Apathy in people with epilepsy and its clinical significance: A case-control study

Purpose: Apathy as a state of decreased motivation has not been highlighted in people with epilepsy (PWE). We investigated its clinical significance in PWE. Methods: We invited adult PWE who had been administered antiepileptic drugs (AEDs) for at least 1 year and compared them with age- and gender-matched healthy controls. Eligible participants completed several questionnaires including the Apathy Evaluation Scale-Self (AES-S), 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), and the Quality of Life in Epilepsy-10 (QOLIE-10). We investigated the degree of interictal apathy in PWE compared with controls and identified its predictors. We also measured the impact of apathy on patients' QOL. Results: The mean overall AES-S score in PWE was similar to that of controls. However, the score was significantly higher in patients with uncontrolled epilepsy than controls (p < 0.01). Among subscale scores of the AES-S, the mean behavioral score was significantly higher in PWE than controls (p < 0.01). Education level, employment, household income, disease duration, AED-related factors, seizure control, and scores of the K-NDDI-E, GAD-7, ESS, and ISI were associated with the overall AES-S score by univariate analyses. However, major predictors were the K-NDDI-E (beta = 0.476, p < 0.001) and duration of AED intake (beta = 0.151, p < 0.01). The degree of apathy was significantly higher in patients receiving AEDs for 20 years or more than those receiving AEDs for 1-9 years (p < 0.01). The overall AES-S score was inversely correlated with the overall QOLIE-10 score (p < 0.001). Conclusion: Duration of AED intake in PWE seems to be a critical factor for apathy regardless of comorbid depression. (C) 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.