Psychiatric Disorders in Epilepsy

Question 1

How many people with epilepsy have a lifetime history of psychiatric disorders?

Answer 1

1 in 3 (35.5%)

(2-5x increased risk)

Question 2

How would you describe the relationship between psychiatric disorders and epilepsy?

Answer 2

Bidirectional

Question 3

What is thought to be responsible for the bidirectional association between seizures and psychiatric symptoms?

Answer 3

Neurochemical and structural changes

Question 4

What epilepsy-related factors are associated with increased risk of psychiatric disorder?

Answer 4

▪️Generalised epilepsy
▪️Higher seizure frequency
▪️Outpatient and A&E visits
▪️Hospitalisation for epilepsy
▪️Older age

(proxys for more severe epilepsy?)

Question 5

Which antiseizure medications have been associated with adverse psychiatric symptoms?

Answer 5

▪️Barbiturates
▪️Benzodiazepines
▪️Levetiracetam
▪️Topiramate
▪️Zonisamide
▪️Vigabatrin

Question 6

What medications have been associated with positive mood-stabilising effects?

Answer 6

▪️Valproic acid
▪️Carbamazepine
▪️Oxcarbazepine
▪️Lamotrigine

Question 7

What effects might lamotrigine have on psychiatric disorder in epilepsy?

Answer 7

▪️Mood-stabilisation
▪️Antidepressant

Question 8

Which antiseizure medications have been associated with anxiolytic effects?

Answer 8

Pregabalin and gabapentin

Question 9

How might withdrawal of antiseizure medications affect psychiatric disorder in epilepsy?

Answer 9

May lead to re-emergence of preexisting mood/anxiety disorders