Obciążenie pacjenta stanem poobjawowym w epilepsji: badanie obserwacyjne prospektywne w pojedynczym ośrodku
The burden of the postictal state in epilepsy: A prospective, single-center observational cohort study
W skrócie
Badacze zbadali, co czują pacjenci z epilepsją zaraz po ataku padaczkowym, używając specjalnego kwestionariusza. Okazało się, że prawie wszyscy pacjenci doświadczają nieprzyjemnych objawów po ataku, zwłaszcza zmęczenia i utraty pamięci, a niektórzy potrzebują ponad godzinę do pełnego powrotu do normy. Osoby z lękiem i depresją w okresach między atakami miały cięższe objawy poobjawowe, co sugeruje, że stan psychiczny pacjenta ma wpływ na to, jak długo czuje się źle po ataku.
Oryginalny abstract (angielski)
OBJECTIVE: The postictal state is a major yet underrecognized component of the epilepsy burden. We aimed to develop a structured patient-reported instrument to quantify postictal recovery, characterize its multidimensional burden, and identify demographic, clinical, psychiatric, and treatment-related factors associated with postictal severity and duration. METHODS: We conducted a prospective, single-center observational cohort study (Timone Hospital, Marseille, February 2025-March 2026). Consecutive patients aged ≥15 years admitted for scalp or stereo-EEG video-monitoring were included. Patients completed the Postictal Recovery Scale (PRS), an 11-domain questionnaire assessing fatigue, mood, sensory, motor, language, orientation, time perception, and postictal amnesia. Items were rated from 0 (severe impairment) to 3 (no symptoms), yielding a total score of 0-33. Internal consistency was assessed using Cronbach's alpha. Associations between PRS scores, subjective postictal duration and covariates were analyzed using group comparisons, correlations, and regression models. RESULTS: Of 107 enrolled patients, 96 were included. PRS showed good internal consistency (Cronbach's α = 0.79). 96% of patients reported experiencing postictal symptoms, with fatigue (80%) and postictal amnesia (79%) being the most frequent and severe manifestations. Recovery exceeded 1 h in 21% of patients. Greater postictal impairment was associated with higher interictal anxiety (Spearman ρ = -0.32, p = 0.0018) and depressive symptoms (Spearman ρ = -0.40, p = 0.0001), whereas demographic, epilepsy-related, and treatment variables showed no significant associations. Altered postictal time perception was reported by 40% of patients and was associated with disorientation, but not postictal psychiatric symptoms. Subjective postictal duration was longer than subjective ictal duration (Wilcoxon test, p < 0.0001). SIGNIFICANCE: The postictal state is a frequent and multidimensional patient-reported experience. Greater postictal severity, particularly concerning anxiety and depression, is associated with interictal psychiatric comorbidity, while altered temporal experience emerges as a distinct dimension of postictal dysfunction. These findings support integrating postictal measures into clinical practice and trials.