The evaluation of any patient with epilepsy and psychiatric symptoms must include:
This discussion will focus specifically on the important steps in the evaluation of psychiatric symptoms or disorders in patients with epilepsy.
Most important, any initial evaluation of patients with epilepsy cannot be complete unless it includes an investigation of the presence of psychiatric symptoms or disorders and cognitive disturbances. The patient and family members should describe the impact (if any) that the seizure disorder had on the patient's quality of life at a social, professional, and familial level.
At the least, clinicians need to ask about the presence of symptoms of depression and anxiety in adult patients, as these are the most frequently reported psychiatric symptoms in adults with epilepsy. Clinicians need to ask whether children have shown impulsive behavior, motor hyperactivity, poor frustration tolerance, problems with concentration, or academic difficulties.
In the evaluation of patients with epilepsy and psychiatric symptoms, it is essential to establish the type of seizures and epilepsy syndrome and the cause of the seizure disorder, if it can be established. Certain epilepsy syndromes are more likely to be associated with certain psychiatric disorders.
It is also important to have a careful description of the type of antiepileptic drugs (AEDs) the patient has taken, the response to these AEDs with respect to seizure control and adverse events, and the course of the seizure disorder over the years.
A careful psychiatric history is also essential, including a detailed description of signs and symptoms, their course over time, circumstances that resulted in an exacerbation or remission, and response to any treatment.
A careful psychiatric family history also should be obtained, because a history of mood or anxiety disorder in a first-degree relative constitutes a strong risk factor for the development of these psychiatric disorders.
The answers to several questions determine whether the seizure disorder or its treatment are directly related to the development of the psychiatric symptoms:
If the patient has a personal psychiatric history that precedes the onset of the seizure disorder, the clinician needs to inquire about the following:
Psychiatric disorders are under-recognized and under-treated in patients with epilepsy because patients are reluctant to report their seizures and symptoms to their treating physicians and the physicians fail to inquire about them. The result is that epilepsy is complicated by the presence of psychiatric disorders that often take a greater toll on the quality of life than the seizures. It is the responsibility of both patient and physician to ensure that this does not happen!
Reviewed and revised April 2004 by Andres M. Kanner, M.D., epilepsy.com Editorial Board.
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