Chapter 15 - Managing psychiatric aspects of seizure disorders

Summary

A seizure may be an acute symptomatic or unprovoked event. Acute symptomatic seizures have a cause such as brain trauma, infection, or drug withdrawal. The disorders in people with epilepsy (PWE) are: psychiatric disorders, depressive disorders, bipolar disorders, anxiety disorders, and cognitive disorders. Psychiatric disorders in PWE are best managed by avoiding the ictus altogether. Although antiepileptic drug (AED) decision-making should be guided by a neurologist, it is important to understand basic treatment strategies along with the potential for rash and fetal malformations. Experts agree that monotherapy is the treatment of first choice for partial and generalized epilepsies. If the first AED fails, neurologists prescribe monotherapy with a second AED. Valproic acid use increases the risk of major malformations and should be avoided during the first trimester. The indications for psychotropic use in someone with epilepsy are the same as in the general population.