A retrospective analysis of medical notes of a large unselected sample from the United States including 4,085 adults recently started on antiseizure medications showed that 1 in 6 individuals with epilepsy develops drug-related psychiatric side effects.26 Sodium channel blockers seem to be less frequently associated with psychiatric side effects,26 but there are no robust head-to-head trials providing strong evidence for that. Psychiatric comorbidities in epilepsy: We learned to recognize them; it is time to start treating them. and transmitted securely. A multicenter case-control study. the contents by NLM or the National Institutes of Health. Maiwald T, Blumberg J, Timmer J, et al. For people with epilepsy, there are many reasons to infer that mental health and related concerns may be more common than in people who do not have epilepsy. Assessment of adolescent mental health and behavioral problems in institutional care: discrepancies between staff-reported CBCL scores and adolescent-reported YSR scores. There is a consistent association between epilepsy and socioeconomic status with . Nevertheless, the management of these people can be challenging regardless of the causes. N. Jett received an annual honorarium for her work as Associate Editor of Epilepsia and is a member of the Editorial Board of Neurology. Understanding their nature and origins, however, is essential to addressing and resolving difficulties effectively. Premonitory symptoms in epilepsy. The odds of mental health comorbidity was 2.20 (95% CI: 2.02-2.39) for children and adolescents with epilepsy and 1.60 (95% CI: 1.48-1.73) for migraine, in reference to children and adolescents with LEF after adjusting for potential confounders. Full remission should always be the ultimate goal of the treatment of any psychiatric comorbidity in epilepsy. Epilepsy Currents, 2016; 16(4): 270-272. (2) Peri-ictal phenomena may be mischaracterized as underlying mood disorders. Another study identified insidious onset prodromal symptoms in 39% of patients; behavioral, mood and cognitive changes were most frequent. The burden of comorbidity in people with epilepsy is high. 9.2.1 Recognise that a diagnosis of epilepsy can have a significant adverse impact on a person's mental health and that people with epilepsy may feel socially excluded and stigmatised. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp. Stevelink R, Koeleman BPC, Sander JW, Jansen FE, Braun KPJ. Epilepsy is a costly and complicated international public health problem 1, 2 In addition to recurrent seizures, epilepsy is associated with abnormalities in cognition, psychiatric status and. Co-morbid mental health conditions in people with epilepsy and This, however, has never been based on any robust clinical evidence. The site is secure. Neurocircuitry models of posttraumatic stress disorder and beyond: a meta-analysis of functional neuroimaging studies. People with epilepsy have high rates of both physical and mental health comorbidity. They also demonstrate a larger proportion of patients overall being referred for evaluation but not having surgery. Addressing apprehensions and correcting the misconceptions of parents early may help optimize outcomes for children later. Depression and anxiety disorders in pediatric epilepsy. Chapman M, Iddon P, Atkinson K, et al. Family predictors of psychopathology in children with epilepsy. Although PNES are uncommon in the pre-school years, they begin to appear in older children, and their frequency increases with age.74 As in adults with PNES, PTSD is a common finding, although in adolescents, it is often secondary to sexual or physical abuse.75 A history of multiple psychiatric diagnoses, particularly internalizing disorders, is also associated with an increased risk of PNES in children.60; 76. Epilepsy in children: Comorbidities, complications, and outcomes Galimberti CA, Ratti MT, Murelli R, et al. Nearly 80% of children with epilepsy had 1 comorbid disorder. A 12-item, self-report screening tool for depression in people with epilepsy aged 1217 years, called NDDI-E-Youth, has been developed,23 but further studies in this area are needed. Child-self report is an important perspective to obtain, yet, in the field of epilepsy, few studies have gathered information directly from children. Interpretation Recently, Eom compared case-control differences in behavior based on parent-proxy and self-report in young people with epilepsy and healthy sibling controls.33 Similar to other reports that utilized parent-proxy measures, cases (under 18 years) had substantially higher levels of behavioral problems than controls across all parent-reported CBCL scales. We need greater precision in articulating and testing hypotheses as well as in developing policies and practice. M. Mula and A.M. Kanner report no additional funding. Psychiatric comorbidities are associated with premature mortality in epilepsy.15 This may be due to a variety of reasons, including increased risk of substance or alcohol abuse, increased risk of injury, poor adherence to medications, and increased suicide rates. 62 Further, in veterans, a group with a high prevalence of combat-related head trauma and at very high risk for post-traumatic stress disorder (PTSD), PNES misdiagnosed as epilepsy were recognized in many patients whose epilepsy had been attributed to mild traumatic brain injury. Before A more nuanced approach to the now-accepted relationship between epilepsy and its psychiatric comorbidities is required in light of at least three considerations: (1) the source of information and specifically the reliance on parent-proxy reports when making behavioral assessments, especially in children; (2) the occurrence in some patients of peri-ictal mood and anxiety symptoms which can complicate the assessment of behavioral and psychiatric symptoms and disorders; and (3) the role of psychogenic nonepileptic seizures (PNES) and misdiagnosis of epilepsy in general in muddying the data. 2 Among adults, depression is 2.7 times more frequent than in the general population, and psychotic disorders are up to 7.8 times more frequent when lookin. Peri-ictal phenomenon can be misinterpreted as underlying mood disorders. Pregnancy outcomes in women aged 14 to 45 years with and without epilepsy and their children were examined. Jones JE, Watson R, Sheth R, et al. Comorbidity of epilepsy and attention-deficit/hyperactivity - Springer In addition, other nonepileptic events were diagnosed in 3% of civilians and 12% of veterans. 2014; 31:127-8. doi: 10.1016/j.yebeh.2013.11.027. The relative contribution of syndrome-specific variables is still unclear, and clinical evidence suggests that psychiatric comorbidities do not necessarily respect such borders. PDF Screening for Psychosocial Comorbidities in Adults With Epilepsy Psychiatric Comorbidities in People With Epilepsy - PMC Jones JE. Scaramelli A, Braga P, Avellanal A, et al. Parental stress and other factors may explain the substantial differences seen in the impact of epilepsy on children based on child self-report versus parent proxy-report for quality of life34; 35 and felt stigma. Epilepsy is the second commonest chronic neurological disorder in developed countries with an estimated prevalence of around 9.7 per 1000 population and an incidence of 0.55 per 1000 per year [1]. Vincentiis S, Valente KD, Thome-Souza S, et al. Federal government websites often end in .gov or .mil. Comorbidities of epilepsy: current concepts and future perspectives Data from prospective observational studies clearly indicate that the relationship between epilepsy and psychiatric disorders is bidirectional. Unlike other postictal behavioral symptoms that typically resolve within hours or days, postictal psychosis can last up to three months (mean duration, 910 days).56 The few studies that examined post-ictal mood used symptom checklists.54; 57 While reporting several mood and anxiety related symptoms post-ictally does not meet clinical criteria for a mood or anxiety disorder, patients with a history of depressive or anxiety disorders was associated with worse post-ictal symptoms.54 These studies are conducted in the setting of the epilepsy monitoring unit (EMU) where patients are participating in pre-surgical work up. All patients with epilepsy should be routinely screened for psychiatric disorder at the onset and at least once a year. Increasing evidence suggests inherent biases in proxy reports and highlights the need to assess children directly. The literature upon which most of the field relies contains some biases that must be carefully examined and resolved in future studies: (1) In the pediatric epilepsy literature, many reports find children with epilepsy have high levels of behavioral and psychiatric disorders when compared to appropriate controls. How valid are proxy assessment of mental health and sleep comorbidities Epilepsy patients are more likely to have poor health outcomes such as frequent hospitalizations, physical disability, and premature mortality. Risperidone, olanzapine, and quetiapine are usually considered first-line treatments in first-episode psychosis.34 Postictal psychoses represent an epilepsy-specific problem, and for this reason, evidence is less compelling, and it is not possible to apply evidence from elsewhere. Outcome of prolonged video-EEG monitoring at a typical referral epilepsy center. Among newer drugs, oxcarbazepine is a weak inducer and topiramate is an inducer at daily doses over 200 mg, whereas other newer drugs are less likely to be culprits for drug interactions.36,37, Antidepressants are extensively metabolized by multiple systems, and this can potentially lead to interactions.36 Regarding tricyclics, dosage adjustments with inducers should be considered on an individual basis, and this is due to a number of pharmacokinetic reasons including the large therapeutic window of this class of antidepressants and the concomitant increase in the free fraction due to a concomitant protein binding displacement interaction.37 Inducers reduce the levels of SSRIs by around a quarter, but again systematic dose adjustments in routine clinical practice are not needed.37 Fluoxetine, fluvoxamine, and, to a lesser extent, sertraline inhibit the CYP2C9, and this can possibly increase the levels of phenytoin and, to a lesser extent, valproate.36,37 Inducers like carbamazepine decrease the blood levels of bupropion by 90% making this interaction clinically relevant.36. A systematic review showed response rates for methylphenidate in children with ADHD and epilepsy between 65% and 83%.22 Data on atomoxetine and amphetamines are available only at the anecdotal level. The CBCL reports total, internalizing, and externalizing problems scores. Related to the above, the child psychiatry literature, in general, reveals considerable differences between child self-report and parent-proxy reports of behavior, 3743 Critical to interpreting parental reports in children with and without a disorder such as epilepsy are the systematic biases in parental report that have been documented. It is essential that we not set up an expectation of limitations, barriers, and ultimately failure that may not exist. Mula M, Kanner AM, Schmitz B, Schachter S. Antiepileptic drugs and suicidality: an expert consensus statement from the Task Force on Therapeutic Strategies of the ILAE Commission on Neuropsychobiology. Given the large proportion of PNES caught during EMU admission,59; 62 one contributing factor may be that PNES patients who had been misdiagnosed as having refractory epilepsy have been more firmly encouraged to have a comprehensive evaluation. Badawy R, Macdonell R, Jackson G, et al. This specific scenario may have major implications in terms of future treatments and the development of disease-modifying agents. Epilepsy and comorbidities -what are we waiting for? Practice parameter: temporal lobe and localized neocortical resections for epilepsy: report of the Quality Standards Subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons. We confirm that we have read the Journals position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Asadi-Pooya AA, Emami M. Juvenile and adult-onset psychogenic non-epileptic seizures. 6; 28 Two studies in school-aged children used the Kiddie Schedule for Affective Disorders (K-SADS) and found a strong association between epilepsy and mood disorders. PDF Screening for Psychosocial Comorbidities in Children With Epilepsy The loss of control and autonomy, the need to take medications, the embarrassment or awkwardness occasioned by a seizure, the stigmatizing misconceptions, and, sometimes, the cruelty with which those who are different are treated, even in our post-ADA society these cannot be ignored. Psychogenic nonepileptic seizures in US veterans. Common psychiatric comorbidities in epilepsy: How big of a - PubMed Baca CB, Vickrey BG, Hays RD, et al. Rodenburg R, Marie Meijer A, Dekovic M, et al. Medication treatment for attention-deficit/hyperactivity disorder and the risk of acute seizures in individuals with epilepsy. Comorbidity psychiatric disorders in epilepsy: a review of literature For individual children, however, the scores varied substantially from one time point to another. Wissel BD, Dwivedi AK, Gaston TE, et al. Devinsky O. Postictal psychosis: common, dangerous, and treatable. Salinsky M, Evrard C, Storzbach D, et al. Mula M, McGonigal A, Micoulaud-Franchi JA, May TW, Labudda K, Brandt C. Validation of rapid suicidality screening in epilepsy using the NDDIE, Validation of the Hamilton Rating Scale for depression in adults with epilepsy, Screening for depression and anxiety in epilepsy, Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Other United Kingdom studies have suggested a prevalence of 7.7 per 1000 population and 5.6 per 1000 population [23]. CARRIERES ET CONSEIL Company Profile - Dun & Bradstreet A full understanding of any association between epilepsy and suicidality must first take these complexities into account. The US Preventive Services Task Forces recommends depression screening for adolescents 1218 96 and such recommendations of course apply equally to young people with epilepsy. Caplan R, Siddarth P, Gurbani S, et al. 30.3% of people with epilepsy have 3+ comorbidities vs 15.5% of those without. Huberty TJ, Austin JK, Harezlak J, et al. Fooled by randomness: the hidden role of chance in life and in the markets. Antidepressants for people with epilepsy and depression, Current and emerging drug therapies for the treatment of depression in adults with epilepsy, Treatment of psychoses in patients with epilepsy: an update, Behavioral disorder in people with an intellectual disability and epilepsy: a report of the Intellectual Disability Task Force of the Neuropsychiatric Commission of ILAE, Pharmacokinetic and pharmacodynamic interactions between antiepileptics and antidepressants, The pharmacological management of psychiatric comorbidities in patients with epilepsy. 72 Such findings raise further questions about reports of mild TBI as a risk factor for epilepsy.73, PNES are not reserved for adults and occur in children as well. Recent Findings People with epilepsy have a 2-5 times increased risk of developing any psychiatric disorder, and 1 in 3 patients with epilepsy have a lifetime psychiatric diagnosis. High-quality outcome studies for major psychiatric comorbidities such as mood, anxiety disorders, and psychoses in people with epilepsy are needed to develop evidence-based treatment strategies. government site. Psychiatric problems could be due to shared neurobiological mechanisms, a consequence of having epilepsy or simply due to the unfortunate occurrence of 2 conditions in the same individual. Despite robust evidence about the frequency and clinical implications of psychiatric disorders in epilepsy, these problems are still underdiagnosed and undertreated. The EMU evaluation confirmed the diagnosis of epilepsy without PNES in only 40% of civilians and 18% of veterans. Data from cross-sectional studies show that all psychiatric disorders seem to occur in a higher proportion of adults and children with epilepsy than in those without epilepsy. 16.3% of people with epilepsy have depression vs 9.5% of those without. Investigations into the associations between epilepsy and various psychiatric and behavioral co-morbidities and consequences must become more sophisticated to reflect the complexities of epilepsy diagnosis, the ictal manifestations of epilepsy, and how information is acquired. These occurred in more than half of their seizures and lasted for a median of 24 hours.25, Psychiatric symptoms as side effects of antiseizure medications are frequently reported. Epilepsy and risk of suicide: a population-based case-control study. Judging from the results reported from EMUs, these individuals may represent a substantial proportion of the patients in the population with uncontrolled epilepsy. Any epidemiological or administrative records-based study reporting an association between epilepsy and psychiatric disorders must be interpreted in light of these concerns.
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