Psychiatric and Behavioral Disorders in Epilepsy Patients*

Behavioral changes are common in epilepsy patients, with the overall spectrum of behavior in this population skewed toward cognitive impairment and psychopathology. Unfortunately, in many cases, the diagnosis is overlooked and therapeutic opportunities are missed. The pathogenesis of these disorders may include central nervous system pathology, ictal and interictal epileptiform activity, antiepileptic drugs, psychologic and environmental factors, and genetic predisposition. Although therapy for behavioral disorders is often deferred for fear of exacerbating epilepsy, treatment with psychopharmacologic agents is unlikely to increase seizure severity or frequency. Indeed, treating depression, anxiety, psychosis, and other disorders can improve sleep, reduce stress, and may even reduce seizure activity. Antiepileptic drugs have psychotropic properties that can be positive or negative and their effects may differ in epilepsy and purely psychiatric populations. (Adv Stud Med. 2003;3(7B):S669-S673) P sychiatric and behavioral changes are common among individuals with epilepsy. The potential causes for such changes as depression, anxiety, memory disorders, sleep disorders, and cognitive changes (Table) are diverse. The pathogenesis of epilepsy-related behavioral changes is discussed later in this article along with potential therapeutic approaches and the role of antiepileptic drugs (AEDs) in exacerbating or ameliorating these disorders. The primary clinical problem in this emerging area is the lack of early recognition and diagnosis. In many cases, patients simply do not spontaneously report the problem. In other cases, the clinician and nurse fail to inquire about the patient’s mental health. Chronic psychiatric symptoms are sometimes even misinterpreted as “a normal reaction” to having epilepsy. Certain patients, especially the elderly, will often deny feelings of depression or sadness when questioned about their mental state. Similarly, many physicians are too quick to deny that AEDs may contribute to behavioral problems, especially to the subtler types of cognitive or school performance problems. Even if the symptoms are recognized, clinicians must realize that the epilepsy-related behavioral and cognitive changes will not always fit neatly into the standard psychiatric diagnostic categories (ie, the Diagnostic and Statistical Manual of Mental Disorders criteria). The development and evolution of negative behavioral problems such as psychosis, anxiety, depression, and memory impairment often follow a pathway distinct from that of patients with primary psychiatric illnesses. Beginning with publication of the classic PROCEEDINGS