Amara Gul  ( Department of Applied Psychology. The Islamia University of Bahawalpur. Pakistan )
Saima Mehreen  ( Department of Applied Psychology. The Islamia University of Bahawalpur, Pakistan. )

Objective: To assess the effectiveness of carbamazepine on emotional intelligence and mindfulness in patients with epilepsy.

Method: The repeated-measure case-control study was conducted at the Nishter Hospital, Multan, Bahawal Victoria Hospital, Bahawalpur, and Civil Hospital, Bahawalpur, Pakistan, from April 2017 to March 2018, and comprised  of patients with partial epilepsy and healthy controls. Baseline data was collected using BarOn Emotional Quotient Inventory and Cognitive and Affective Mindfulness Scale-Revised. Subsequent data was collected twice in titration and maintenance phases during carbamazepine therapy for patients, while the controls were on no medication. Data was analysed using SPSS 20.

Results: Of the 80 subjects, 40(50%) were cases with a mean age of 37.92±9.09 years, and 40(50%) were controls with a mean age of 37.80±9.00 years. The patients had significantly lower emotional intelligence and mindfulness compared to the controls (p<0.001). Patients showed improved emotional intelligence and mindfulness after the therapy compared to their baseline scores (p<0.05).

Conclusion: Carbamazepine was found to be effective in improving emotional intelligence and mindfulness in patients with epilepsy.

Keywords: Epilepsy, Carbamazepine, Mindfulness, Cognition, Emotional intelligence. (JPMA 71: 1103; 2021)

DOI: https://doi.org/10.47391/JPMA.754

 

Introduction

 

Epilepsy is one of the most common neurological disorders, affecting 50 million people around the world. Majority of such people live in low and middle income countries (LMICs). Epilepsy is characterised by partial or generalised recurrent seizures.¹ Carbamazepine (C15H12N2O) is a recommended drug to treat seizures in epilepsy. It acts through two potential mechanisms: reduction of poly-synapse-related responses, and blockage of post-tetanic potentiation. Alongside, it acts as an antidepressant through induction of cytochromes, like P450 3A4, P450 1A2, P450 2B6, and reduction of disorganised electrical activity in the central nervous system (CNS).² The effectiveness of carbamazepine in reduction of behavioral and psychological disorders in patients with epilepsy is a unique characteristic of carbamazepine as an antiepileptic drug.³ In recent years, mindfulness-based interventions have gained popularity for the treatment of behavioural and psychological symptoms in epilepsy patients. Studies have demonstrated that mindfulness-based interventions are associated with functional and structural changes in brain, and improve quality of life (QOL), anxiety and depression in epilepsy patients.^4,5 It has been found that people with low mindfulness ability show weak activation in amygdala. In contrast, hyper-activation was observed in prefrontal cortex, anterior cingulate cortex and insular cortex during emotion processing.⁶ A recent study suggested that primary emotion processes, such as empathy, are positively correlated with trait-like ability, i.e., mindfulness, in healthy subjects.⁷ Further research demonstrated that people with adequate mindfulness ability are better at stress management compared to those with low mindfulness.⁸ Also, behavioural studies have demonstrated that cognitive functioning and emotional intelligence (EI) are correlated, especially when emotional information is required to resolve a cognitive task.⁹ It has been suggested that people with higher EI are better at recovery from stress.¹⁰ These variables are interlinked in studies with people having psychiatric disorders. For instance, it was found that cognitive performance of people with mental health problems is interfered with in the presence of emotional material.¹¹

No study has examined the effect of carbamazepine on mindfulness and EI in patients with epilepsy. The current study was planned to fill the gap in literature by examining whether any differences exist on EI and mindfulness ability between healthy individuals and epilepsy patients, and to explore if carbamazepine exerts any effect on EI and mindfulness ability of epilepsy patients.

 

Patients and Methods

 

The repeated-measure case-control study was conducted at the Nishter Hospital, Multan, Bahawal Victoria Hospital, Bahawalpur, and Civil Hospital, Bahawalpur, Pakistan, from April 2017 to March 2018. After approval from ethics review board of the Islamia University, Bahawalpur, the sample size was calculated with anticipated effect size 0.5, desired statistical power 0.5 and probability level 0.05. The sample was raised using purposive sampling technique from among the newly-diagnosed patients with partial epilepsy in whom the diagnosis was confirmed with electroencephalogram (EEG). A matching group of healthy individuals were also included as controls. Patients were included if they had at least two partial seizures with or without secondary generalised seizure in the year before the testing session was done, had awareness intact or impaired, and with motor movements, such as automatism, non-motor symptoms like autonomic symptoms, and were not taking any medication.

Patients were excluded if they were using any medication, had antiepileptic drugs for more than two weeks, had CNS-related infection or disease, had any neurological or medical disease, or had idiopathic generalised epilepsy. Patients who were prescribed carbamazepine as a monotherapy were included in the study with eight weeks of titration and twenty weeks of maintenance period. Healthy individuals were included if they had no previous history or present symptoms of any neurological and psychiatric disorder.

The patients were evaluated thrice in the hospital on cognitive tests during the study; at baseline; at the completion of the titration phase; and at the completion of maintenance phase.

The dose during the titration period ranged from 100mg/day to 600mg/day, whereas in the maintenance period, it ranged from 600mg/day to 1200mg/day.

Cognitive testing was performed by a clinical psychologist blinded to the study objectives. Cognitive and Affective Mindfulness Scale-Revised (CAMS-R)¹² was administered to assess mindfulness. It is a 12-item scale to assess four domains of mindfulness, which are Present Focus (PF), Acceptability (ACC), Awareness (AW) and Attention (ATT). Each one is scored on a 4-point Likert scale, where 1 = not at all and 4 = almost always. Higher score shows greater mindfulness (MF) ability, and the maximum score is 48. The scale has good internal consistency, convergent and discriminant validity with other measures of MF, distress, and emotion regulation. BarOn Emotional Quotient Inventory (BarOn EQ-i)¹³ was administered to assess EI. The subject had to respond to statements on a 5-point scale. The scores are interpreted as 70 = atypical under-developed EI; 70-79 = extremely under-developed EI; 80-89 = under-developed EI; 90-109 = adequate EI; 110-119 = well-developed EI; 120-129 = extremely well-developed EI; 130 and above = atypical well-developed EI. It is a valid and reliable instrument to measure EI with an internal consistency of 0.97. Reliability for the current study was 0.95. In order to control practice effect, the order of presentation for CAMS-R and BarOn EQ-i was completely randomised across the sample on each assessment.

Data was analysed using SPSS 20. Descriptive statistics were used demographic data. Group differences in terms of EQ-i scores were assessed through multivariate analysis of variance (ANOVA) with dependent variables. Repeated-measure ANOVA was used to see whether the intervention exerted any difference on scores pertaining to each component of EQ in the patient group. P<0.05 was considered significant.

 

Results

 

Of the 80 subjects, 40(50%) were cases with a mean age of 37.92±9.09 years, and 40(50%) were controls with a mean age of 37.80±9.00 years (Table-1).

The patients had significantly lower EI and MF scores compared to the controls (p<0.001) in all subscales (Table-2).

Within the patient group, there was significant improvement in EI and MF terms after the therapy compared to the baseline scores (p<0.05) (Table-3).

 

Discussion

 

Patients with epilepsy and healthy individuals responded differently on EI and MF scales. The patients had extremely under-developed EI and MF compared to the controls. The finding is consistent with earlier studies.¹⁴ Emotion recognition has also been found impaired in epilepsy patients.¹⁵ However, the current study showed an extended picture of EQ in terms of its components. The current study also showed that epilepsy patients had lower MF ability than the controls, and had lower PF, ACC, AW and ATT than the healthy individuals. This finding is consistent with previous research.^14,16 Disturbance in emotional behaviour is related with reduced synchronisation between signals from the neural network involved in emotion centres of the brain affected by epilepsy.¹⁷ Studies have suggested that maladaptive behaviours are associated with low EI in epilepsy patients.¹⁸ The current study revealed that carbamazepine therapy improved all components of EI and MF ability in the patients. The result is consistent with previous research.³ Along with excellent properties as an anti-convulsant, carbamazepine improves performance on mental tasks requiring attention and problem-solving skills. These results have implications in rehabilitation of epilepsy patients.

The current study has limitations, like a small sample size, and the sample being without very young and very old patients with epilepsy. As such, the generalisability of the findings are limited to a specific age group. Further research is recommended to examine various age groups in order to assess the efficacy of carbamazepine.

 

Conclusion

 

Carbamazepine was found to be effective in reducing EI and MF deficits in patients with partial epilepsy.

 

Disclaimer: None.

Conflicts of Interests: None.

Source of Funding: None.

 

References

 

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