Interictal fatigue and its predictors in epilepsy patients: A case-control study
Introduction from Dr Markus Reuber, editor-in-chief of Seizure
Some complaints are more common in my epilepsy clinic than seizures – memory problems and fatigue are the first two that come to mind. Both can be a real nuisance to patients and clinicians. The adverse effects on patients are obvious – memory problems and fatigue can impair functioning and quality of life. Why clinicians should experience their patients’ memory problems or fatigue as a nuisance is more complicated. Both problems are perceived as complex, multifactorial, difficult to measure and even harder to improve. Both are particularly irritating in the context of using antiepileptic drugs (AEDs) with good effects of seizures. Should one really jeopardise seizure to pursue– potentially small – chance of finding alternative treatment with fewer side effects?
Of these two particularly common problems associated with epilepsy, its underlying causes, treatment and comorbity, memory issues have been studied intensively. Fatigue, on the other hand, has hardly featured as a primary topic in epilepsy research.
My editor’s choice from the current issue of Seizure is a laudable exception to the general rule that neither clinical nor academic epileptologists are particularly interested in fatigue. In their well-conducted case-control study comparing 270 patients with epilepsy and 200 healthy volunteers on a range of measures of fatigue, sleep problems, depression, anxiety and epilepsy severity, doctors Kwon and Park use a multivariate approach to explore what it means when patients with epilepsy complain of fatigue (1).
Kwon and Park found that fatigue is reported more commonly patients with uncontrolled epilepsy than in healthy controls, suggesting that regular seizures may cause symptoms fatigue. Within the epilepsy group fatigue was correlated with continuing seizures, lack of paid employment, a low household income, exclusion from holding a river’s license, unmarried status, early age of onset, use of combination AED treatment , coadministration of psychiatric drugs, increased sleep disturbance, higher levels of depression, anxiety and lower quality of life. In their multivariate model fatigue was predicted by sleep related impairments and by depression.
In a recent study, we showed that patients’ with epilepsy who complain about their memory may well be telling us that they are depressed (2). Whilst fatigue may remain difficult to explain and improve, the study by Kwon and Park alerts us to the fact that clinicians also need to think about depression when patients with epilepsy complain about fatigue.
(1) OY Kwon, SP Park. Interictal fatigue and its predictors in epilepsy patients: a case-control study. Seizure 2016;34:48-53.
(2) R Samarasekera, C Helmstaedter, M Reuber. Cognitive impairment in adults with epilepsy: The relationship between subjective and objective assessments of cognition. Epilepsy and Behav 2015;52:9-13.