Abstract
BACKGROUND
Epileptic seizures are a common symptom in glioma patients and generally treated with antiepileptic drugs (AEDs), which are considered to have the potential of mood-modulating and neurocognitive adverse effects. This observational study aimed to assess the independent association between AEDs and depression, anxiety and subjective cognitive impairment in glioma patients.
MATERIAL AND METHODS
Use of AEDs was defined as a categorical variable (none or at least one). Depression and anxiety were measured with the Hospital Anxiety and Depression Scale, while subjective cognitive impairment was measured with the Medical Outcomes Study-Cognitive Functioning Scale. Hierarchical multivariable logistic regression analyses were performed for each outcome separately. Besides use of AEDs, other confounding variables such as seizure severity and Karnofsky Performance Status score were included. Analyses were repeated for the two most commonly prescribed AEDs separately, levetiracetam or valproic acid, with the same confounding variables.
RESULTS
A total of 272 grade II-IV glioma patients were included in the study, of which 68% used at least one AED. Prevalence of depression was 10% for patients taking 0 AEDs and increased significantly to 21% (adjusted Odds Ratio [aOR]=2.4 [95%Confidence Interval {CI}=1.0–5.8]) for those taking ≥1. Prevalence was not significantly different between patients using 0 and using ≥1 AEDs for both anxiety (19% versus 26%, aOR=1.1 [95%CI=0.6–2.2]) and subjective cognitive impairment (16% versus 21%, aOR=1.2 [95%CI=0.6–2.5]). Although prevalences of depression (13% versus 23%, aOR=1.6 [95%CI=0.8–3.2]) and anxiety (17% versus 31%, aOR=1.8 [95%CI=0.9–3.3]), but not subjective cognitive impairment (20% versus 18%, aOR=1.7 [95%=0.4–1.4]), differed significantly between patients not using and using levetiracetam, these associations were not independent. No significant differences were found between patients not using and using valproic acid on the three outcome measures.
CONCLUSION
After adjustment of confounders, only depression was associated with the use of AED’s. No such relation was found for anxiety or subjective cognitive impairment. Use of levetiracetam or valproic acid were not independently related to depression, anxiety or subjective cognitive impairment.