http://www.tarekasaad.com/

1. Psychiatric Aspects of
“Epilepsy”
Dr.Tarek Asaad

2. Agenda & Objectives
• Epilepsy : definition, classification,…
• Psychiatric symptoms in relation to epilepsy:
i-pre-ictal / ii-ictal / iii-post-ictal / iv-inter-ictal.
• Psychiatric DD in relation to epilepsy.
• Epilepsy & possible pathogenesis of psychiatric
disorders.
• Psycho-pharmacology of epilepsy in relation to
psychiatry :
a-Use of anti-epileptics in psychiatry.
b-Psychiatric side effects of anti-epileptics.
c-Use of psychotropics in epilepsy.

3. Epilepsy
• Prevalence : 1%.
• Definition : Transient paroxysmal pathophysiologic disturbance of
cerebral function, caused by spontaneous excessive discharge of
neurons.
• Classification :
I-Partial : a-with elementary symptoms & no impaired consciousness
( motor / sensory / autonomic / compound).
b-with complex symptoms & impaired consciousness
( psychomotor or TLE ).
c-with secondary generalization.
II-Generalized ( petit-mal, grand-mal, myoclonic, tonic, atonic,clonic,
akinetic, infantile spasms..).
III-Unilateral seizures.
IV-Unclassified seizures.

4. Complex Partial Seizures
• Synonyms : Psychomotor epilepsy, TLE, limbic
epilepsy…(not accurate?).
• Prevalence : most common form of epilepsy in adults
(3/1000)?
• Psychiatric comorbidity : 30%, commonly depression.
• Subtypes :
-with impaired consciousness only.
-with cognitive symptoms.
-with affective symptoms.
-with psychosensory symptoms.
-with psychomotor symptoms ( automatism ).
-compound forms.

5. Psychiatric Manifestations of Epilepsy
• Pre-ictal Symptoms ( Aura) : cognitive ( déjà
vu, jamais vu, dreamy state..) , affective ( fear,
panic, depression, elation..).
• Ictal Symptoms :brief, disorganized, uninhibited
behavior..(rarely, organized directed violent
behavior) / amnesia / use of sphenoidal or
ant.temporal electrodes or sleep EEG..? / LT
EEG recording? / Medico-legal aspects?
• Post-ictal Symptoms : confusion, abnormal
behavior...

6. Psychiatric Manifestations of Epilepsy
• Inter-ictal Symptoms (epileptic equivalent) :
1-Epileptic personality : religiosity, viscosity,change of
sexual behavior ( most frequent abnormality).
2-Psychosis : 10% of TLE, female, Lt. lesions,
hallucinations & paranoid delusions, usually preceded by
personality, unlike S : preserved affect &
circumstantiality, rather than association problems.
3-Violence : especially temporal & frontal ?
4-Mood : less than psychosis, episodic, non-dominant
temporal foci, may explain increased suicide in epilepsy?

7. Psychiatric DD in relation to epilepsy
• Conversion x epileptic seizures ?
• Sleep related epilepsy x sleep terror,
walking and RMBD ?
• Epilepsy x Narcolepsy ?
• Panic attacks x epilepsy ?
• Transient psychosis x epilepsy ?
• NE x epilepsy ?

8. Conversion x epileptic seizures
Seizure Pseudo-seizure
1-nocturnal fits Common Uncommon
2-stereotyped aura Usually None
3-Cyanotic skin
changes
Common Rare
4-self-injury Common Rare
5-incontinence Common Rare
6-post-ictal
confusion
Yes No
7-body movements Tonic, clonic… Non-stereotyped
8-effect of
suggestion
No Yes
9-EEG Spike, slowing… NAD
10-Lab Increased
prolactin ?
No change in
prolactin

9. Psychopharmacological Perspectives
• Indications of Anti-epileptics in psychiatry?
• Psychiatric side effects of Anti-epileptics?
• Psychotropics & epilepsy :
-Anti-pressants ?
-Anti-psychotics ?
-Stimulants ?
-Sedatives ?