Interictal irritability and associated factors in epilepsy patients

Irritability has been reported in epilepsy patients. We identified associated factors for interictal irritability in epilepsy patients.

Adult epilepsy patients who received antiepileptic drugs (AEDs) for at least 1year were invited to participate in this study. For eligible patients, several questionnaires, such as the Irritability in Adult Patients with Epilepsy (I-Epi), the Korean version of the Neurological Disorders Depression Inventory for Epilepsy (K-NDDI-E), the Generalized Anxiety Disorder-7 (GAD-7), the Epworth Sleepiness Scale (ESS), and the Insomnia Severity Index (ISI), were administered. We investigated factors for determining the overall I-Epi score using univariate and multivariate analyses.

A total of 276 patients with epilepsy were included in the study. Mean duration of epilepsy was 15.4 years (2-58 years), and 146 patients (52.9%) had a seizure freedom for 1year. Mean overall I-Epi score was 46.1 (18-105), and 163 patients (59.1%) had at least a moderate level of irritability. Although several factors, including demographic, socioeconomic, psychosomatic, epilepsy-related factors, and levetiracetam intake, were associated with the overall I-Epi score, the strongest factor was the K-NDDI-E score, followed by the ISI score, the GAD-7 score, the ESS score, seizure control, and duration of epilepsy.

An appropriate management of psychosomatic problems and epileptic attacks is likely to reduce irritability in epilepsy patients. Acknowledgment of irritability by clinicians will reduce drug failure when they administer AEDs with negative psychotropic profiles, especially irritability and aggression.