Abstract
ObjectiveImpulsivity is a multidimensional construct that can predispose to psychopathology. Meta‐analysis demonstrates an association between response impulsivity and Juvenile Myoclonic Epilepsy (JME), a common genetic generalized epilepsy. Here, we test the hypotheses that trait impulsivity is (i) elevated in JME compared to controls; (ii) moderated by specific seizure characteristics; and (iii) associated with psychiatric adverse effects of antiepileptic drugs (AEDs).Methods322 participants with JME and 126 age and gender‐matched controls completed the Barratt’s Impulsiveness Scale (BIS‐brief) alongside information on seizure history and AED use. We compared group BIS‐brief scores and assessed associations of JME BIS‐brief scores with seizure characteristics and AED adverse effects.ResultsThe mean BIS‐brief score in JME was 18.1 ± 4.4 compared with 16.2 ± 4.1 in controls (P = 0.0007). Elevated impulsivity was associated with male gender (P = 0.027), frequent absence seizures (P = 0.0004) and lack of morning predominance of myoclonus (P = 0.008). High impulsivity significantly increased the odds of a psychiatric adverse event on levetiracetam (P = 0.036), but not any other psychiatric or somatic adverse effects.InterpretationTrait impulsivity is elevated in JME and comparable to scores in personality and neurotic disorders. Increased seizure frequency and absence of circadian seizure pattern moderate BIS score, suggesting disruption of both cortico‐striatal and thalamocortical networks as a shared mechanism between seizures and impulsivity in JME. These findings warrant consideration of impulsivity as a distinct target of intervention, and as a stratifying factor for AED treatment in JME, and perhaps other types of epilepsy. The role of impulsivity in treatment adherence and psychosocial outcome requires further investigation.
Highlights
Impulsivity is a notable feature of Juvenile Myoclonic Epilepsy (JME), a common genetic epilepsy with complex inheritance.[1]
The clinical utility of antiepileptic drugs (AEDs), such as levetiracetam, in JME is limited by psychiatric adverse effects, which highly impulsive individuals or those with comorbid psychiatric disorders may be predisposed to 18-21
Trait impulsivity is significantly elevated in JME over matched controls by two points on the Barratt Impulsiveness Scale (BIS)-brief and to a score comparable to personality and neurotic disorders in the literature using BIS-11.34,39,40 The extent of this psychological comorbidity in epilepsy has previously not been well-defined, and adds to known associations of impulsivity with personality disorders and externalizing psychiatric disorders.[9,22,23,30,32,42]
Summary
Impulsivity is a notable feature of Juvenile Myoclonic Epilepsy (JME), a common genetic epilepsy with complex inheritance.[1]. We have recently shown reduced response inhibition, a dimension of impulsivity, in a meta-analysis of 1,047 JME patients[9]; evidence for impairment in other dimensions of impulsivity, such as choice[5,10,11,12,13,14] and trait impulsivity,[10,12,13,15] are scarce or arise from small, uncontrolled studies. The characterization of these discrete dimensions of impulsivity (response, choice and trait) is necessary, as they each contribute to distinct psychiatric phenotypes.[16,17] the clinical utility of antiepileptic drugs (AEDs), such as levetiracetam, in JME is limited by psychiatric adverse effects, which highly impulsive individuals or those with comorbid psychiatric disorders may be predisposed to 18-21
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