Nov 15, Epilepsy is not a mental illness. Learn the relation between seizure frequency, AEDs, and mental illness, as well as ways to get help. This paper outlines a spectrum of mental health presentations, including Other conditions that could be commonly misdiagnosed for epilepsy include but are. Mental health and behavioral problems are among the many issues that can affect children with epilepsy. As with other manifestations, epilepsy's psychological.
and Other Mental Health Disorders Epilepsy
Dysphoric events, characterized by irritability, with or without bursts of fury, were considered by him the most frequent psychiatric disorder in PWE. Depression, anxiety, headache, and insomnia were very frequent complementary symptoms, although euphoric mood was less common [ 41 ].
More recently, the introduction of advanced techniques of neuroimaging, like Positron Emission Tomography PET , Magnetic Resonance Imaging MRI , and the spectroscopy, combined with animal models and refined behavioral tests, made it possible the identification of common physiopathological mechanisms to both the epilepsies especially TLE and psychiatric disorders especially major epression.
There are few community-based studies on prevalence of psychiatric conditions in PWE. Most of these studies involve specific epileptic populations, in tertiary centers for attention to PWE.
Recently, Tellez-Zenteno et al. The great variability of results obtained has been ascribed to differences in the methodology applied and in populations studied. Psychiatric assessment can be made basically by two types of interviews: Non-structured interviews have been progressively replaced by structured interviews in the last years, to obtain a greater diagnostic accuracy. Structured interviews are composed by a set of key questions intending the fulfillment of well-defined diagnostic criteria included in the Diagnostic and Statistical Manual, Fourth Edition DSM-IV.
Results obtained by self-applicable tests tend to be overrated regarding prevalence of psychiatric disorders. Nevertheless, studies of lifelong prevalence of psychiatric disorders in PWE point to upper indices, compared to those found in general population [ 59 ]. For a comparison between several studies, see Tables 1 and 2. In community-based studies Table 1 , prevalences varied between 5.
Only one study Davies et al. Regarding studies of selected populations performed in tertiary centers, in general as part of a presurgical evaluation , prevalence varied between 6. Clearly, patients with difficult-to-control seizures, and especially those studied with structured interviews, trend to show increased frequencies of psychiatric comorbidities. Prevalence of psychiatric comorbidities in PWE.
Prevalence psychiatric comorbidities in PWE. Studies in selected populations. Many papers have been demonstrated that patients with TLE have an increased risk for psychiatric disorders, when compared to patients with other non-neurological chronic diseases [ 7 , 38 , 54 , 60 ]. Notwithstanding, it is still controversial if patients with TLE have increased risk for development of a mental disorder when compared with patients with other types of epilepsy.
It is possible that greater prevalence of psychiatric disorders in patients with TLE could depict just the dominant prevalence of TLE related to other epilepsies [ 63 ]. Despite this conjecture, it is plausible to believe that the same neuronal circuitries involved in the physiopathogenic mechanisms of TLE are also responsible for the production of psychiatric symptoms [ 15 ]. Purposed mechanisms for this frequent association could be arbitrarily divided in clinical, biological and environmental causes.
Regarding clinical factors, it has been enrolled: Biological factors concern chemical and structural changes in the Lymbic System circuitry, the site of processing of behavior and emotions [ 14 ]. Environmental factors possibly involved with psychiatric comorbidities in epilepsy include: In a prospective study achieved in the New York University, Devinsky et al.
Neither other factor frequency of seizures, localization, age, gender, marital status, duration and type of seizure, or number of DAE was predictor for quality of life [ 65 ].
PWE have a significantly increased risk for suicide related to general population. Two big studies, made in Canada [ 9 ] and Denmark [ 10 ], showed that PWE has 2 to 3 times more risk of suicide than control individuals.
Danish study found a risk of suicide even greater between epileptic patients with a specific comorbidity: Main neurobiological risk factors for depression in PWE that has been studied are: Regarding lateralization, Hurwitz et al. In this study, seizures yielded by the right hemisphere were followed by laughter and seductive behavior.
Other theory hypothesizes that a seizure activity in the non-dominant hemisphere could result in neglect of negative emotions [ 63 ]. A complex interaction between several factors would be employed in this association. Patients with a left-sided temporal focus presented more depressive symptoms as well as a bilateral inferior frontal lobe hypo metabolism. Victor off et al. It has not been found any correlation between current affective state and metabolism in the frontal lobes, but it was interesting to observe that a history of depressive episodes identified by SCID significantly correlated with a left frontal lobe hypo metabolism.
Contrarily, a right-sided focus was inversely associated to frontal dysfunction and dysphoria non-significant results. Our group studied 97 patients with TLE regarding risk factors for affective disorders [ 74 ]. A positive family history of psychiatric disorders O. This article reinforced the importance of biological factors, specifically genetic and anatomical substrates, for the development of humor disorders in PWE. Few studies evaluated the association between hippocampal volume loss, depression and epilepsy.
Another study also identified an association between higher scores for depression and increased volume of left hippocampus, in patients with right hippocampal sclerosis [ 76 ].
The risk factors pointed for the association between epilepsy and anxiety are: Frequency of seizures was associated to anxiety in some works [ 80 , 81 ], but this is not an unanimity [ 82 ]. Studies combining PET with electrophysiological data indicate the right temporal lobe as the main structure responsible for pathogenesis of anxiety in epilepsy [ 83 ].
Probably, more than the frequency of seizures, fear of falling down or to die is the real critical factor for the development of anxiety in PWE. Regarding age, minimal effects were observed, although a late onset of epilepsy could be associated with higher degrees of anxiety [ 85 ]. Risk for anxiety seems to be greater in focal epilepsies especially TLE than in generalized epilepsies [ 86 ]. Higher indices of anxiety were found in patients with poor pharmacological control of their seizures [ 87 , 88 ].
An important factor linked to anxiety in PWE is the stigma perception [ 89 , 90 ], and this factor is heavier in young patients [ 83 , 91 ]. Literature regarding risk factors for psychotic disorders in epilepsy is highly controversial, and most studies are restricted to interictal psychosis [ 92 ].
TLE is the epilepsy most associated with psychosis in almost all case series. Major criticism to these studies is that their results may reflect just the higher prevalence of TLE in the community. Severity of epilepsy is one of the most important risk factors for psychosis, and it could be measured by duration and multiplicity of seizures, history of status epilepticus, and poor clinical response to treatment [ 40 ].
Flor-Henry [ 93 ] originally suggested that left temporal lobe dysfunction was a risk factor for schizophreniform psychosis. Psychotic epileptic patients showed and increased blood flow in the superior temporal gyrus, during activation, related to the other groups. Psychotic patients showed significant reduction of NAA in the left temporal lobe, with a more accentuated phenomenon observed in epileptic patients.
PWE showed bilateral volume reduction, whereas psychotic patients had a more prominent atrophy of the left amygdalohippocampal complex. Interictal psychosis seems to be different from schizophrenia, especially because interictal psychosis courses with more affective symptoms and has a better prognosis.
Although hippocampal alterations could be related to both disorders, bilateral increase of amygdales with less volumetric changes in hippocampi is typical of interictal psychosis, suggesting a great difference between both conditions. This hypothesis was supported by a recent study, with 26 patients with epileptic psychosis, 24 non-psychotic patients with TLE, and 20 normal controls. Psychotic patients had significant bilateral increases of amygdales, in comparison with the other groups.
These findings were not correlated with lateralization of the focus, and neither with the duration of epilepsy [ 96 ]. It is demonstrated that some specific humor and behavioral disorders may show a bidirectional relation with the onset of epileptic seizures, namely, a psychiatric diagnosis may precede onset of seizures, especially in three situations: Case-control studies [ 97 , 98 ] as well as longitudinal studies [ 99 ], in children, showed an increased risk of 2.
Three controlled studies assessed the temporal relation between depression and epilepsy. One population-based case-control study found a 7-fold increased risk for and adult with depression to develop epileptic seizures, ompared to normal individuals. The risk increased to fold with focal epilepsies [ 49 ]. Data from these two studies were confirmed in a population-based controlled study, proceeded in Island, with patients above 10 years of age, with a first non-provoked seizure or newly diagnosed epilepsy, and controls: This same atudy showed that a suicide temptation is associated with a 3.
This bidirectionality suggests a common underlying susceptibility to epilepsy and humor disorders. Literature is plentiful of studies on molecular and cellular biology and anatomy of the brain in both diseases [ ].
Thosemechanisms are strongly interconnected, and functional and structural alterations in one disease may give rise to the other. One of the best studied models in TLE uses convulsant substances, like kainate and pilocarpine, in general, systemically injected. After induce a status epilepticus in the animal, in this model, it follows a period of latency along some weeks, with further development of spontaneous seizures [ ]. Other experimental model utilized is the electrical kindling, but this method does not seem to reproduce the typical physiopathological events of TLE, compared to the pharmacological method.
With kindling, seizures do not occur spontaneously, a hippocampal sclerosis does not develop, and there is no latency period between initial precipitant injury and the development of seizures. Recently, Mazaratti et al.
Two to four weeks after application of 84 subconvulsant electrical stimuli each five minutes in ventral hippocampus of adult Wistar rats, the authors applied two tests: Immobility in the tank on FST is equivalent to depression, as the animal does not show any initiative to escape in a stress situation.
The second test aims to reproduce the loss of ability to seek pleasure, a frequent ymptom in depression. The study showed that rats submitted to kindling exhibited a significant increase in time of immobility on FST, associated to a loss of preference of sweet taste, compared to controls. The authors concluded that the alterations in neuronal plasticity caused by kindling would be followed by a depressive behavior. The role of neurotransmitters in the physiopathologic mechanisms of humor disorders is recognized since some decades ago [ ].
The roles of gama-aminobutyric acid GABA and glutamate in epileptogenesis were already demonstrated in several studies in animals and humans. In this model, mutated animals are highly sensible to auditory stimuli, to which they answer with generalized tonic-clonic seizures.
Moreover, GEPRs show endocrinologic changes similar to those identified in depressive patients: Defective arborizations of noradrenergic and serotonergic circuitries were observed in those animals. An increase in the levels of these neurotransmitters could prevent seizures, whereas diminished levels have the opposite effect [ ]. One classic study showed that fluoxetine, a selector synaptic serotonin reuptake inhibitor, provoked a dose-dependent reduction in the frequency of seizures in GEPRs, which correlated with extracellular thalamic serotonin concentrations [ ].
Animal serotonergic transmission was demonstrated in the brain of depressed patients [ , ], the same feature found in studies with PET, in patients with TLE [ , ]. In a more recent study, Hasler et al. Beyond a decreased binding to 5-HT1A receptors in the epileptic focus, patients with major depression exhibited a more extensive reduction in binding, involving non-lymbic areas, distant from the epileptic focus.
This element may influence both neuronal electrical activity and memory and behavior functions, which are directly related to hippocampus in its connections. Changes in BDNF are associated to hippocampus atrophy, alterations in memory, and temporary amygdalar hypertrophy, with alteration in fear process.
Moreover, studies with PET suggest a glucose hypometabolism in temporal and frontal lobes in the TLE-depression association [ ]. A functional polymorphism of BDNF gene, the Val66Met, has been studied as a predisposition factor for many neurological and psychiatric disorders, with variable results. Notwithstanding, depression, anxiety, psychosis and eating disorders have been often associated to the presence of Val66Met polymorphism in the BDNF gene [ ].
A recent meta-analysis affirmed the association of Val66Met to substance-related disorders, eating disorders, and schizophrenia [ ]. Our results agreed with several other studies showing that low transcriptional activity 5-HTT genotypes are associated with neuropsychiatric disorders, such as depression, suicidal behavior, attention deficit hyperactivity disorder, and personality disorder [ ].
There is a growing evidence for psychiatric comorbidities in epilepsy. Researchers from Rutgers University wanted to develop a screening tool to detect sleep apnoea in patients with epilepsy as it is known that sleep apnoea can increase read more.
Sleep disorders in people with epilepsy can exacerbate their symptoms and often remains undiagnosed. Now researchers from Rutgers University have developed a tool to help neurologists identify people with obstructive sleep apnoea whose epilepsy may be magnified by their sleep disorder.
Identifying sleep disorders and treating them can help in seizure control in some people. At the moment specialists have read more.
A team of researchers from the Royal Holloway have found that one particular protein which was known to be implicated in both epilepsy and bipolar disorder seems to be the key linking the treatment of both disorders.
Sodium valproate which is associated with an increased chance of birth defects if taken during pregnancy, is used in the treatment of both read more. Researchers at the University of California uncovered a potential new link between epilepsy and multiple sclerosis MS , an auto-immune disease where the immune system attacks the myelin sheath that covers nerve fibres.
This new finding could lead to potential new treatments against epilepsy as well as MS. The study that was published in the journal Neuroscience, showed that people with read more. Some forms of epilepsy such as nodding syndrome, could be autoimmune in nature according to a study published in the journal Science Translational Medicine. The side and site of epilepsy surgery affects its psychological outcome according to a new study published in the journal Epilepsy and Behavior.
This finding highlights the importance of considering psychological changes that may occur as a result of epilepsy surgery, on an individual patient basis. According to the authors, further studies are needed to identify potential risk factors that read more.
Young people with temporal lobe epilepsy are more likely to have mental health conditions than those with other types of epilepsy, a new study published in the scientific journal Epilepsy and Behavior suggests. According to the authors Dr William Schraegle and Dr Jeffrey Titus, these findings reinforce the relationship between depression and temporal lobe epilepsy. In order to determine whether read more. Restless leg syndrome RLS or the urge to move the legs, is more common in people with epilepsy than the general public, according to a study published in the scientific journal Epilepsy and Behavior.
The authors suggest that the syndrome could in fact be an early warning indicator for seizures. The study also showed that RLS seems to occur more read more. A major receptor found in the brain called PAR1 is involved in the regulation of anxiety-related behaviour, suggests a recent study, published in the journal Epilepsy and Behavior. The study used an animal model of temporal lobe epilepsy TLE , the most common type of focal epilepsy in adults, which is often associated with psychiatric complications such as depression and anxiety.
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Feb 4, Psychotic or other psychiatric symptoms occur after a seizure or, more . The incidence of developing bipolar affective disorder in epilepsy is. Jun 6, People with epilepsy have higher rates of autism, attention deficit hyperactivity disorder (ADHD) symptoms, or depression than adults without. May 1, Although not a psychiatric disorder, epilepsy has a psychiatric aspect. stroke, poisons, drug overdoses, and other neurological disorders.