Personalised treatment for epilepsy: gender-specific comorbid emotional disturbances in drug-resistant epilepsy in neurosurgical patients

Background. Because of the apparent frequency and impact on patients’ quality of life, it is important to investigate the emotional domain of neurosurgical patients with drug-resistant epilepsy. The objective of this study was to investigate gender-specific signs of depression and anxiety in neurosurgical patients with drug-resistant epilepsy.

Design and methods. In 2019–2020, Polenov Neurosurgical Institute studied comorbid emotional disturbances in 46 neurosurgical patients with drug-resistant epilepsy in two gender groups: Group 1 — male patients and Group 2 — female patients, using HADS, GAD-7, and Beck’s Depression Inventory in-depth screening.

Results. The mean age of participants in the study was 30.8 ± 7.1 years. The male-to-female ratio was 1.5 to 1. The disease lasted an average of 19.2 years, with a mean age of onset of 11.7 years. HADS: normal in 74 % and 61 % of cases, subclinical anxious/depressed in 10 % and 17 % of cases, and clinical anxious/depressed in 16 % and 22 % of cases, respectively. On the GAD-7 scale, 57 % and 50 % were minimally anxious, 25 % and 11 % mildly anxious, 7 % and 33 % moderately anxious and 11 % and 6 % severely anxious. On the Beck’s Depression Inventory, 50 % and 37 % had no depressive symptoms, 32 % and 26 % had mild depression, 7 % and 23 % had moderate depression, 7 % and 5 % had severe depression, and 4 % and 9 % had clinical depression. Personalisation of treatment approaches for patients with affective disorders is driven by two key points: the inclusion of medications with antidepressant and antianxiety effects in addition to AEDs, and consideration of the effect of a given AED on the emotional domain.

Conclusion. Among neurosurgical patients with drug-resistant epilepsy, patients without symptoms of anxiety and depression predominate in both male and female patients. In the long-term course of drug-resistant epilepsy, the gender differences in the emotional range of patients flatten out. There is a need to expand the sample and further investigate gender characteristics of neurosurgical patients in order to personalise the treatment of drug-resistant epilepsy.

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