NeuroPsychiatric Aspects of Epilepsy (Seizures)

Epilepsy is one of the commonest neurological disorders, affecting approximately 75 million people worldwide, and it is now recognized as a disorder of the brain characterized not only by recurrent seizures, but also by its neurobiological, cognitive, psychological, and social consequences.

The nature of the relationship between psychosis and epilepsy has been of great interest to psychiatrists for over a century. Epidemiologic studies point to a bidirectional relationships between epilepsy and neuropsychiatric disorders. People with epilepsy are more likely to develop certain neuropsychiatric disorders, and those with these disorders are more likely to develop epilepsy. This relationship suggests the possibility of shared underlying pathophysiologies.

Mood and anxiety disorders are the most frequently reported psychiatric comorbidities with epilepsy, with a prevalence of 20% to 22%, however, in select populations, the prevalence can reach 50%. Reasons for the association are both biological and psychosocial. Epilepsy is a chronic disorder that brings about a number of social limitations and discriminations that lead to demoralization and poor selfesteem. Moreover, epilepsy and mood disorders seem to share a common neurobiology, with involvement of the limbic structures and the modulation of major neurotransmitter pathways by anticonvulsant medications.

Compared with mood disorders, psychoses seem to be relatively rare in patients with epilepsy but represent serious complications that affect morbidity and mortality. Epidemiological data indicate that the incidence of nonorganic, nonaffective psychoses, including schizophrenia and related disorders, is generally overrepresented in patients with epilepsy compared with the general population or those with other chronic medical conditions. The relationship between epilepsy and psychoses has strong neurobiological underpinnings related to the involvement of specific brain areas.

Epileptic seizures are characterized not only by the ictal phase but also by a number of behavioral manifestations that may precede or follow the seizure. Such periictal, ictal or postictal symptoms may fail to meet temporal DSM criteria when too shortlasting. However, it appears that they are highly responsible for the atypical presentations of psychiatric disorders in epilepsy. The phenomenology of postictal psychoses is polymorphic, but most patients present with abnormal mood and paranoid delusions with mystic and religious content. Consciousness can be variably impaired (eg, from overwhelming confusion to totally clear sensorium). High levels of anxiety with a fear of impending death represent another typical symptom that may precipitate in episodes of violence, selfinjury, or suicide if command hallucinations are present.

Postictal psychoses are characterized by spontaneous remission within days or weeks; antipsychotic drug treatment is only required to reduce mortality and morbidity. Finally, it has to be kept in mind that in a minority of cases, postictal psychoses may evolve into chronic interictal psychosis.


In this video, I have made attempt to review the neuropsychiatric aspects of epilepsy, impact of antiseizure medications and therapeutic options for treatment. Diagnosis and treatment involve close collaboration among a multidisciplinary team.