Received 2020 Jan 2; Accepted 2020 Mar 17. When adjustment was made for a measure of parental emotional impact (impact associated with the child him or herself) the case-control differences reported by the parents all but disappeared. Salpekar JA, Berl MM, Havens K, et al. Focusing primarily on the last 5 years, we review current evidence about the epidemiology and clinical aspects of psychiatric disorders in epilepsy. FOIA Targeted Self-Management of Epilepsy and Mental Illness for - PubMed Epilepsy, suicidality, and psychiatric disorders: a bidirectional association. Management of Psychiatric Comorbidities in Epilepsy, In the general population, psychological interventions are the first-line treatment for all anxiety disorders and for mild to moderate depression. Abstract Psychiatric comorbidities, including mood, anxiety, and psychotic disorders, are common in epilepsy, often occurring at rates 2-3-fold or higher than in the general population without epilepsy. Hesdorffer DC, Hauser WA, Olafsson E, et al. Benbadis SR. How many patients with pseudoseizures receive antiepileptic drugs prior to diagnosis? Hesdorffer DC, Ishihara L, Mynepalli L, et al. It is unclear how such errors are ultimately corrected in the administrative records that many researchers depend upon. National Library of Medicine This entails the need for health care professionals in other disciplines such as psychiatrists, clinical psychologists, neuropsychologists psychiatric nurses, and social workers to ensure that the individual receive the best management. The misdiagnosis of epilepsy in people with intellectual disabilities: a systematic review. Reuber M, Pukrop R, Bauer J, et al. Hilger E, Zimprich F, Pataraia E, et al.. Psychoses in epilepsy: a comparison of postictal and interictal psychoses, Prevalence and clinical characteristics of postictal psychiatric symptoms in partial epilepsy, Psychiatric and behavioral side effects of antiepileptic drugs in adults with epilepsy. Sander is based at NIHR University College London Hospitals Biomedical Research Centre, which receives a proportion of funding from the UK Department of Health's Research Centres funding scheme. For these reasons, neurologists need to familiarize themselves with the spectrum of side effects of psychotropic medications, in particular antidepressants.36, Historically, psychotropic drugs were thought to be associated with an increased risk of seizures, and this is reported in the information leaflet of many psychotropic medications from antidepressants to antipsychotics. The EMU evaluation confirmed the diagnosis of epilepsy without PNES in only 40% of civilians and 18% of veterans. Valuable research and technology reports The burden of comorbidity in people with epilepsy is high. This "bi-directional" relationship between epilepsy and mental health issues is critical . Physical and mental health comorbidities of patients with epilepsy in Abstract Psychiatric illness and epilepsy commonly co-occur in adults and in children and adolescents. The subjects were studied approximately 15 years after the onset of epilepsy, and most were seizure-free and off medication at the time of assessment. This systematic literature review identified original research articles that reported the prevalence of psychiatric comorbidities based upon clinical assessments in a sample of PWE and assessed the clinical features of the populations found in studies included in our review of mental health comorbidity. Behavioral issues involving children and adolescents with epilepsy and the impact of their families: recent research data. Hughes J, Devinsky O, Feldmann E, et al. 19408842 Abstract While reviewing the available literature, we noticed comorbidity of epilepsy and psychiatric disorders. Davies S, Heyman I, Goodman R. A population survey of mental health problems in children with epilepsy. In epilepsy, treatment and prognosis are dependent on the accurate definition of the epilepsy syndrome. The study outcomes included the associations between epilepsy and different physical and mental disorders documented within 365 days after the index date as well as multimorbidity defined as at least two, three, four, and five different diagnoses. Validated screening instruments are available for mood and anxiety disorders in adults as well as attention-deficit hyperactivity disorder in children with epilepsy. Child-self report is an important perspective to obtain, yet, in the field of epilepsy, few studies have gathered information directly from children. Bethesda, MD 20894, Web Policies However, when selected patients with stereotypic prodromal symptoms used a personal digital device to report these symptoms, there was no relation between prodromal symptom and seizure occurrence.52 This finding emphasizes the limits of self- or proxy-report for symptoms that occur around the time of seizures, since 1) a common human bias is finding causal patterns in chance occurrences,53 and 2) memory is often impaired peri-ictally, limiting the validity of self-reports. A large UK observational cohort study involving over 10,000,000 subjects found that depression was associated with a 2.5-fold (95% CI 2.492.60) increased risk of developing epilepsy.7 Suicide risk was increased 2.9 fold (95% CI 2.53.4) even before the diagnosis of epilepsy.8 All these findings suggest the presence of shared pathogenic mechanisms between epilepsy and all major psychiatric disorders. 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. Nogueira MH, Yasuda CL, Coan AC, Kanner AM, Cendes F. Concurrent mood and anxiety disorders are associated with pharmacoresistant seizures in patients with MTLE. Physical and mental health comorbidities of patients with epilepsy in Some studies have found a lower probability of achieving seizure freedom after temporal lobectomy,13 whereas others have refuted these findings.14 The same holds true for psychiatric outcomes, as some studies showed an increased risk of recurrence of depression or anxiety during the first year after surgery, whereas other studies showed long-term improvement. Kimford J. Meador, M.D., from Stanford University in Palo Alto, California, and colleagues conducted a prospective, observational multicenter cohort study at 20 epilepsy centers in the United States. Further, when cases and control were compared based on self-reported measures either as older adolescents or as young adults, there was no evidence of greater behavioral burden in the epilepsy versus control group. 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. In the 1930s, Lennox commented that Many persons subject to ordinary grand mal or petit mal seizures also have disturbances in mood or behavior which may only be a result of difficult circumstances.1 Livingston echoed this 30 year later: The most serious hazard of an epileptic disorder is frequently not the seizures, but the associated emotional disturbances which are prone to develop in a youngster as a result of mismanagement by his family, by his classmates and friends and by society. For instance, frontal-temporal dysfunction has been implicated in mood and anxiety disorders,20; 21 including suicide related behavior and post-traumatic stress disorder.22; 23 It is likely that seizure foci in frontal or temporal regions as well as white matter changes affecting functions in or between those regions could disrupt those pathways. For this reason, epilepsy clinics should have a clear pathway for access to mental health care. Psychogenic non-epileptic seizures misdiagnosed as epilepsy may induce errors in the assessment of psychiatric disorders and epilepsy. Clancy MJ, Clarke MC, Connor DJ, Cannon M, Cotter DR. What is the worst part about having epilepsy? Badawy R, Macdonell R, Jackson G, et al. A multicenter case-control study. The level of evidence is higher for treatment of ADHD in epilepsy than for other psychiatric comorbidities, despite the limited number of studies. The impact of psychiatric comorbidities in terms of seizure outcome and psychiatric outcome, in epilepsy surgery, is complex and yet to be established. Epilepsy across the spectrum: promoting health and understanding. Epilepsy, cognition, and neuropsychiatry (Epilepsy, Brain, and Mind, part 2). He also receives research support from the Marvin Weil Epilepsy Research Fund, the UK Epilepsy Society, and the Christelijke Vereniging voor de Verpleging van Lijders aan Epilepsie, The Netherlands. Psychoeducation and psychological interventions still represent first-line treatments for PNES.31 No studies have specifically addressed the management of PNES in people with epilepsy, but it is obvious that explaining the diagnosis and educating individuals and caregivers about the differences between epilepsy and PNES are extremely important. Bermeo-Ovalle, A. 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. Finally, as so exquisitely described by Lennox and later Livingston, there are ample situational factors that must surely have a negative impact on the individual with epilepsy. Family predictors of psychopathology in children with epilepsy. The site is secure. Brikell I, Chen Q, Kuja-Halkola R, et al.. How valid are proxy assessment of mental health and sleep comorbidities Drug-related seizures are a complex problem, and it is not just restricted to psychotropic medications. 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. Epilepsy Behav. As discussed in this section, current evidence on the management of psychiatric comorbidities in epilepsy is limited. (2) Peri-ictal phenomena may be mischaracterized as underlying mood disorders. Krishnan V, Nestler EJ. * Mental health care provider includes psychiatrists, clinical psychologists, neuropsychologists, social . Data from children with epilepsy are not different despite an obvious emphasis on developmental disorders. J.W. All patients with epilepsy should be routinely screened for psychiatric disorder at the onset and at least once a year. A prospective PDA-based study. 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]. Patients with psychogenic nonepileptic seizures, alone or epilepsy-associated, share a psychological profile distinct from that of epilepsy patients. This concept is distinct from auras or immediate postictal phenomena that manifest as psychic or mood disruption only circa a seizure. Nearly 80% of children with epilepsy had 1 comorbid disorder. government site. Occurrence and recurrence of attempted suicide among people with epilepsy, Chronic stress shifts the GABA reversal potential in the hippocampus and increases seizure susceptibility, Psychiatric side effects and antiepileptic drugs: observations from prospective audits. Psychogenic nonepileptic seizures, while widely recognized as posing a diagnostic dilemma in the clinic, may account for some of these research findings. Still, the majority of studies included in these meta-analyses come from high-resource countries, whereas less than 10% are from medium- and low-resource countries. Psychological distress, comorbidities, and health behaviors among U.S. adults with seizures: results from the 2002 National Health Interview Survey. Premonitory symptoms, defined as occurring at least 30 minutes before a seizure, were reported by 29% of patients with focal epilepsy50 and occur less frequently among patients with generalized epilepsies.51 The premonitory symptoms were continuous and lasted up to 3 days. 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. An accurate, undistorted understanding of the relation between mental health disorders and epilepsy is essential to insure appropriate therapy and avoid unnecessary and potentially harmful treatments and avoid common misconceptions. The relative contribution of syndrome-specific variables is still unclear, and clinical evidence suggests that psychiatric comorbidities do not necessarily respect such borders. Maguire MJ, Weston J, Singh J, Marson AG. For children, there is also much to learn. Vincentiis S, Valente KD, Thome-Souza S, et al. Muller JM, Achtergarde S, Furniss T. The influence of maternal psychopathology on ratings of child psychiatric symptoms: an SEM analysis on cross-informant agreement. Josephson CB, Lowerison M, Vallerand I, et al.. Association of depression and treated depression with epilepsy and seizure outcomes: a multicohort analysis. The https:// ensures that you are connecting to the This is, however, a global issue in mental health as highlighted by the Mental Health Action Plan 20132020 developed by the World Health Organization. We should never deny or ignore problems that are truly there. 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. These include, among other factors, cultural barriers to mental health issues, lack of training of neurologists and psychiatrists about these comorbidities, and lack of allocated resources for a multidisciplinary approach (table 1). the contents by NLM or the National Institutes of Health. 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. Mula M, Kanner AM. Risk factors for psychogenic nonepileptic seizures in children and adolescents with epilepsy. Inclusion in an NLM database does not imply endorsement of, or agreement with, Lin JJ, Mula M, Hermann BP. Thus, the control group was constructed such that children with the disorders of interest were largely excluded. Comorbidity of medical condition was also associated with a common mental disorder, three times higher risk as compared to participants with no comorbid medical illness. Despite robust evidence about the frequency and clinical implications of psychiatric disorders in epilepsy, these problems are still underdiagnosed and undertreated. Accurate diagnosis of PNES has important implications for interpreting large population surveys. Externalizing disorders reflect disruptive behaviors (aggression and rule-breaking behaviors). Two main clinical instruments have been validated for symptoms of anxiety in adults with epilepsy: the Hospital Anxiety and Depression Scale (HADS) and the Generalized Anxiety Disorder 7 (GAD-7). Physical and mental health comorbidities of epilepsy - ScienceDirect Salinsky M, Evrard C, Storzbach D, et al. Rescorla LA, Ginzburg S, Achenbach TM, et al. Whitehead K, OSullivan S, Walker M. Impact of psychogenic nonepileptic seizures on epilepsy presurgical investigation and surgical outcomes. See other industries within the Health Care and Social Assistance sector: Child Care Services , Community Food and Housing, and Emergency and Other Relief Services , Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly , General Medical and Surgical Hospitals , Home Health Care Services , Individual and Family Services , Medical and Diagnostic Laboratories . Forty-nine studies involving 172,206 individuals assessed the prevalence of ADHD in epilepsy, and the characteristics of the included studies are reported in Table 1.The subjects included children, adolescents and adults with a mean age between 6.4 and 37.17 years, and the proportion of women ranged from 30 to 75%. 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. Refractory juvenile myoclonic epilepsy: a meta-analysis of prevalence and risk factors. Parent and family stress factors predict health-related quality in pediatric patients with new-onset epilepsy. Cross-informant agreement between parent-reported and adolescent self-reported problems in 25 societies. Psychological treatments for adults and children with epilepsy: evidence-based recommendations by the international league against epilepsy psychology task force. sharing sensitive information, make sure youre on a federal In an analysis of cross-informant comparisons, proxy reports by depressed mothers of their childrens psychopathology were higher than ratings of the same children performed by teachers and therapists who evaluated the children. Epilepsy and comorbidities -what are we waiting for? 59; 70 Such disorders are a means of coping with severe trauma and generally do not occur in complete isolation from other psychiatric symptoms. Psychiatric comorbidities represent a poor prognostic marker as they have been associated with a poor response to treatment (drugs and surgery), increased morbidity, and mortality. Federal government websites often end in .gov or .mil. First, mood disorders may aggregate in families. Interictal dysphoric disorder and periictal dysphoric symptoms in patients with epilepsy. 4; 5; 2426 These studies all tend to demonstrate a greater burden of such disorders or symptoms of these disorders in children with epilepsy compared to sibling, 4; 25 cousin, 6; 26 or other types of controls. Psychogenic nonepileptic seizures in US veterans. Such patients tend to receive the wrong diagnosis (epilepsy), are treated for a disorder they do not have (sometimes for years), and do not receive the treatment they need for a conversion disorder that they actually do have, therapies for which, particularly Cognitive Behavioral Therapy (CBT) are appropriate but only if the nature of the events is correctly diagnosed.94 The magnitude of this problem is evident in the results from the monitoring unit studies.59; 62; 95 These data argue strenuously for the inclusion of psychiatric services and routine evaluation in many (perhaps most) patients presenting with new-onset seizures. 12; 1418. Psychiatric Comorbidities in Epilepsy: Implications for Clinical Practice Federal government websites often end in .gov or .mil. Salbach-Andrae H, Klinkowski N, Lenz K, et al. Premonitory symptoms in epilepsy. Prodromal symptoms in epileptic patients: clinical characterization of the pre-ictal phase. Comorbidity of epilepsy and attention-deficit/hyperactivity - Springer Accordingly, a multidisciplinary approach is required. The pathophysiology remains uncertain, but a recent systematic review pointed out that antipsychotic drug use does not predict complete resolution of psychiatric symptoms in comparison with antiepileptic drug withdrawal suggesting a connection with the mechanism underlying seizure control.27. An International League Against Epilepsy (ILAE) document has discussed limitations of the Food and Drug Administration meta-analysis on which the black box warning was based, and it has emphasized the need for continuous screening and identification of high-risk individuals to develop prevention strategies.28 Psychiatric side effects of antiseizure medications reported with a prevalence higher than 1% are summarized in table 3. Hesdorffer DC, Ishihara L, Webb DJ, Mynepalli L, Galwey NW, Hauser WA. For epilepsy characteristics, 73.8% of patients had focal epilepsy compared to 26.1% with generalized epilepsy. the contents by NLM or the National Institutes of Health. Parent-proxy report of childrens behavior is biased by parental perceptions and reactions to illness. Kotagal P, Costa M, Wyllie E, et al. Before Berg AT, Vickrey BG, Testa FM, et al. Personality and Psychopathology in Nonepileptic Attack Disorder and Epilepsy: A Prospective Study. A 30-Year Study of 3 Generations at High Risk and Low Risk for Depression. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Clancy MJ, Clarke MC, Connor DJ, et al. Co-morbid mental health conditions in people with epilepsy and In the setting of a diagnosis of epilepsy in a child, current evidence suggests there may be an important role for educational interventions and perhaps counseling directed not just to the child but to the parents, or even the entire family.

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