Recognizing psychiatric manifestations is an area that needs improvement. Once symptoms are identified, thefollowing questions arise
:Are the symptoms related to the occurrence of seizures (preictal, ictal, postictal)?Are the symptoms related to antiepileptic drugs (AEDs)?Is the onset of symptoms associated with the remission of seizures in patients who had previously failed torespond to AEDs?Because of the phenomenology of epilepsy, the close association between epilepsy and psychiatry has a longhistory. The traditional approach to epilepsy care has been to focus on the seizures and their treatment.Concentrating only on the treatment of the seizures, which occupy only a small proportion of the patient's life, doesnot seem to address many of the issues that have an adverse impact on the quality of life of the patient with epilepsy.Sackellares and Berent stated that comprehensive care of the epileptic patient requires "attention to thepsychological and social consequences of epilepsy as well as to the control of seizures."
Although undoubtedly important in the care of the patient with epilepsy, advances in neurologic diagnosis andtreatment tended to obscure the behavioral manifestations of epilepsy until Gibbs drew attention to the highincidence of behavioral disorders in patients withtemporal lobe epilepsy.
Frequency of psychiatric disorders in patients with epilepsy
Vuilleumier and Jallon estimated that 20-30% of patients with epilepsy have psychiatric disturbances.
Tucker reported that 70% of patients with intractable complex partial seizures had 1 or more diagnoses consistent withDiagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R); 58% of these patients hada history of depressive episodes, 32% had agoraphobia without panic or other anxiety disorder, and 13% hadpsychoses.
Torta and Keller reported that the risk of psychosis in populations of patients with epilepsy may be 6-12 times that of the general population, with a prevalence of about 7-8% (in patients with treatment-refractory temporal lobe epilepsy,the prevalence has been reported to range from 0-16%).
Differences in the rates may result from differences inpopulations studied, time periods investigated, and diagnostic criteria.The most common psychiatric conditions in epilepsy are depression, anxiety, and psychoses.
[12, 13, 14, 15, 16, 17]
(Seethe Table below.)Table. Prevalence Rates of Psychiatric Disorders in Patients With Epilepsy and the General Population (2007data)
(Open Table in a new window)
Psychiatric DisorderControlsPatients With Epilepsy
Major depressive disorder10.7%17.4%Anxiety disorder11.2%22.8%Mood/anxiety disorder19.6%34.2%Suicidal Ideation13.3%25.0%Others20.7%35.5%The psychiatric symptoms characteristic of the neurobehavioral syndrome of epilepsy (ie, Morel syndrome) tend tobe distinguished in the following ways:Atypical for the psychiatric disorder EpisodicPleomorphic
A 27-year-old man with history of primary generalized epilepsy not controlled with medical therapy presented to athird neurologist for evaluation. His generalized tonic-clonic seizures began 7 years ago. The patient had a complete
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