Table E-1
Prevalence and median duration of postictal psychiatric and cognitive symptoms in 100 patients with intractable partial epilepsy.
POSTICTAL SYMPTOM / PREVALENCE / MEDIAN DURATION in hours (range)Symptoms of depression, total / 43
Irritability / 30 / 24 (0.5 – 108)
Poor frustration tolerance / 36 / 24 (0.1 – 108)
Anhedonia / 32 / 24 (0.1 – 148)
Hopelessness / 25 / 24 (1.0 – 108)
Helplessness / 31 / 24 (1.0 – 108)
Crying bouts / 26 / 6 (0.1 – 108)
Suicide ideation / 13 / 24 (1.0 – 240)
Active suicidal thoughts / 8
Passive suicidal thoughts / 13
Feelings of self deprecation / 27 / 24 (1.0 – 120)
Feelings of guilt / 23 / 24 (0.1 – 240)
Neurovegetative symptoms, total / 62
Early night insomnia / 11 / -
Middle night awakening / 13 / -
Early AM awakening / 11 / -
Excessive somnolence / 43 / 24 (2 – 72)
Loss of appetite / 36 / 24 (2 – 148)
Excessive appetite / 10 / 15 (0.5 – 48)
Loss of sexual interest (not related to fatigue) / 26 / 39 (6 – 148)
Symptoms of anxiety, total / 45
Constant worrying / 33 / 24 (0.5 – 108)
Panicky feelings / 10 / 6 (0.1 – 148)
Agoraphobic symptoms / 29 / 24 (0.5 – 296)
Due to fear of seizure recurrence / 20 / -
Compulsions / 10 / 15 (0.1 – 72)
Self Consciousness / 26 / 6 (0.05 – 108)
Psychotic symptoms, total / 7
Referential thinking / 5 / 15 (0.1 – 108)
Auditory hallucinations / 2 / 6.0 (0.1 – 108)
Paranoid delusions / 4 / 0.2 (0.1 – 0.25)
Religious delusions / 3 / 6.0 (0.1 – 108)
Visual hallucinations / 1 / 36 (6 – 48)
Hypomanic Symptoms, total / 22
Excessive energy / 9 / 2 (0.15 – 48)
Thought racing / 15 / 2 (0.1 –24)
Fatigue / 37 / 24 (0.1 – 108)
Cognitive symptoms, total / 82
Difficulty in concentration / 71 / 6 (0.1 –108)
Problems with memory / 66 / 6 (0.1 –108)
Confusion / 65 / 2 (0.1 – 72)
Disorientation / 46 / 1 (0.05 – 24)
Thought blockage / 42 / 9 (0.1 – 98)
Only cognitive symptoms / 14 / -
No postictal symptoms / 12 / -
APPENDIX A
POSTICTAL PSYCHIATRIC AND COGNITIVE SYMPTOMS QUESTIONNAIRE
(TO BE COMPLETED BY INVESTIGATOR)
Name/ID#:______
Age:______
Epileptic syndrome:______
Seizure type(s):______
Age of first seizure:______
Average frequency of seizures:______
Maximal frequency of seizures:______
Clustering of seizures? yes no
Current medications:______
INSTRUCTIONS TO BE READ TO PATIENTS:
Patients with epilepsy may at times experience a variety of psychiatric and cognitive symptoms. These symptoms can happen at any time, independent of the occurrence of seizures.
In some patients, however, these symptoms may only occur after a patient has had one or more seizures. We call these symptoms, postictal psychiatric and cognitive symptoms. These symptoms can occur anytime within three days after a seizure or cluster of seizures. This period of three days that follows a seizure is called the postictal period. In this study we are interested in investigating the occurrence of psychiatric and cognitive symptoms that you may have experienced during the postictal period in the course of the last three months.
In some patients, psychiatric and cognitive symptoms can occur as well in the absence of seizures. We call these, interictal symptoms. For each symptom that we are investigating, we are going to ask you if you have experienced it only after having seizures, or both, in the absence of seizures and after having seizures. In such cases, we want you to tell us if the severity of the symptom worsens significantly after having seizures. We also want you to estimate the average duration of each symptom.
CODING:
For each question, investigator needs to circle the corresponding number:
0 = never
1 = occasionally (after less than 50% of seizures)
2 = frequently (after more than 50% of seizures)
3 = all the time
PLEASE REMEMBER THAT THESE QUESTIONS PERTAIN TO SYMPTOMS OCCURRING UP TO THREE DAYS AFTER A SEIZURE THAT YOU MAY HAVE EXPERIENCED IN THE LAST THREE MONTHS.
After having seizures:
1.Do you feel cranky or crabby where things that usually would not bother you get on your nerves? 0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
If yes, is this symptom much more severe after having seizures?______
2.Do you have trouble enjoying the things that you usually find pleasure in?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
If yes, is this symptom much more severe after having seizures?______
3.Do you get easily frustrated with people or when things do not turn-out the way you want?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
If yes, is this symptom much more severe after having seizures?______
- Do you feel that you have lost hope in your life?
0 1 2 3
Average duration:______
Do you also feel this way when You are not having seizures?______
If yes, is this symptom much more severe after having seizures?______
5.Do you feel that there is nothing you can do to help you feel better about yourself?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
- If yes, is this symptom much more severe after having seizures?______
- Do you start crying over things that usually do not upset you?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
- If yes, is this symptom much more severe after having seizures?______
- Do you have thoughts of wanting to be dead?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
- If yes, is this symptom much more severe after having seizures?______
- Do you think about ways of killing yourself?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
- If yes, is this symptom much more severe after having seizures?______
9.Do you start feeling that you are a bad person?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
- If yes, is this symptom much more severe after having seizures?______
10.Do you feel that nothing that you do is good enough?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
- If yes, is this symptom much more severe after having seizures?______
11.Do you experience feelings of guilt even though you have not done anything wrong?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
- If yes, is this symptom much more severe after having seizures?______
12.Do you feel that you do not have any energy to do things?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
- If yes, is this symptom much more severe after having seizures?______
REMIND THE PATIENT AGAIN:
PLEASE REMEMBER THAT THESE QUESTIONS PERTAIN TO SYMPTOMS OCCURRING UP TO THREE DAYS AFTER A SEIZURE THAT YOU MAY HAVE EXPERIENCED IN THE LAST THREE MONTHS.
13.Is it hard for you to concentrate after having seizures?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
- If yes, is this symptom much more severe after having seizures?______
- Do you have a hard time remembering things after having seizures?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
- If yes, is this symptom much more severe after having seizures?______
- Is your thinking confused after having seizures?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
- If yes, is this symptom much more severe after having seizures?______
16.After having seizures, do you forget where you are?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
- If yes, is this symptom much more severe after having seizures?______
17.After having seizures, do you forget what day it is?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
- If yes, is this symptom much more severe after having seizures?______
- After having seizures, do you get the feeling that you cannot finish your thoughts?
0 1 2 3
Average duration:______
Do you also feel this way when you are not having seizures?______
- If yes, is this symptom much more severe after having seizures?______
- On the days you have seizures, do you have a hard time falling asleep?
0 1 2 3
For how long does it go on?:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
- On the days that you have seizures, do you have a hard time staying asleep?
0 1 2 3
For how long does it go on?:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
- Do you wake up the next morning after having seizures earlier than usual?
0 1 2 3
For how long does it go on?:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
- Do you sleep too much after having seizures?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
23.Do you lose your appetite after having seizures?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
After having seizures:
- Do you feel like you want to eat too much?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
25.Do you lose your sexual drive?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
26.Do you worry about things that normally would not bother you?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
27.Do you have feelings of sudden panic as if something terrible is going to happen?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
28.Do you feel afraid to leave the house?
0 1 2 3
If yes, is it because you are afraid of having another seizure? Yes____ No____
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
29.Do you feel afraid to be alone?
0 1 2 3
If yes, is it because you are afraid of having another seizure? Yes____ No____
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
30.Do you get the urge to do things over and over again (i.e., washing your hands, checking the stove, etc.), even though you know that it makes no sense?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
- Do you get the feeling that others are staring at you?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
32.Do you feel that others are talking about you (even people that do not know you)?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
- Do you feel that others are plotting against you?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
- Do you feel that somebody wants to hurt you?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
- Do you hear voices even when no one is around?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
36. Do you see things that are not really there, or that others may not see?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
- Do your thoughts race in your mind?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
- Do you have more energy than usual?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
39.Do you feel as if you were on top of the world?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
40.Do you get the feeling as if you have been put on earth for a special mission?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
41.Do you get the feeling that you are receiving special messages from God?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______
42.Do you feel that you are getting special messages from the radio or television?
0 1 2 3
Average duration:______
Does this also happen on the days you do not have seizures?______
- If yes, is this symptom much more severe after having seizures?______