Abstract
Objectives The findings of previous studies focused on personality disorders in epileptic patients are difficult to interpret due to nonhomogeneous samples and noncomparable methods. Here, we aimed at studying the personality profile in patients with mild temporal lobe epilepsy (mTLE) with psychiatric comorbidity. Materials and Methods Thirty-five patients with mTLE (22 males, mean age 40.7 ± 12.1) underwent awake and sleep EEG, 3T brain MRI, and an extensive standardized diagnostic neuropsychiatric battery: Temperament and Character Inventory-Revised (TCI-R), Beck Depression Inventory-2, and State-Trait Anxiety Inventory. Drug history was collected in detail. Hierarchical Cluster Analysis was performed on TCI-R data, while all other clinical and psychological variables were compared across the resulting clusters. Results Scores of Harm Avoidance (HA), Reward Dependence (RD), Persistence (P), Cooperativeness (C), and Self-Transcendence (ST) allowed the identification of two clusters, describing different personality subtypes. Cluster 1 was characterized by an early onset, more severe anxiety traits, and combined drug therapy (antiepileptic drug and Benzodiazepine/Selective Serotonin Reuptake Inhibitors) compared to Cluster 2. Conclusions Our findings suggest that different personality traits may play a role in determining the clinical outcome in patients with mTLE. Specifically, lower scores of HA, RD, P, C, and ST were associated with worse clinical outcome. Thus, personality assessment could serve as an early indicator of greater disease severity, improving the management of mTLE.
Highlights
Temporal lobe epilepsy (TLE), the most common type of focal epilepsy in adulthood, is frequently associated with psychiatric disorders [1, 2], which mainly occur in the form of depression and generalized anxiety disorders [3].Over the past 2 decades, studies from nonsurgical series of mesial TLE patients confirmed the existence of a mild form of mesial TLE, which is characterized by at least 24 seizure-free months with or without antiepileptic medication [4].Early diagnosis—and consequent management—of psychiatric symptoms in TLE patients is desirable, since it might lead to a better epilepsy outcome, both in terms of quality of life and of healthcare costs [5]
It has been suggested that the quality of life of epileptic patients may Behavioural Neurology be influenced by personality traits [7] and that, in turn, these traits might be negatively affected by the presence of depression and anxiety [8]
A quantitative and validated instrument to study the expression of personality traits is the psychobiological model of Cloninger, known as the Temperament and Character Inventory-Revised (TCI-R), which provides a distinction between individual subtypes of personality [12]
Summary
Temporal lobe epilepsy (TLE), the most common type of focal epilepsy in adulthood, is frequently associated with psychiatric disorders [1, 2], which mainly occur in the form of depression and generalized anxiety disorders [3].Over the past 2 decades, studies from nonsurgical series of mesial TLE patients confirmed the existence of a mild form of mesial TLE (mTLE), which is characterized by at least 24 seizure-free months with or without antiepileptic medication [4].Early diagnosis—and consequent management—of psychiatric symptoms in TLE patients is desirable, since it might lead to a better epilepsy outcome, both in terms of quality of life and of healthcare costs [5]. While the success rate of resection of epileptogenic tissue is increasing, thanks to advances in neurosurgical techniques, up to 40% of patients still suffer disabling seizures after intervention [6]. In this context, it is possible that underrecognized—and undertreated—psychiatric comorbidities may influence seizure control and tolerance to medications and surgical outcome. It has been suggested that the quality of life of epileptic patients may Behavioural Neurology be influenced by personality traits [7] and that, in turn, these traits might be negatively affected by the presence of depression and anxiety [8]. We aimed to investigate the personality profile in a population of consecutive patients with mTLE
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