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Abstract
Depression is reported that 42% of the epileptic population develops depression, making it the most prevalent psychiatric illness associated with epilepsy. The impact of depression on people with epilepsy is significant. In addition to impairing daily functioning, it can lead to greater seizure frequency and less seizure control through sleep deprivation and a failure to comply with medication or due to its role as an emotional stressor (Lowe, 2004).
Many factors can contribute to major depression in an individual with epilepsy. No one factor is entirely responsible and it is felt that it is usually their combined effect that generally contributes to depression, with one factor perhaps predominating more than another in a given individual. Seizure activity, poor seizure control and kindling like phenomena may be causes of depression. Some people may also experience Postictal-depression which is depression after seizures (Engel et al., 1997).
There is a suggestion that those suffering from left temporal lobe epilepsy are more predisposed towards depression, as well as those who have underlying brain disturbances producing seizures. Psychosocial factors predisposing to depression in people with epilepsy include adjustment difficulties, the limitations and restrictions which the disorder imposes, as well as the unpredictable nature of the seizures and the associated feelings of helplessness and loss of control over one’s life (British Epilepsy Association, 2003).
The aim of this work was to assess the prevalence of depression in epileptic patients attending neuropsychiatric outpatient clinic in Suez Canal University hospital and to determine the risk factors of depression in epileptic patients.
This study was designed as a cross sectional study to assess the prevalence of depression in epileptic patients. Ninety patients of both sexes, above 18 years, diagnosed clinically and with EEG that they have epilepsy at least for 6 months, and have no psychotic symptoms were recruited in the study. The patients were conducted from neuropsychiatric outpatient clinic in Suez Canal University hospital. All patients subjected to; history and neurological examination for diagnosis of epilepsy, ZSDS, SSQ and EEG.
The ZSDS index is categorize the scores into; normal (not depressed, score < 50), mild (score 50–59), moderate (score 60–69), and severe (score ≥ 70) ranges for depression (Passik et al., 2001). So, according to the definition of ZSDS, the patient was considered depressed when his/her score ≥ 50. The patients were divided into two groups; depressed group (48 patients) and non-depressed group (42 patients).
In this study, the prevalence of depression among the studied epileptic patients is 53.3%.
In our study regarding the EEG findings in both studied groups, in the depressed group there were 16 patients (33.3%) had EEG findings, while in the non-depressed group there were only 4 patients (9.5%) had EEG findings. In the depressed group; left temporal and left fronto-temporal were the most common epileptogenic dysfunction, while left parieto-central and subcortical were the least common epileptogenic dysfunction. There was statistically significant difference between both groups (p < 0.05).
In our study, Seizure Severity Questionnaire (SSQ) was used to assess the severity of seizure in the epileptic patients. Outcome was categorized as “good” (mild seizures and not bothersome) score 1-25, “intermediate” (moderate seizures and bothersome) score 26-51, or “poor” (severe seizures and very bothersome) score 52-77 (Reuber et al., 2003).
The most frequent SSQ score was the poor score, which was present in 31 patients (64.6%) of the depressed group. The least frequent SSQ score was the good score, which was present in 2 patients (4.2%) only of the depressed group. The difference between both groups was highly statistically significant (p < 0.01).
from our study we concluded that the patients with epilepsy have a higher prevalence of depression than does the general population, and the intractability of the seizure disorder is seem to be an independent risk factor for the occurrence of depression.