Impact of psychiatric comorbidities on the treatment of epilepsies in adults

ABSTRACT

Introduction

Epilepsy is often accompanied by psychiatric comorbidities and the management of epilepsy in these patients presents unique challenges due to the interplay between the underlying neurological condition and the psychiatric symptoms and the combined use of multiple medications.

Areas covered

This paper aims to explore the complexities associated with managing epilepsy in the presence of psychiatric comorbidities, focusing on the impact of psychiatric disorders on epilepsy treatment strategies and the challenges posed by the simultaneous administration of multiple medications.

Expert opinion

Patients with epilepsy and psychiatric comorbidities seem to present with a more severe form of epilepsy that is resistant to drug treatments and burdened by an increased morbidity and mortality. Whether prompt treatment of psychiatric disorders can influence the long-term prognosis of the epilepsy is still unclear as well as the role of specific treatment strategies, such as neuromodulation, in this group of patients. Clinical practice recommendations and guidelines will prompt the development of new models of integrated care to be implemented.

KEYWORDS:

• Epilepsy
• psychiatric disorders
• antiseizure medications
• interactions
• seizure

Article highlights

• Psychiatric comorbidities in epilepsy are associated with drug-resistance, increased risk of side effects from antiseizure medications and increased morbidity and mortality.

• The role of psychiatric comorbidities on seizure outcome after epilepsy surgery is still unclear and controversial.

• Data on neuromodulation in people with epilepsy and psychiatric comorbidities is preliminary but promising.

• Clinically relevant drug interactions between psychotropic drugs and antiseizure medications involve mainly bupropion and quetiapine but individual clinical monitoring is advisable.

• Clinical practice recommendations and guidelines will prompt the development of new models of integrated care to be implemented.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.