Key Points
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Psychiatric and neurological comorbidities are relatively common in epilepsy, affecting up to half of the patients
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Psychiatric and neurological comorbidities have a complex relationship with epilepsy: comorbidities can exacerbate epilepsy or each other, and vice versa
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Treatment of psychiatric and neurological comorbidities needs to be incorporated into the overall management of patients with epilepsy
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Both pharmacological and surgical management of the seizure disorder can have either a negative or a positive impact on psychiatric and neurological comorbidities
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Neurologists should be able to treat some of the more common psychiatric comorbidities in patients with epilepsy and identify patients at risk of adverse events from psychotropic medications, because psychiatric care is not available to all patients
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This Review provides practical principles and considerations for the management of the most common psychiatric and neurological comorbidities in patients with epilepsy
Abstract
The treatment of epileptic seizure disorders is not restricted to the achievement of seizure-freedom, but must also include the management of comorbid medical, neurological, psychiatric and cognitive comorbidities. Psychiatric and neurological comorbidities are relatively common and often co-exist in people with epilepsy (PWE). For example, depression and anxiety disorders are the most common psychiatric comorbidities in PWE, and they are particularly common in PWE who also have a neurological comorbidity, such as migraine, stroke, traumatic brain injury or dementia. Moreover, psychiatric and neurological comorbodities often have a more severe impact on the quality of life in patients with treatment-resistant focal epilepsy than do the actual seizures. Epilepsy and psychiatric and neurological comorbidities have a complex relationship, which has a direct bearing on the management of both seizures and the comorbidities: the comorbidities have to be factored into the selection of antiepileptic drugs, and the susceptibility to seizures has to be considered when choosing the drugs to treat comorbidities. The aim of this Review is to highlight the complex relationship between epilepsy and common psychiatric and neurological comorbidities, and provide an overview of how treatment strategies for epilepsy can positively and negatively affect these comorbidities and vice versa.
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Kanner, A. Management of psychiatric and neurological comorbidities in epilepsy. Nat Rev Neurol 12, 106–116 (2016). https://doi.org/10.1038/nrneurol.2015.243
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DOI: https://doi.org/10.1038/nrneurol.2015.243
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