Neuropsychiatric and Cognitive Comorbidities in Epilepsy

Abstract

PURPOSE OF REVIEW: This article discusses psychiatric and cognitive comorbidities of epilepsy over the lifespan and illustrates opportunities to improve the quality of care of children and adults with epilepsy.RECENT FINDINGS: One in 3 people with epilepsy have a lifetime history of psychiatric disorders, and they represent an important prognostic marker of epilepsy. Contributors are diverse and display a complex relationship. Cognitive comorbidities are also common among those living with epilepsy and are increasingly recognized as a reflection of changes to underlying brain networks. Among the cognitive comorbidities, intellectual disability and dementia are common and can complicate the diagnostic process when cognitive and/or behavioral features resemble seizures. SUMMARY: Comorbidities require consideration from the first point of contact with a patient because they can determine the presentation of symptoms, responsiveness to treatment, and the patient's day-to-day functioning and quality of life. In epilepsy, psychiatric and cognitive comorbidities may prove a greater source of disability for the patient and family than the seizures themselves, and in the case of essential comorbidities, they are regarded as core to the disorder in terms of etiology, diagnosis, and treatment.

Cognitive and psychological dysfunction is present after a first seizure, prior to epilepsy diagnosis and treatment at a First Seizure Clinic

“…In this regard, we suggest two potential drivers of the findings. Firstly, these deficits present from disease onset likely reflect, and are symptomatic of, the underlying network disturbance that is also responsible for generating seizures 42,43 . That is, while seizures represent a dramatic paroxysmal manifestation of altered brain activity within neural networks, we assume that a degree of network disruption remains present in the interictal period giving rise to cognitive and psychological dysfunction.…”

Comparative effectiveness of digital mental healthcare models for adults with epilepsy: A study protocol of a randomized controlled trial

“…1 Comorbid neurological and mental health difficulties can increase healthcare utilization and burden of disease, 2,3 with poor mental health disrupting the medical management, self-management, quality of life, morbidity, and prognosis of epilepsy, even when symptoms are mild. 1,[4][5][6] Despite this, there continues to be significant unmet mental health needs of PWE worldwide, prompting recent calls for reform in this area by the World Health Organization. 7 Despite evidence that psychological treatments can lead to significant improvements in mental health and quality of life for PWE, 8,9 there are significant barriers that prevent access to such treatments.…”

“…13 To complicate matters, many PWE report a lack of independence (e.g., lack of driving license) and significant difficulties with their cognitive function (e.g., inattention and poor memory), which can impede their ability to both attend and benefit from traditional face-toface psychological interventions. 4,14 Digital mental health interventions (i.e., that do not require face-to-face contact) are an innovative development that is improving access to psychological care. 15 These treatments can teach the same core psychological skills as face-to-face treatments, such as cognitive restructuring and behavioral activation, but use carefully developed online modules to facilitate learning.…”

“…Poor mental health is highly prevalent among people with epilepsy (PWE), with one in three estimated to have a lifetime mental health diagnosis 1 . Comorbid neurological and mental health difficulties can increase healthcare utilization and burden of disease, 2,3 with poor mental health disrupting the medical management, self‐management, quality of life, morbidity, and prognosis of epilepsy, even when symptoms are mild 1,4–6 . Despite this, there continues to be significant unmet mental health needs of PWE worldwide, prompting recent calls for reform in this area by the World Health Organization 7…”

The presence, nature and network characteristics of behavioural phenotypes in temporal lobe epilepsy

“…A substantial population-based and clinical literature has documented the increased risk of cognitive, behavioural and social complications of the epilepsies including their rates of occurrence and the clinical, sociodemographic and neuroimaging correlates that accompany them. 1-3 These neurobehavioural risks and their associated burdens, including on life course, are widely recognized and have been addressed by national and international reports, commissions and task forces. 4 , 5 …”