Impulsivity and Seizure Frequency, but Not Cognitive Deficits, Impact Social Adjustment in Patients with Juvenile Myoclonic Epilepsy

Purpose: Despite growing evidence on the occurrence of poor psychosocial adjustment, to the moment there is no formal assessment of social adjustment (SA) using a validated instrument developed and standardized for this purpose in patients with juvenile myoclonic epilepsy (JME). We aimed to: (1) verify social adjustment in patients with JME with an objective scale and; (2) identify whether clinical variables, impulsiveness, and neuropsychological profile are associated with worse social adjustment.

Methods: We prospectively evaluated 42 patients with an unequivocal diagnosis of JME and 42 controls. The inclusion criteria for patients and controls included age range from 16 to 40 years and an estimated intelligence quotient (IQ) ranging from 85 to 110. One trained neuropsychologist administered the scales and tests in a standard sequence. Social Adjustment was evaluated by The Self-Report Social Adjustment Scale (Weissman & Bothwell, 1976), a 42-item scale, measuring performance in seven major areas: work; social and leisure activities; relationship with extended family; marital role as a spouse; parental role; membership in the family unit; and economic adequacy. Impulsivity was assessed by using the Temperament and Character Inventory (Cloninger, 2000). Patients with JME and control subjects were evaluated with a comprehensive battery of neuropsychological tests evaluating executive and memory functions. We evaluated the age at onset; time from onset to seizure control with antiepileptic drugs (duration of epilepsy); seizure control; frequency of myoclonic seizures; frequency of generalized tonic-clonic GTC seizures; frequency of absence seizures; family history of epilepsy; family history of psychiatric disorders; and personal history of psychiatric disorders.

Key Findings: The score on Global Social Adjustment was worse than controls (p = 0.001), especially on the factors: Work (p = 0.032); Extended Family (p = 0.005). Higher Novelty Seeking (NS) scores were significantly correlated with worse on Global (p = 0.002); Work (p = 0.001) and Leisure (p = 0.003). There was no correlation between cognitive performance and Social Adjustment Scale (SAS) factors. Higher seizure frequency--myoclonic (p = 0.005) and GTC (p = 0.035)--were correlated with higher scores on factor Work of SAS.

Significance: Our findings suggest that patients with JME have worse social adjustment in two relevant aspects of their lives--work and familiar relationship. In this series of patients with JME, higher seizure frequency and impulsive traits, but not cognitive performance, were correlated with worse social adjustment.