Postictal aggression in epilepsy: prevalence, clinical correlates, and psychosocial impact

Postictal aggression (PIA) is an under-researched phenomenon with potentially harmful consequences for patients and their environment. This study assessed the prevalence of PIA, its associated clinical variables, and its relationship with quality of life (QoL), anxiety, and depression.

In this cross-sectional study, consecutive patients with epilepsy (≥ 1 seizure in the past 12 months; age ≥ 16 years) were surveyed using standardized questionnaires in a tertiary epilepsy center. Occurrence of PIA was retrospectively assessed over the preceding 12 months and defined by a score of ≥ 2 on the Overt aggression scale modified (OAS-M). Anxiety and depression were measured with the Hospital anxiety and depression scale (HADS-A, HADS-D) and the Neurological disorders depression inventory in epilepsy (NDDI-E).

A total of 201 patients were included (57% male; median age 47 years; 76% focal epilepsy, 14% idiopathic generalized epilepsy (IGE), 10% unclassified). Twenty-four patients (12%) reported clinically relevant PIA. Patients with PIA had lower QoL (QOLIE-10 median 40 vs. 37, p = 0.031) and more frequent clinically relevant anxiety (HADS-A ≥ 8: 58% vs. 30%, p = 0.019). Depressive symptoms were more common in PIA (NDDI-E ≥ 16: 21% vs. 10%) without statistical significance (p = 0.309). IGE (OR 3.13, 95% CI 1.06-8.98) and anxiety (OR 2.51, 95% CI 1.02-6.26) were independently associated with PIA. There were no associations with antiseizure medications or their dosage. Ten patients reported adverse consequences of PIA, most commonly shame and fear.

Almost one in eight patients experienced PIA. It was associated with reduced QoL and increased anxiety, highlighting the psychosocial burden.