Introduction: Depression is the most common neuropsychological complication of stroke. It affects quality of life, prolongs hospitalization, and leads to more frequent doctor visits. The incidence of depression after stroke ranges from 18% to 33%. About 6–15% of patients develop epilepsy following stroke. Patients with post-stroke epilepsy tend to experience depression more frequently.

Objective: The aim of this study was to compare the incidence of depression during the first year after stroke in patients who developed epilepsy versus those who did not.

Patients and Method: We tested patients during the first year after stroke, treated at the Department of Neurology, General Hospital Nikšić, Montenegro. Two groups of 60 patients each were assessed: one group with post-stroke epilepsy and the other without epilepsy. Depression was measured using the Hamilton Depression Scale. Statistical analysis included mean values, t-test, and Chi-square test (χ²). A significance level of p < 0.05 was used for all tests.

Results: The incidence of depression after stroke was high among our patients. Depression prevalence in the post-stroke epilepsy group was 55%, while it was 26.7% in the group without epilepsy.

Conclusion: Patients with epilepsy have almost twice the incidence of depression compared to those without epilepsy after stroke (p < 0.05). These patients require special monitoring and more frequent follow-ups. Early detection of epilepsy and timely initiation of treatment with appropriate antiepileptic drugs, along with early management of depression, are important to prevent suicide and mortality and to improve quality of life.

 

post-stroke depression, post-stroke epilepsy

 

1. Dafer RM, Rao M, Shareef A, Sharma A. Poststroke depression. Top Stroke Rehabil. 2008;15(1):13–21. doi:10.1310/tsr1501-13.
2. Medeiros GC, Roy D, Kontos N, Beach SR. Post-stroke depression: A 2020 updated review. Gen Hosp Psychiatry. 2020;66:70–80. doi:10.1016/j.genhosppsych.2020.06.011.
3. Guo J, Wang J, Sun W, Liu X. The advances of post-stroke depression: 2021 update. J Neurol. 2022;269:1236–49. doi:10.1007/s00415-021-10597-4.
4. Liu L, Marshall IJ, Pei R, Bhalla A, Wolfe CD, O’Connell MD et al. Natural history of depression up to 18 years after stroke: a population-based South London stroke register study. Lancet Reg Health Eur. 2024;40:100882. doi:10.1016/j.lanepe.2024.100882.
5. Hamilton M. A rating scale for depression. J NeurolNeurosurg Psychiatry. 1960;23(1):56–62. doi:10.1136/jnnp.23.1.56.
6. Nickel A, Thomalla G. Post-stroke depression: impact of lesion location and methodological limitations—A topical review. Front Neurol. 2017;8:498. doi:10.3389/fneur.2017.00498.
7. Ladwig S, Werheid K, Südmeyer M, Volz M. Predictors of post-stroke depression: validation of established risk factors and introduction of a dynamic perspective in two longitudinal studies. Front Psychiatry. 2023;14:1093918. doi:10.3389/fpsyt.2023.1093918.
8. Phan J, Ramos M, Soares T, Parmar MS. Poststroke seizure and epilepsy: a review of incidence, risk factors, diagnosis, pathophysiology, and pharmacological therapies. Oxid Med Cell Longev. 2022;2022:7692215. doi:10.1155/2022/7692215.
9. Zelano J, Holtkamp M, Agarwal N, Lattanzi S, Trinka E, Brigo F. How to diagnose and treat post-stroke seizures and epilepsy. Epileptic Disord. 2020;22(3):252–63. doi:10.1684/epd.2020.1159.
10. Kanner AM. Depression and epilepsy: a new perspective on two closely related disorders. Epilepsy Curr. 2006;6(5):141–6. doi:10.1111/j.1535-7511.2006.00125.x.
11. Jamil A, Csendes D, Gutlapalli SD, Prakash K, Swarnakari KM, Bai M, et al. Poststroke depression, an underrated clinical dilemma: 2022. Cureus. 2022;14(12):e32948. doi:10.7759/cureus.32948.
12. Elger CE, Johnston SA, Hoppe C. Diagnosing and treating depression in epilepsy. Seizure. 2017;44:184–93. doi:10.1016/j.seizure.2016.10.018.
13. Myint PK, Staufenberg EFA, Sabanathan K. Post-stroke seizure and post-stroke epilepsy. Postgrad Med J. 2006;82(971):568–572. doi:10.1136/pgmj.2005.041426.
14. Yang Y, Yang M, Shi Q, Wang T, Jiang M. Risk factors for depression in patients with epilepsy: a meta-analysis. Epilepsy Behav. 2020;106:107030. doi:10.1016/j.yebeh.2020.107030.
15. Huang J, Zhou FC, Guan B, Zhang N, Wang A, Yu P, et al. Predictors of remission of early-onset poststroke depression and the interaction between depression and cognition during follow-up. Front Psychiatry. 2019;9:738. doi:10.3389/fpsyt.2018.00738.
16. Volz M, Ladwig S, Werheid K. Gender differences in post-stroke depression: a longitudinal analysis of prevalence, persistence and predictive value of known risk factors. Neuropsychol Rehabil. 2021;31(1):1–17. doi:10.1080/09602011.2019.1648301.
17. Kim HJ, Park KD, Choi KG, Lee HW. Clinical predictors of seizure recurrence after the first post-ischemic stroke seizure. BMC Neurol. 2016;16(1):212. doi:10.1186/s12883-016-0729-6.
18. Wolf ME, Ebert AD, Chatzikonstantinou A. The use of routine EEG in acute ischemic stroke patients without seizures: generalized but not focal EEG pathology is associated with clinical deterioration. Int J Neurosci. 2017;127(5):421–6. doi:10.1080/00207454.2016.1189913.
19. Qin SK, Yang ZX, Guan ZW, Zhang JH, Ping X, Lu Y, et al. Exploring the association between epilepsy and depression: a systematic review and meta-analysis. PLoS One. 2022;17(12):e0278907. doi:10.1371/journal.pone.0278907.
20. Eskut N, Tamer P, Delibas HD, Erdogan E. Evaluation of a group of patients with epilepsy regarding sleep quality, fatigue and depression. Sanamed. 2020;15(3):285–91. doi:10.24125/sanamed.v15i3.452.
21. Maj M, Stein DJ, Parker G, Zimmerman M, Fava GA, De Hert M, et al.The clinical characterization of the adult patient with depression aimed at personalization of management. World Psychiatry. 2020;19(3):269–93. doi:10.1002/wps.20771
22. Guedes de Pinho L, Lopes MJ, Correia T, Sampaio F, Reis do Arco H, Mendes A, et al. Patient-centered care for patients with depression or anxiety disorder: an integrative review. J Pers Med. 2021 Aug 10;11(8):776. doi: 10.3390/jpm11080776.