Managing psychiatric illness in patients with epilepsy

Neurodevelopmental disorders
The incidence of epilepsy in children who have an autism spectrum disorder is 5% to 38%; the disorder is more common in the presence of mental retardation or cere­bral palsy.⁵⁵

A significant percentage of youth who are referred for evaluation of attention-deficit/ hyperactivity disorder (ADHD) eventually are given a diagnosis of absence seizures. The incidence of ADHD in children with epi­lepsy is 20%; these patients display epilepti­form EEG changes, and require meticulous screening, which includes ictal induction by hyperventilation to differentiate ADHD from a seizure disorder.⁵⁶ Many AEDs, especially GABAergic drugs, can cause symptoms of ADHD. Methylphenidate is safe in children whose seizures are well-controlled, and has no significant interactions with AEDs.⁵⁷

Management. Adequate seizure control is the only effective means to slow regression in cases of epilepsy comorbid with autism spectrum disorder, mental retardation, and cerebral palsy.⁵⁸

BOTTOM LINE
Patients who have epilepsy have a lifetime susceptibility to psychopathology, especially depression and anxiety. Psychiatric practitioners should work collaboratively with patients' primary care provider to evaluate, diagnose, and treat both conditions. Quick action is the key to the best possible outcomes, including reducing the risk of recurrent seizures.

Related Resources
• Clancy MJ, Clarke MC, Connor DJ, et al. The prevalence of psychosis in epilepsy; a systematic review and meta-analysis. BMC Psychiatry. 2014;14:75.
• Centers for Disease Control and Prevention. Comorbidity in adults with epilepsy—United States, 2010. MMWR Morb Mortal Wkly Rep. 2013;62(43):849-853.
• Kui C, Yingfu P, Chenling X, et al. What are the predictors of major depression in adult patients with epilepsy? Epileptic Disord. 2014;16(1):74-79.
• Lunde ME, Rasmussen KG. Electroconvulsive therapy in patients with epilepsy. Epilepsy Behav. 2006;9(2):355-359.

Drug Brand Names

Aripiprazole • Abilify                               Risperidone • Risperdal
Chlorpromazine •  Thorazine                   Quetlapine • Seroquel
Citalopram •  Celexa                               Sertraline • Zoloft
Clozapine •  Clozaril, FazaClo                   Tiagabine • Gabitril
Escitalopram • Lexapro                            Topiramate • Topamax
Haloperidol • Haldol                                 Tramadol • Ryzolt, Ultram, ConZip
Lamotrigine • Lamictal                             Valproate • Depokate
Levetiracetam • Keppra                            Vigabatrin • Sabril
Methylphenidate • Methylin, Ritalin            Ziprasidone • Geodon

Disclosures
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.