Impulsivity in persons with epilepsy: Association with seizure severity and suicide risk

Sang-Ahm Lee; Eun Ju Choi; Ji-Ye Jeon; Su-Hyun Han; Hyun-Woo Kim; Gha-Hyun Lee; Han Uk Ryu; Kayeong Im; Ha-Rin Yang

doi:10.1016/j.eplepsyres.2021.106825

Impulsivity in persons with epilepsy: Association with seizure severity and suicide risk

Epilepsy Res. 2022 Jan:179:106825. doi: 10.1016/j.eplepsyres.2021.106825. Epub 2021 Nov 23.

Authors

Sang-Ahm Lee¹, Eun Ju Choi², Ji-Ye Jeon³, Su-Hyun Han⁴, Hyun-Woo Kim⁵, Gha-Hyun Lee⁶, Han Uk Ryu⁷, Kayeong Im², Ha-Rin Yang²

Affiliations

¹ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: salee@amc.seoul.kr.
² Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
³ Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
⁴ Department of Neurology, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
⁵ Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University, Yangsan, Republic of Korea.
⁶ Department of Neurology, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
⁷ Department of Neurology and Research Institute of Clinical Medicine, Jeonbuk National University School of Medicine and Hospital, Jeonju, Republic of Korea.

PMID: 34864632
DOI: 10.1016/j.eplepsyres.2021.106825

Abstract

Purpose: Clinical research regarding impulsivity in patients with epilepsy is limited. The present study investigated the associations between impulsivity and seizure-related factors or suicidality in patients with epilepsy, independent of depression and anxiety.

Methods: The multicenter study included 146 subjects (63% men). We utilized the Barratt Impulsiveness Scale-11 (BIS-11), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and suicidality module of the Mini International Neuropsychiatric Interview (MINI). Stepwise regression analyses and an analysis of covariance with interaction terms were performed.

Results: The mean BIS-11 score was 59.3 (SD = 10.7). Psychiatric pathologies, including suicidality, were reported in relatively large proportions of patients, including PHQ-9 score ≥ 10 in 29 (19.9%) patients, GAD-7 score ≥ 7 in 35 (24.0%) patients, and MINI suicidality score ≥ 6 in 15 (10.3%) patients. Stepwise linear regression revealed that BIS-11 score was positively associated with the PHQ-9 scores (p < 0.001), antiseizure medication polytherapy (p < 0.001), use of lamotrigine (p = 0.009), and recurrence of generalized or focal to bilateral tonic clonic seizures (p = 0.010). The coefficient of determination for the model was 0.397. Generalized or focal to bilateral tonic clonic seizure recurrence tended to be positively associated with total BIS-11 scores in men but not in women. In subscale analyses, somewhat different variables were associated with different BIS-11subscales. A trend for a positive association between BIS-11 score and suicidality was found (p = 0.066).

Conclusions: This study identified a positive association between clinical seizure severity and impulsivity, and found that this association tended to be sex-specific, occurring only in males. Impulsivity could potentially be weakly associated with suicidality in patients with epilepsy.

Keywords: Aggression; Antiepileptic drug; Depression; Epilepsy; Polytherapy; Suicidality; Trait impulsivity.