Psychiatric and behavioral comorbidities in epilepsy: A critical reappraisal

Abstract

Psychiatric and behavioral disorders are important aspects of epilepsy and have received increasing attention in the last several years. 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. Most of these studies rely on parent-proxy completed instruments to assess these behavioral endpoints. Parents’ reports are not objective but reflect parents’ reactions and emotions. Increasing evidence suggests inherent biases in proxy reports and highlights the need to assess children directly. (2) Peri-ictal phenomena may be mischaracterized as underlying mood disorders. (3) Many studies report elevated levels of psychiatric morbidity before and after the diagnosis of epilepsy suggesting an inherent relation between the two types of disorders. Psychogenic nonepileptic seizures, while widely recognized as posing a diagnostic dilemma in the clinic, may account for some of these research findings. Diagnostic errors between epilepsy and PNES need careful consideration when evaluating studies demonstrating associations between psychiatric disorders and epilepsy or poorer seizure control in association with psychiatric disorders in people who have epilepsy. Mental health concerns are important for everyone. 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.

Prevalence of psychiatric comorbidities among the patients of epilepsy attending general hospital psychiatric unit

“…An accurate, undistorted understanding of the relation between mental health disorders and epilepsy is essential to ensure appropriate therapy and to avoid unnecessary and potentially harmful treatments and common misconceptions. 19…”

Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: Systematic review and meta-analysis of frequency, correlates, and outcomes

“…In some cases, details from the patient's history can be misleading. For instance, mild traumatic brain injury is a risk factor for the development of not only epilepsy, but also posttraumatic stress disorder and PNES 127 . On the other hand, although stress and adverse experience are considered established risk factors for the development of PNES in some individuals, they can also contribute to the development/exacerbation of epilepsy 128 129 . This systematic review had several limitations.…”

An Overview of Anxiety Disorders and Depression in Children with Epilepsy: A Literature Review

“…23 There are other authors stating that these results found in the medical literature were exaggerated. 3,24 Psychosocial Factors Family/Caregiver Factors Epilepsy is known to have significant adverse effects on the development of the child and quality of life. Social difficulties caused by epilepsy, stigma, and decrease in the quality of life may cause anxiety and depression symptoms.…”

“…53,54 The authors who approached the multiplicity of psychiatric comorbidities in epilepsy and the bidirectional hypothesis with suspicion stated that in most of the studies the source of information about the child was the parent and this could lead to bias, that the periictal mood symptoms could be confused with anxiety and depressive disorders, and the misdiagnosis of common psychogenic nonepileptic seizures as epilepsy may impair the data. 24 In a community-based cohort of young adults, published in 2015, neurotypical young adults with childhood-onset epileptic seizure were compared with sibling controls and external controls. In the 15-year follow-up study, there was no evidence showing that current mood or anxiety disorder, and suicide attempts were higher in young adults with childhood-onset epilepsy.…”