bubble_chart Overview

Psychiatric disorders associated with epilepsy can occur before, during, or after a seizure, and may also present as persistent mental disorders during the interictal period. Some scholars further classify these disorders based on their characteristics into: ① experiential psychiatric seizures; ② episodic psychiatric disorders; and ③ chronic psychiatric disorders.

bubble_chart Clinical Manifestations

Before an epileptic seizure, some patients may experience general discomfort, irritability, dysphoria, restlessness, depressive mood, dysthymia, and often nitpicking or complaining about others. These can manifest as brief abnormal experiences, such as simple to complex visual hallucinations, visual distortions, or somatic sensory illusions and hallucinations, followed by an epileptic seizure. This is also referred to as a psychic aura. Some patients may suddenly experience impaired consciousness, a vacant stare, aimless chewing or lip-licking, unbuttoning or buttoning clothes, pulling at the corners of clothing, or humming sounds. Their movements may be clumsy and repetitive, lacking purpose, which is termed psychomotor automatism. These symptoms can also occur independently.

After an epileptic seizure, patients often exhibit confusion and disorientation. Sometimes, emotional outbursts may occur, such as panic, irritability, agitation, aggression, or destructive behavior, known as a twilight state. Electroencephalography (EEG) may show diffuse slow waves predominantly in the dominant frontal lobe or spike or sharp wave discharges in the temporal lobe.

A few epileptic patients, after years of recurrent seizures, may develop associative disturbances, forced thinking, persecutory delusions, and auditory hallucinations resembling paranoid schizophrenia while remaining conscious. This is termed chronic epileptic schizophreniform psychosis. In these seasonal disease patients, epileptic seizures are often reduced or have stopped. The psychiatric symptoms may persist for months or even years, yet they can still maintain good emotional responses. Most scholars believe these cases belong to temporal lobe epilepsy. Some also suggest it may be related to long-term use of antiepileptic drugs leading to folic acid metabolism disorders.

Some epileptic patients may gradually develop personality changes after prolonged seizures, characterized by viscous thinking and emotional outbursts. These patients become self-centered, argumentative, overly focused on trivial matters, struggle with shifting thoughts, lack creativity, and exhibit circumstantiality. During emotional outbursts, they may become impulsive, aggressive, and engage in self-harm or harm others uncontrollably. A few patients, due to frequent seizures, may experience cognitive and intellectual decline, particularly if the onset occurs at a younger age, which has a greater impact on intelligence. This is termed epileptic dementia. These conditions arise not only from secondary brain damage caused by seizures but also from genetic factors, adverse effects of antiepileptic drugs, psychosocial factors, and cultural and educational influences.

bubble_chart Diagnosis

There is a history of previous epileptic seizures, with psychiatric symptoms being episodic, and each episode is essentially similar. It is accompanied by varying degrees of impaired consciousness, which is of significant reference value for diagnosis. For cases with a prolonged course and atypical symptoms, repeated EEG examinations are necessary, and diagnostic treatment with antiepileptic drugs may be administered if needed. If both psychiatric symptoms and EEG findings improve after medication, this can serve as important evidence for diagnosis. Diagnosis should also distinguish whether the mental disorder occurs before or after the seizure, as this has reference value for treatment.

bubble_chart Treatment Measures

The treatment of epileptic mental disorders should be tailored according to different circumstances. For mental disorders occurring before or after seizures, the goal of treatment is to adjust the types and doses of antiepileptic drugs to control epileptic episodes. For interictal mental disorders, the approach is the same as for non-epileptic patients, but it should be noted that many antipsychotic drugs can increase the risk of epileptic spasms. For patients with intellectual disabilities and personality changes, education and management should be strengthened, along with rehabilitation measures such as psychotherapy and occupational and recreational therapy.