A Review on the Pathomechanism of Interictal Psychiatry Comorbidities in Epilepsy

Anna SzAcs, Andras Horvath, Daniel Fabo, Andrea Kovacs, Peter Halasz, Geza Szabo
2018 Journal of Neurology and Neuroscience  
Epilepsies, especially mesiotemporal epilepsy in adulthood, are frequently associated with chronic cognitive loss, psychiatry symptoms and conditions. We aim to present the pathophysiology of interictal psychiatric comorbidities interlocked with cognitive loss; severely compromising the quality of life of epilepsy patients. We will present the mechanism of cognitive harm related to interictal spiking; and the abnormalities of brain networks in epilepsy, especially of the default mode network,
more » ... iefly looking into psychosocial and pharmacology effects, too. In addition to seizures, interictal epileptic activity, mainly in sleep, may exert chronic cognitive harm, increasing the risk for primarily non-cognitive psychotic conditions as well. Interictal spikes and pathological high frequency oscillations curiously resemble normal memory traces; enabling them to "behave" and be mistaken for engrams by the memory process. Epileptic activity impairs the white and grey matter of the brain; likely contributing to brain network changes. The epileptic network changes resemble those seen in non-epileptic psychiatry conditions, offering a network-interpretation of psychiatric comorbidity. Based on the adoption of the existence of atypical forms by ILAE, we venture not to use detailed psychiatry nosology categories in our work; rather, we refer to groups based on leading symptoms such as depressions-mood disorders, 1 anxiety syndromes, psychoses and schizophreniform psychoses in general. The background of interictal psychopathology disturbances in epilepsy While the cognitive damage of seizures and the instant harm of interictal discharges, called transient cognitive impairment, are relatively easy to interpret, the mechanism of enduring psychiatry symptoms and conditions far away from clinical seizures is less clear [4][5][6][7][8]. The following data demonstrate the proportions of such comorbidities. More than half of the epilepsy population suffer from low moods and each epilepsy patient develops at least one episode of clinically significant depression, contrasting with just 16% of patients with diabetes, 17% with asthma and 9% of the general population [9-11]. Forty percent of epilepsy patients suffer with anxiety conditions [12]. The risk of suicide is elevated several-fold compared to the general population; twenty-fivefold in temporal lobe epilepsy [11,[13][14][15][16]. The prevalence of psychosis is sevenfold of the general population, and the schizophreniform psychoses affect more than half of TLE patients [17][18][19][20]. During ten years of follow-up, 10% of children suffering in temporal lobe epilepsy have developed an episode of schizophrenic psychosis [21]. There are several concepts on the causes of chronic psychiatry comorbidity in epilepsy.
doi:10.21767/2171-6625.1000244 fatcat:mduycegnafgvzaivzgfhbp335i