Mental complications in connection with epilepsy

It is well known that many patients, particularly those with chronic epilepsy, "build up" to a seizure with particular mental symptoms, which give them warning that the seizure is coming. These symptoms can be increased irritability, bad temper, and depression, or the complete opposite, heightened activity and noticeably good humor. These symptoms may last for hours or days. Not much is known about what causes them. No particular changes are visible on EEG in the time before a seizure

The violent electrical discharges from the nerve cells, which form the background of the epileptic seizure, will often affect consciousness.

In generalized convulsive seizures there is always deep unconsciousness during the seizure. Consciousness is only momentarily affected during absences in children.

In complex partial seizures consciousness may be affected to a greater or lesser degree. This is shown by the various levels of memory of what has happened during a seizure.

Simple partial seizures with mental symptoms which can be remembered afterwards, have from ancient times been known as "aura". They are often followed by a convulsion. They are often dream-like, and can be the same each time. Simple partial seizures will often develop into complex with consciousness being affected. As the "aura" is a simple partial seizure, localized changes can often be seen on EEG which show that the seizure is under way.

It is an advantage to have these warnings, as many people can manage to get into a safe place before the seizure starts. On the other hand, hallucinations and dream-like experiences can affect the persons state of mind in a negative way. He thinks that he is going mad, and that others will come to the same conclusion, if he tells them of his experiences.

It has long been debated as to whether persons with epilepsy have particular personality traits, which are different from other people's. It has particularly been singled out that people with temporal lobe epilepsy are more emotionally unstable than others, perhaps with a tendency towards aggression. Some people were said to be self-centered, they could be sensitive to the point of paranoia, and took every chance remark as a personal slight. They were described as being given to brooding over things, and were particularly interested in religious, mystic, philosophical and moral issues. They were said to be less interested in sex, with a reduced libido and impotence.

Many investigations have confirmed that some persons with epilepsy with scars on the temporal lobe may have these particular personality disturbances.

Persons with seizures on awakening, for example juvenile myoclonic epilepsy, are said to lack energy and suffer from perseverance, and to mature later than others, both mentally and physically.

It has also been said that they are gipsy-types, with an urge to live a bohemian life. However most persons with juvenile myoclonic epilepsy function well socially.

In all events, it is a fact that suicide, and overdoses in connection with attempted suicide, are more common amongst persons with epilepsy than amongst the rest of the population. Suicide has often involved phenobarbital, so, for that reason amongst others, prescribing it should be avoided.

Hallucinations

People with temporal lobe epilepsy, more often than others, may develop a mental condition which resembles schizophrenia. This manifests itself most often when the person has had complex partial seizures with convulsions for about 15 years. The person gets the feeling that they are being persecuted and develops hallucinations. Their emotional contact with other people, however, is always much better than in cases of true schizophrenia.

The course of this mental illness is also much better than in the case of schizophrenia, as it often seems to cure up by itself. If this does not happen, treatment with psychopharmacological drugs may be needed, in addition to the anti-epileptic treatment.

The symptoms consist of the person keeping stubbornly on and on about the same subject (this is called perseverance), regarding themselves to be the centre of everything, emotionally clinging to the people around them, and being totally lacking in initiative.

These symptoms, which are often seen in people who have had many seizures, do not only occur in people with epilepsy. They are also seen in other persons suffering from dementia.

The reason that these symptoms have been linked with epilepsy is that they are often seen in patients who have had many seizures. It has been well known for some time that any convulsions, particularly status epilepticus with generalized convulsions, cause loss of nerve cells. The latest investigations also point to minor seizures and possibly even the epileptic activity in the brain between seizures, as leading to the loss of nerve cells.

It would not be possible to see changes in the brain after just a few seizures, but it is likely that every single seizure has a damaging effect on the brain. If the loss of nerve cells becomes sufficiently large, a reduction of the mental abilities (dementia) will follow. This is an important reason for carrying out the most careful treatment of seizures.