Evaluation of pain sensitivity in epileptic patients

Purpose: The aim of this study was to evaluate central sensitization by means of clinical scales and quantitative sensory tests for patients who applied to Karadeniz Technical University Faculty of Medicine Farabi Hospital and were diagnosed with epilepsy according to the 2017 ILAE diagnostic criteria. Method: Considering the criteria, 35 epilepsy patients who applied to the Neurology Outpatient Clinic of Karadeniz Technical University Faculty of Medicine between June 2019 and March 2021, and 35 healthy individuals with similar demographic characteristics to the patient group were included in this prospective study. A quantitative sensory test (QST) protocol consisting of pressure pain threshold (PPT), temporal summation (TS) and conditional pain modulation (CPM) were applied to the patients and control groups. Central sensitization inventory (CSI) and pain sensitivity questionnaire (PSQ) were performed as clinical scales. Beck depression scale (BDI), fatigue severity scale (FSS), and Pittsburgh sleep quality index (PSQI) were used to evaluate depression, sleep disturbance and chronic fatigue symptoms that are known to be associated with central sensitization. According to CPM results, epilepsy patients were grouped as central sensitized (SaS+) and nonsensitized (SaS-). The QST and scale results of the groups were compared. Results: Thirty-five epilepsy patients and 35 healthy controls were included in the study. There was no significant difference between epilepsy patients and healthy groups in terms of age (p=0.865), gender (p=1,000), education (p=0.332), smoking (p=0.332) and body mass index (p=0.155). Central sensitization was detected in 17 (48.6%) of the epilepsy patients and in 3 (8.6%) of the healthy group. When QST results were compared for the patient and control groups, PPT values were found to be low (p=0.036) in the patient group, but no difference was found between the TS values. When clinical scale results were compared for SaS+ and SaSepilepsy patients and control groups, a significant difference was observed between vi CSI, PSQmodatare and PSQtotal values (p values 0.001, 0.016, 0.039, respectively). There was a significant difference between the groups in BDI distributions (p=0.001), and mild depression was detected in 35.3% of SaS+ epilepsy patients and 11.91% of SaS- epilepsy patients, whereas depression was not observed in the healthy group. Conclusion: Epilepsy and painful symptoms are the most common comorbidities. This can be explained by the central sensitization mechanisms playing a role in the pathophysiology of both diseases. In this thesis study, it was shown that pain sensitivity was statistically significantly increased in epilepsy patients compared to controls, with the difference in both pain threshold and central sensitization. In addition, it was thought that the detection of mild depression in clinical scales may be related to central sensitization, despite the absence of depressive complaints in epilepsy patients. In consideration of this information, this situation should be considered in the follow-up and treatment process of epilepsy patients. Keywords: Epilepsy, pain, central sensitization, quantitative sensory tests, central sensitization scales