Confusion or other symptoms did not distinguish epilepsy patients from those with NES. All epilepsy patients had at least one post-ictal symptom while 12 NES patients (52%) had none (P = 0.001). Therefore, patients evaluated for epileptic vs. non-epileptic seizures who have post-ictal fatigue or headache, are more likely to have epileptic seizures. Patients with a diagnosis of NES who note post-ictal fatigue or headache should be investigated further.

Felbamate-Induced Headache

We prospectively investigated drug‐induced headaches (HA) among 60 epileptic patients receiving felbamate (FBM). Twenty patients (33%) experienced HA. HA was pounding in 11 (55%), steady in 9 (45%), moderate or severe in 19 (95%), occurred at least once a week in all patients, and was relieved by nonnarcotic analgesics in 14 (70%). Mean duration on FBM before HA onset was 19 days. HA occurred with higher FBM doses and was relieved in 8 of 13 patients (62%) with FBM dose reduction. FBM was discontinued in most cases because of risks of anemia or hepatitis; not because of HA. Other side effects included insomnia (25%), gastrointestinal symptoms (27%), and agitation or restlessness (23%). HA is a common dose‐related complication of FBM, occurs early after initiation of FBM treatment, and is relieved by dose reduction.

Postictal SPECT in Epileptic Versus Nonepileptic Seizures

Abstract Despite advances in video-electroencephalogram (EEG) technology, in many patients distinguishing epileptic seizures from nonepileptic seizures (NES) remains a challenge. Reliable methods to make this distinction are needed. In a pilot study, we performed postictal and interictal single photon emission computed tomography (SPECT) in 22 patients undergoing video-EEG monitoring who had altered responsiveness during an episode. Eleven had seizures, defined as episodes associated with EEG seizure patterns or postictal prolactin (PRL) elevations greater than 1.5 times the highest interictal baseline PRL; 11 had NES. Among the 11 seizures, postictal SPECT was abnormal in seven (regions of hypoperfusion in six and hyperperfusion in one) and normal in four. In six cases (55%), the interictal and postictal SPECT changed. Among the 11 NES cases, postictal SPECT was abnormal in three cases (all hypoperfusion abnormalities) and normal in eight cases. In no case did the interictal and postictal SPECT change. This small sample revealed a trend toward greater hypometabolism (postictal versus interictal) on SPECT for epileptic seizures compared to NES ( p

Symptoms of Psychiatric Disturbance in Epilepsy

Abstract To assess the severity and nature of symptoms of psychiatric distress among tertiary center epilepsy patients, we administered the Brief Symptom Inventory (BSI) and Center for Epidemiologic Studies-Depression Scale (CES-D) to adult patients evaluated at our tertiary center who were diagnosed with Epilepsy (EPI; n = 37), or Chronic Lyme Disease (CLD, n = 38). We compared results in these groups to published studies in normal healthy adults (NHA) and psychiatric outpatients (Psych). Mean global BSI and CES-D scores were both markedly elevated in the EPI and CLD groups compared to NHA but less than Psych. Subscores of the BSI varied among the EPI and CLD groups with higher obsessive compulsive symptoms among CLD patients ( p = .014), higher paranoid symptoms in the EPI group ( p = .021), and a trend toward higher somatization subscores in the CLD group ( p = .054). Symptoms of psychiatric distress including depression are common among tertiary epilepsy center patients as well as patients with CLD.

Patient reporting of seizure exacerbation near the time of menses helps distinguish epileptic from nonepileptic seizures

The purpose of this study was to determine whether patient reporting of a relationship between seizure exacerbation and menses helps distinguish premenopausal women with epileptic seizures from those with nonepileptic seizures (NES). We reviewed the responses to the question What tends to bring on your seizures?, administered during the initial evaluation of women ages 18–45 years with epileptic seizures ( n = 27) and NES ( n = 38) at our outpatient clinic. Only one out of 38 women with NES versus 13 of 27 women with epilepsy reported a relationship of seizures with the menstrual cycle ( p = .0001). Other precipitants identified for seizure exacerbation such as stress, or emotional upset, did not distinguish these two groups. Patient reporting of a relationship between seizure exacerbation and menses can help distinguish epileptic from NES in premenopausal women.