Alexithymia in Adults with Epilepsy: Associations with Affective Symptoms but Not Epilepsy-Related Clinical Variables

Alexithymia, characterized by difficulties in identifying and describing emotions, has been increasingly recognized in neurological disorders. This study aimed to evaluate alexithymia in adult patients with epilepsy (PWE) compared with HCs and to examine its association with affective symptoms and epilepsy-related clinical variables.

In this cross-sectional case-control study, adult PWE and HCs were assessed using the Toronto Alexithymia Scale-20, Beck Depression and Beck Anxiety Inventory. Clinical epilepsy variables, including seizure type, seizure control status, age at epilepsy onset, duration of epilepsy, antiseizure medications, EEG findings, and MRI abnormalities, were recorded. Group comparisons were performed according to alexithymia status. Multivariable binary logistic regression analysis was conducted to identify factors independently associated with alexithymia.

PWE exhibited significantly higher alexithymia, anxiety, and depression scores compared with HCs (all p < 0.05). Within the epilepsy group, patients with alexithymia had significantly higher anxiety and depression scores in univariate analyses. However, no significant associations were observed between alexithymia and epilepsy-related clinical characteristics. In multivariable logistic regression analysis including anxiety score, depression score, age at epilepsy onset, and duration of epilepsy, none of these variables independently predicted the presence of alexithymia.

Alexithymia is more prevalent in PWE and is associated with increased affective symptom burden; however, it appears to be independent of epilepsy-related clinical variables and is not fully explained by anxiety or depressive severity. These findings support the conceptualization of alexithymia as a distinct affective construct in epilepsy and highlight the importance of its direct assessment in routine clinical practice.