Choosing the Right Doctor

A neurologist and psychiatrist both need to be involved in the diagnosis and treatment of the patient. The neurologist needs to be initially involved to identify the existence and type of a seizure disorder. If the symptoms are predominately psychiatric in nature, the psychiatrist is the logical person to manage all of the medications on the longer term.

Dr. Blumer (2000) discusses the large knowledge gap between the two disciplines of neurology and psychiatry. He reports that the neurologist does not know how to handle the psychiatric problems associated with epilepsy. Psychiatrists on the other hand have not had the training or experience to know about the psychiatric problems associated with the epileptic population. The old time psychiatrists knew about the depressive symptoms of the epileptic population. However, the current rigid separation of the neurology and psychiatry disciplines has led to a significant gap in knowledge to the detriment of the patient. The medical profession has recognized these shortfalls and has created a new discipline called “neuropsychiatry”. 

Our experience is that the neurologist and psychiatrist did not consult with each other. The neurologist was content to monitor the anticonvulsant to insure that that a high-range therapeutic serum value was being achieved. The neurologist showed no knowledge or interest in dealing with the psychiatric conditions. We later learned that this approach is unwise because of the interactions between medications and the fact that the anticonvulsant needs to stay within the low-therapeutic range to avoid a “forced normalization” of electrical activity that can increase the depressive symptoms.

A neuropsychiatrist or a psychiatrist with experience in seizure disorders should be the best choice for management of the illness. Neuropsychiatrists are usually located in the larger cities and are thus not available for most patients.

It is our experience that the involved family members have to be knowledgeable about the illness so that they can work with the psychiatrist on the recounting of past experiences and observations of the patient. Family involvement is critical. In nearly all cases, the psychiatrist treated the symptoms with ever increasing amounts of neuroleptics. This approach does not work and can easily create a crisis requiring hospitalization.