Neurobehavioral and Psychiatric Comorbidities of Epilepsy
Abstract & Commentary
By Nitin K. Sethi, MD, Assistant Professor of Neurology, Weill Cornell Medical College. Dr. Sethi reports no financial relationships relevant to this field of study.
Synopsis: Epilepsy is associated with behavioral, psychiatric, cognitive, and social comorbidities. The associated comorbidities change across the lifespan of a person with epilepsy. Early detection and treatment of these comorbidities has the potential to significantly improve quality of life for patients with epilepsy.
Source: Lin JJ, et al. Uncovering the neurobehavioral comorbidities of epilepsy over the lifespan. Lancet 2012;380:1180-1192.
The authors searched PUBMED (from 1950 to August 2012) and identified all English-language papers that reported on psychiatric, behavioral, and social comorbidities of adult and child epilepsies. An increased prevalence of mood disorders, anxiety disorders, attention deficit disorder, depression, bipolar disorder, panic disorder, and other social phobias was found in children and adults with epilepsy. With respect to children, the increased prevalence of psychiatric and mood disorders was greatest for those with complicated epilepsies (epilepsy plus brain lesions), although even children with uncomplicated epilepsies (normal neuroimaging and normal neurological examination) were not immune. Similarly, cognitive comorbidities (lower scholastic performance, impaired non-verbal intelligence and executive functions) were most evident in children with complicated epilepsies. The authors found social comorbidities in both children (inability to form productive and mutually satisfying relationships) and adults. Adults with epilepsy were more likely to be single and unemployed, and to have lower incomes, lower academic achievements, and higher rates of obesity, inactivity, and smoking.
The authors reported many potential mediators of neurobehavioral and psychiatric comorbidities of epilepsy such as the type of epilepsy syndrome and neuroanatomical anomalies. Temporal lobe epilepsy (TLE) was associated with hippocampal atrophy leading to cognitive deficits in multiple domains of memory and executive functioning, as well as language, while involvement of the orbital frontal cortex and cingulated gyrus in TLE was likely the mediator of psychiatric comorbidities such as depression and psychosis. Children with Rolandic epilepsy were found to have language problems and mild deficits in attention and executive function. Children with epilepsy have altered brain development and connectivity and this likely affects the expression of cognitive, behavioral, social, and psychiatric comorbidities. On the other end of the lifespan, the aging brain is more likely to have a lower baseline cognitive reserve thus predisposing it to cognitive and psychiatric comorbidities of epilepsy. The authors identified core epilepsy-specific characteristics, namely the frequency of interictal epileptiform discharges, the age of epilepsy onset, the duration of the epilepsy, and the cognitive and psychotropic effects of anticonvulsant drug regimens that are likely mediators of neurobehavioral and psychiatric comorbidities of epilepsy. Modification of these core epilepsy characteristics may be one way to treat the neurobehavioral and psychiatric comorbidities of epilepsy.
Commentary
As noted in the accompanying editorial,1 epilepsy is a global health problem and a costly and complex one at that. The cognitive, neurobehavioral, social, and psychiatric comorbidities add to the burden of this common disease. This burden remains, and at times increases, over the lifespan of the individual with epilepsy. Psychiatric and neurobehavioral comorbidities of epilepsy have been well reported in both the psychiatric and neurology literature. This is akin to the chicken and egg causality dilemma. Did the seizure disorder come first followed by the psychiatric and behavioral morbidities or are patients with psychiatric and behavioral disorders more prone to seizure disorders? Whatever the answer to the above question, there is a pressing need to better identify these comorbidities in our patients with epilepsy and to develop epilepsy-specific and individual specific treatment options.
Reference
1. Wanted: A global campaign against epilepsy. Lancet 2012; 380:1121.
Epilepsy is associated with behavioral, psychiatric, cognitive, and social comorbidities. The associated comorbidities change across the lifespan of a person with epilepsy. Early detection and treatment of these comorbidities has the potential to significantly improve quality of life for patients with epilepsy.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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