Focal Epilepsy Diagnosis Delay Increases Suicidal Ideation Among Youth

Monica Ferrer, MD

In a recent retrospective, observational study on focal epilepsy, the results showed that delays in diagnosis are associated with an increased prevalence of suicidal ideation and suicidal behaviors among younger individuals.¹ This study provides new evidence on the characteristics associated with SI in adolescents with newly diagnosed focal epilepsy based on the evaluation of seizure characteristics and antiseizure medications (ASMs) selected.

Eighty-six percent of the participants with suicidal ideation and delays to a diagnosis of 1 year or longer showed evidence of nonmotor seizures which were undiagnosed up until the conversion of motor symptoms. The findings from the study were presented as a poster at the 2022 American Epilepsy Society Annual Meeting, held December 2 to 6, in Nashville, Tennessee, and conducted by Monica Ferrer, MD, pediatric neurologist, department of neurology, NYU Grossman School of Medicine, and colleagues.

“This study shows new evidence linking delays to epilepsy diagnosis with lifetime suicidal ideation and suicidal behaviors in adolescents with focal epilepsy,” Ferrer et al wrote.

The data were compiled from an international multi-institutional study which had data that comprised of 34 international sites, called the Human Epilepsy Project. The collection of data was selected between 2012 and 2017, with participants' age ranging from 11 to 67 years. The participants, in order to be eligible to participate, had to be within 4 months of initiated treatment specifically for focal epilepsy.

Furthermore, additional data came from the Columbia Suicide Severity Rating Scale (C-SSRS), medical records, treatment logs, and seizure diaries. The analysis gathered a broad range of data to have a large sample for identifying suicidal ideation in patients with focal epilepsy, as well as having records based on characteristics of seizures and preenrollment for monotherapy antiseizure medications (ASMs).

All told, 63.2% of individuals with a delay in diagnosis of 1 year or more had no suicidal ideation, whereas the remaining 36.6% had any suicidal ideation. A delay in diagnosis of 1 year or less was present among 85.4% of patients with no suicidal ideation, whereas 14.6% had any suicidal ideation. As for suicidal behavior, 78.9% of patients with a delay in diagnosis of more than 1 year had no suicidal behavior whereas 21.1% had any suicidal behavior. For a delay in diagnosis of less than 1 year, 95.8% showed no suicidal behavior and 4.4% had any suicidal behavior.

In the suicidal ideation seizure semiology analysis, among participants with suicidal ideation (n = 14), 50% had less than 1 year of delay in diagnosis (n = 7) and 50% had 1 or more years of delay in diagnosis (n = 7). In comparison, of those that had no suicidal ideation (n = 53), 77% had been diagnosed in less than 1 year (n = 41) whereas 23% were diagnosed after 1 or more years (n = 12).

In the selection of ASMs, there was no difference observed between youth with lifetime suicidal ideation and those without. Additionally, use of negative psychotropic ASMs (ie, levetiracetam, topiramate, zonisamide, phenytoin, and barbiturates) showed no differences between youth who experience suicidal ideation in comparison with those who did not.

Ferrer and colleagues noted that screening for the diagnosis of epilepsy and mental health issues should be prompted, as its importance lay in guiding individuals toward comprehensive care for new-onset epilepsy in youth. Notably, they wrote, "over 1 in 5 adolescents have reported suicidal ideation at the time of focal epilepsy diagnosis."

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REFERENCES
1. Ferrer M, Greenwood H, Jandhyala N, et al. Characteristics Predictive of Suicidal Ideation in Adolescents with Focal Epilepsy. Presented at: AES Annual Meeting; December 2-6, 2022; Nashville, TN, and virtual. Poster.