Journal international de neuroréadaptation

Epilepsy and its Management in Relation to Psychiatry

Abstract

Amir Mufaddel

The relation between psychiatry and epilepsy remains one of the topics that have been continuously attracting attention in medical literature since the time of Hippocrates. Forced normalization was later conceptualized when biological treatment for psychiatric disorders was developed. Recently, several reports were published regarding possible adverse psychiatric effects of antiepileptic medications. The picture is further complicated by the fact that psychotropic medications, which may be used for treatment of psychiatric disorders in epilepsy, can have negative effects on seizure control. This paper aimed to review psychiatric presentations in individuals with epilepsy and the adverse psychiatric effects of antiepileptic medications. The paper also briefly discusses available treatment options with regards of better psychotropic treatment options. Recent developments in this field led to the observation that psychiatric symptoms, in relation to seizure, can be categorized into the following types pre-ictal, post-ictal, inter-ictal and ictal symptoms. Depression and anxiety are commonly associated with epilepsy and can occur as pre-ictal, ictal, post-ictal or inter-ictal symptoms. Depression can be severe and suicidal behavior has been reported as one of the common psychiatric associations with epilepsy and has also been linked to use of some antiepileptic drugs. Psychosis can occur as an acute or chronic form. Transient pleomorphic postictal psychosis particularly observed in those with hippocampal sclerosis. There is an increased risk of developing schizophrenia and schizophrenia-like psychosis in patients with epilepsy. Psychiatric symptoms can also emerge during use of some of the antiepileptic drugs. Adverse psychiatric events include depression, psychosis, suicidal risk, and cognitive impairment. Some of the psychotropic medications are known to be epileptogenic. Therefore, selection of psychotropic medications should be based on their possible effects on seizures and those known to be epileptogenic should be avoided.