Link between epilepsy and psychiatric disorders

EPILEPSY is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behaviour or sometimes convulsions, muscle spasms and loss of consciousness.

Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity from illness to brain damage to abnormal brain development can lead to seizures. Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signalling chemicals called neurotransmitters, or some combination of these factors. Having a seizure does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy. EEGs and brain scans are common diagnostic test for epilepsy

It is estimated that 20-30 percent of patients with epilepsy have psychiatric disturbances. Of those 58 percent of the patients have a history of depressive episodes, 32 percent have agoraphobia without panic or other anxiety disorder, and 13% have psychosis.

The risk of psychosis in patients with epilepsy may be 6-12 times that of the general population, with a prevalence of about 7-8 percent in patients with treatment - refractory temporal lobe epilepsy, the prevalence has been reported to range from 0-16 percent.

The most common psychiatric conditions in epilepsy are depression, anxiety, and psychoses.

See the table below of Prevalence Rates of Psychiatric Disorders in Patients with Epilepsy and the General Population, under headings: (a) Psychiatric Disorder, (b) Patients With Epilepsy Major depressive disorder 17,4% Anxiety disorder 22,8% Mood/anxiety disorder 34,2% Suicidal Ideation 25,0% Others 35.5% Because of this association, it is crucial to look for and assess for psychiatric condition in all individuals with epilepsy. Comorbid psychiatric illnesses must be treated concurrently with the epilepsy as the psychiatric condition can have detrimental effects to the patient out comes and quality of life. This is best done by a specialist psychiatrist, as drug to drug interaction are common and if not managed well will lead to non compliance. DISCLAIMER: This column contains information about mental health related issues. However, the information is not advice, and should not be treated as such. The writer accepts no responsibility for misuse and misrepresentation caused by the use or misunderstanding of this article. No warranties or assurances are made in relation to the safety and content of this article and attachments. Sender accepts no liability for any damage caused by or contained in any attachments. No liability is accepted for any consequences arising from this article. Dr S.M. Chirisa is a passionate mental health specialist who holds an undergraduate medical degree and postgraduate master’s degree in psychiatry both from the University of Zimbabwe. He is currently working as a Senior Registrar in the Department of Psychiatry at Parirenyatwa Group of Hospitals and is also the current national treasurer of the Zimbabwe Medical association (ZiMA). He can be reached at drsmchirisa@yahoo.com