Personality disorders in idiopathic generalized epilepsies in adults

Adults with idiopathic generalized epilepsy (IGE) exhibit higher rates of psychiatric symptoms and poorer social outcomes. Here, we studied the inter-relationships of epilepsy, psychiatric diagnoses/symptoms, and social outcomes to understand their psychosocial challenges.

The study consisted of a cross-sectional cohort study on IGE patients identified at the Epilepsy Clinic at the Odense University Hospital and a case-control study using Danish registers. In the cross-sectional study, patients answered validated screening tools for personality disorder (PD), depression, anxiety, impulsivity, and questions on epilepsy and social status. In the case-control study, we identified IGE patients and age-, sex- and geography-matched normal population controls (1:10) in the Danish National Patient Registry using ICD-10 codes. Markers of social status and health care use were compared according to co-incident PD diagnoses.

In the cohort study (n = 286), IGE patients with ≥ 2 seizure types reported increased PD symptoms; reported PD symptoms were the strongest independent predictor of adverse social outcomes and other psychiatric symptoms. The complementary register-based case-control study comprised 7.879 IGE patients and 78.790 matched controls. A registered IGE diagnosis was associated with a 2.4 × increased risk of being diagnosed with PD (4.8% IGE patients vs. 2.0% controls). The pattern of PD diagnoses differed between IGE and controls, with IGE patients having significantly more borderline PD and fewer obsessive-compulsive or avoidant PD diagnoses. A PD diagnosis in IGE patients (n = 376) was associated with lower family income, more epilepsy-related hospital visits, and more additional psychiatric diagnoses. Comparing PD patients with and without IGE revealed lower employment rates and an even larger additional psychiatric disease burden in patients with both PD and IGE. The presence of a PD diagnosis was associated with a higher rate of legal violations in both IGE patients and controls.

Higher rates of symptoms of PD may be a crucial and independent contributor to adverse social outcomes and psychiatric comorbidity in IGE patients.