Past Trauma Is Associated With a Higher Risk of Experiencing an Epileptic Seizure as Traumatic in Patients With Pharmacoresistant Focal Epilepsy.

Sara Mariotti,Alexis Tarrada,Louis Maillard,Coraline Hingray,Damien Valentin,Jean-Pierre Vignal,Stéphane Sanchez,Louise Tyvaert,Deniz Ertan,Jan Chrusciel,Wissam El-Hage,Raymund Schwan

doi:10.3389/fneur.2021.669411

Abstract

Objective: The present study aimed to evaluate the prevalence of traumatic experienced seizures (TES) and of postepileptic seizure PTSD (PS-PTSD) in patients with pharmacoresistant focal epilepsy and to explore the determining factors of TES.Methods: We conducted an observational study enrolling 107 adult refractory epilepsy patients. We used the DSM-5 criteria of traumatic events and PTSD to define TES and PS-PTSD. We assessed all traumatic life events unrelated to epilepsy, general and specific psychiatric comorbidities, and quality of life.Results: Nearly half (n = 48) of the 107 participants reported at least one TES (44.85%). Among these, one-third (n = 16) developed PS-PTSD. The TES group was more likely to experience traumatic events unrelated to epilepsy (p < 0.001), to have generalized anxiety disorder (p = 0.019), and to have specific psychiatric comorbidities [e.g., interictal dysphoric disorder (p = 0.024) or anticipatory anxiety of seizures (p = 0.005)]. They reported a severe impact of epilepsy on their life (p = 0.01). The determining factors of TES according to the multifactorial model were the experience of trauma (p = 0.008), a history of at least one psychiatric disorder (p = 0.03), and a strong tendency toward dissociation (p = 0.03).Significance: Epileptic seizures may be a traumatic experience in some patients who suffer from pharmacoresistant epilepsy and may be the source of the development of PS-PTSD. Previous trauma unrelated to epilepsy and psychiatric history are determining factors of TES. These clinical entities should be explored systematically.

Highlights

Epilepsy is defined as a chronic brain disorder characterized by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological, and social consequences of this condition [1]
A majority of participants (55.14%) reported at least one traumatic experience unrelated to epilepsy in their lifetime
The traumatic experience of an epileptic seizure (TES) group was more likely to experience trauma before the onset of epilepsy (37.5 vs. 20%, p = 0.048) and to have a history of posttraumatic stress disorder (PTSD) unrelated to epilepsy (20.83 vs. 7.27%, p = 0.045)

Summary

Introduction

Epilepsy is defined as a chronic brain disorder characterized by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological, and social consequences of this condition [1]. Psychiatric disorders have been identified in 25–50% of patients with epilepsy, with a higher prevalence among patients with poorly controlled seizures [3]. Early-life stress might promote epileptogenesis during brain development with a vulnerability to limbic epilepsy [4, 5]. People with posttraumatic stress disorder (PTSD) have a higher risk of developing epilepsy in the future [6]. Acute stress due to traumatic events could trigger an epileptic seizure [8]. PTSD is a mental health condition that is known to affect people who have experienced or witnessed a traumatic event [11]. Several studies have proven that acute diseases could be considered traumatic for patients, such as acute coronary syndrome [12], stroke [13, 14], asthma [15], or first-episode psychosis [16]

Methods

Results

Conclusion