Patients With Epilepsy and PTSD Show Executive Attentional Overcontrol

Individuals with epilepsy that have posttraumatic stress disorder (PTSD) display overcontrol of executive attention and have difficulties with emotional inhibition, according to study findings published in the journal Epilepsy & Behavior.

The effects of PTSD on patients with epilepsy are not well understood. Previous studies have shown that PTSD can impair executive functions and memory. Researchers conducted a study to assess the cognitive effects in patients with drug-resistant epilepsy (DRE) who display signs of PTSD.

The study group consisted of 54 patients aged 18 to 54 with DRE, including 27 men and 27 women participants. The control group had 61 participants without long-term illness or psychiatric symptoms, including 43 women and 18 men participants.

All participants answered a questionnaire and performed the Attention Network Test (ANT) tasks to determine executive attentional control. Emotional inhibition was tested using the Go/No-Go task. 

The researchers used the Post-traumatic Stress Disorder Diagnosis Scale for DSM-5 (PDS-5) to assess PTSD symptoms. After completing the questionnaire, participants were interviewed by a psychologist according to the DSM-5 international guidelines.

Compared with the control group, there were lower attentional executive control scores among participants with epilepsy (t-test, -3.05; degrees of freedom [df], 109; P =.003). When evaluating groups with and without PTSD, however, compared with participants without PTSD, those with PTSD had improved executive attentional control (t-test, -2.26; df, 48; P =.028).

Compared with the control group, participants with PTSD also reported better executive attentional control, but the results were insignificant. 

When analyzing all participants with epilepsy, the researchers reported a negative correlation between PDS-5 score and attentional executive control (Pearson’s r, 0.361; P =.039). There was a positive relationship between PDS-5 and ANT task performances.

Errors in behavioral inhibition correlated with the severity of PTSD scores (Pearson’s r, 0.602; P =.023). Emotional bias measured using response times showed a negative correlation with hypervigilance (Pearson’s r, 0.571; P =.033).

Participants with more PTSD symptoms showed a faster response reaction time in an aversive condition in the Go/No-Go task. 

There were no major differences reported between patients with and without PTSD for anxiety or depression (P <.05).

There was a positive correlation reported for seizure anticipation among participants with more PTSD symptoms and those who were more alert. Compared with participants without PTSD, those with PTSD symptoms showed improved seizure control.

The researchers wrote, “Patients with epilepsy presenting PTSD symptoms seem to be characterized by attentional overcontrol and difficulties with emotional inhibition (towards anger-related stimuli).”

“These cognitive responses may be associated with hyperactive traumatic memory, which may promote difficulty in managing the threat of re-exposure to traumatic stimuli during inter- and peri-ictal period (epilepsy-specific PTSD symptoms),” they noted. “This cognitive profile could be explained by the maintenance of PTSD symptoms associated with fear and anxiety of seizure occurrence.”

Study limitations included the lack of formal validation of the questionnaires created and the differences and age and gender ratios between study groups. 

This article originally appeared on Neurology Advisor