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This website provides information on a psychiatric disorder that originates with seizures. This illness often produces symptoms that are similar to schizophrenia. However, the two illnesses are distinctly different and are treated in different ways. Proper diagnosis can lead to a favorable outcome. Conversely, a misdiagnosis can lead to a treatment program that is detrimental to the patient.

Background

The information contained in this website is for only informational purposes only. It is intended to serve as a resource for the patient and family members who suspect that a seizure disorder underlies an on-going psychiatric disorder.  This website has been prepared by a family who has dealt with the illness of a son. The family has worked as a team. The mother has provided on-going support over the years. The father has conducted research on the illness and has worked closely with the treating physicians in the administration of medications. The son, who has dealt with the illness for 18 years, is an expert on computers and is responsible for the design of this website. The father is responsible for the technical content in this website. Although he does not have a medical background, he holds a PhD in the engineering sciences and has spent a career in research.

The father has reluctantly delved into the medical literature in search of answers for a son who has been quite ill. It has been difficult to find help in the medical community since the illness lies between the traditional domains of neurology and psychiatry. Our search has revealed that a considerable amount of knowledge is available within the medical community. However, the typical local practicing physician is not aware of this information. In spite of the difficulties, we have found an excellent local psychiatrist who is knowledgeable about the illness and who has been very effective in guiding the treatment program.

We have relied principally on the work of Dr. Dietrich Blumer, Professor of Psychiatry at the University of Tennessee College of Medicine, Memphis, Tennessee. He is an internationally recognized expert in the treatment of psychiatric disorders associated with epilepsy. He has also consulted with us over the past 15 years. Other prominent physicians include Dr. John Barry at Stanford University and Dr. Michael Trimble at the Institute of Neurology, University College of London. Dr. Blumer has provided an excellent online review of the illness at: http://www.neuropsychiatryreviews.com/dec00/npr_dec00_epilepsy.html.

Description and Treatment Overview

Slater (1963) published a historically significant paper discussing his findings that a large number of persons having epilepsy also demonstrate a psychosis that resembles schizophrenia. These schizophrenia-like symptoms include depression, psychosis, anxiety, and personality disturbances. In spite of the similarity, the two illnesses are distinctly different. Persons having a seizure-related psychosis usually have a baseline of intact emotionality and rapport with others. The psychotic state develops out of the depression, which forms the basis for the treatment approach. The outcome is highly variable depending upon the severity of the illness.

Psychosis is most commonly associated with temporal lobe epilepsy, but can also occur in other forms of epilepsy. The psychosis tends to develop in patients with temporal lobe epilepsy after an average of 14 years of illness. The seizures can vary widely from grand mal seizures to those in which there is no loss of consciousness. The seizures may be in such a subtle form that they are only recognized on an EEG. The psychosis normally occurs during the interictal phase where there is clear consciousness and low seizure frequency. This illness has been referred by Dr. Blumer (2000) as an “interictal dysphoric disorder”. The illness is referred to as a “subictal dysphoric disorder” in cases where the seizures occur only in a mute form.  The psychiatric illness that is associated with this illness is often referred to as an “organic affective disorder”, “depression with psychotic features”, or “psychotic depression”. Blumer (1988) discusses the treatment of the illness where the seizures exist in a mute form.

Dr. Blumer recommends treatment with a combination of an anticonvulsant, dual antidepressants, and a neuroleptic. The following are examples of suitable medications:

 

Suitable Medications

Example

Anticonvulsant

Tegretol, Depakote, Lamictal

800 mg Tegretol XR

Antidepressants

Effexor, Cymbalta, Remeron, Lexapro,

Paxil, Zoloft, Pamelor

30 mg Paxil

150 mg Pamelor

Neuroleptic

Risperdal, Haldol

4 mg Risperdal

Very important considerations in the treatment include:

  • Tegretol is usually a suitable choice for the anti-convulsant. The newer anticonvulsants that are highly effective in suppressing seizure activity should be avoided. These may increase the psychotic activity.
     

  • The two antidepressents should be able to increase norepinephrine and serotonin levels in the blood. The antidepressants are effective in dealing both with the depression and also the psychosis.
     

  • The selected neurolepic must not strongly reduce the seizure threshold and must be administered at a low to moderate level. Risperdal is the usual choice. High levels of the neuroleptic worsen the problem.

Additional details are provided in the individual sections.

Efforts have been made to communicate our message in simple language. For example, references are made to the Brand names of medications rather than the technical terms.

Disclaimer

The purpose of this website is to provide information related to the treatment of those persons dealing with a psychiatric illness that has origins in a seizure disorder. The website has been prepared by an individual with no formal medical training. No actions should be taken as a result of the information in this website. The reader is urged to seek competent medical opinion before any treatment plan is implemented.      

This website provides information on a psychiatric disorder that originates with seizures. This illness often produces symptoms that are similar to schizophrenia. However, the two illnesses are distinctly different and are treated in different ways. Proper diagnosis can lead to a favorable outcome. Conversely, a misdiagnosis can lead to a treatment program that is detrimental to the patient.