Participants and procedures
This is a cross-sectional case–control study. All participants included 139 patients admitted from March 2021 to June 2021 at the Assiut University Hospital adult outpatient epilepsy clinic. The following inclusion criteria are fulfilled for all enrolled patients: (1) age between 18 and 50 years and (2) matching the clinical, imaging, and electroencephalographic (EEG) diagnosis symptoms of idiopathic epilepsy.
In our epilepsy clinic, clonazepam is a good choice for seizure control in people with epilepsy that are refractory to various antiepileptic medications and is mostly used as add-on medication to the other AED. Through the indirect method, we studied clonazepam and evaluated its clinical efficacy compared to carbamazepine and valproate alone. In this research, 99 epileptic patients with AED and 40 epileptic patients without AED (new diagnosis with epilepsy) were assigned as the control group. So, the participants were classified into different groups based on the drugs administered: group 1, carbamazepine; group 2, valproate; group 3, carbamazepine and clonazepam; group 4, valproate and clonazepam; and group 5, epileptic patients without AED.
Measure
After written informed consent was obtained from the participants, the studied samples had the following.
A detailed interview with personal demographic data
A detailed interview with personal demographic data, such as age, sex, education, history of occupation, past medical history, family history, and medical, neurological, and psychiatric disorders, was conducted.
Information on the clinical features of epilepsy
Information on the clinical features of epilepsy, including the duration of epilepsy, the duration of drug intake, the frequency of seizures, the type of seizure, and the use of AED, was collected from all participants. Neuroimaging findings were obtained and analyzed to confirm the absence of structural changes.
Intelligence assessment using the Arabic version of the Wechsler Adult Intelligence Scale (WAIS)
The test consists of six verbal subtests and five performance subtests. All of the samples studied were obtained in accordance with the Deterioration Index. In each subtest, we calculated the score and got the quotient of verbal intelligence (VIQ), performance intelligence quotient, and full intelligence quotient. Cognitive function was assessed at least 1 week after the last attack in epileptic patients to avoid interference from transient cognitive impairment after seizures.
Conventional EEG study
Eight-channel standard wakefulness EEG was conducted using the Nihon Kohden system model (4217). With hyperventilation and photostimulation for each patient, monopolar, bipolar, and double-distance montages were performed. In terms of background activity and the presence of any epileptogenic activity, EEG tracings were carefully analyzed.
The Structured Interview for the Five-Factor Personality Model (SIFFM) [16]
The Five-Factor Personality Model is a model based on general language personality descriptors, and its theory suggests five broad dimensions that are commonly used to describe human personality [11, 12]. The five factors defined by the acronyms OCEAN or CANOE were openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism.
Assessment of the Hamilton Depression Rating Scale [17]
It is a clinical rating scale for assessing depression severity. The total score is obtained by summing each item’s score (0–4) (symptom is absent, mild, moderate, or severe). Scores can range from 0 to 54 for the 17-item version. Moreover, total scores of 0 to 7 do not indicate depression, scores of 8 to 13 indicate mild depression, scores of 14 to 18 indicate moderate depression, scores of 19 to 22 indicate severe depression, and scores of 23 or more indicate very severe depression.
The Hamilton Anxiety Rating Scale [18]
The Hamilton Anxiety Rating Scale [18] is a clinician-rated scale intended to analyze the severity of anxiety. The scale consists of 14 items. Each item is scored on a scale from 0 (not present) to 4 (severe), with a total score range of 0–56, wherein the overall score is 0–13 = normal, 14–17 = mild anxiety, 18–24 = moderate anxiety, and 25–30 = severe anxiety.
The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) [19]
The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) [19] is a psychological test with a range of symptoms of psychopathology and personality traits that are maladaptive. It is designed with 10 clinical scales that evaluate 10 major categories of abnormal human behavior and four validity scales that assess the test’s accuracy. The clinical scales include the following: 1, hypochondriasis (Hs); 2, depression (D); 3, hysteria (Hy); 4, psychopathic deviation (Pd); 5, masculinity–femininity (Mf); 6, paranoia (Pa); 7, psychophrenia (Pt); 8, schizophrenia (Sc); 9, hypomania (Ma); and 10, social introversion (Si). According to the T-score, more than 65 responses were considered symptomatic in each clinical subscale, 45–65 borderline, and less than 45 normal.
Statistical analysis
Data were gathered and analyzed using Statistical Package for the Social Science (SPSS, version 26). Continuous data were expressed as mean ± standard error, whereas nominal data were expressed as frequency (percentage). In this study, the chi-square test was used to compare nominal data, whereas the Kruskal-Wallis test was used to compare continuous data from different groups. The correlation model was done by Spearman coefficients. The confidence level was maintained at 95%, and the P value was considered significant if it was < 0.05.