The Neuropsychiatry of Epilepsy

Cover......Page 1
Half-title......Page 3
The Neuropsychiatry of Epilepsy......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 10
Part I - Background......Page 13
1 Introduction......Page 15
Introduction......Page 17
Population-based studies of psychiatric comorbidity in epilepsy......Page 18
Some large hospital-based studies......Page 21
Are psychiatric disorders commoner in epilepsy?......Page 22
The classification of psychiatric disorders in epilepsy......Page 23
REFERENCES......Page 27
Introduction......Page 30
The limbic system......Page 31
Normal structure......Page 33
Hippocampal sclerosis......Page 35
Amygdala......Page 36
Hippocampal commissure......Page 39
Affective disturbances......Page 40
Schizophrenia......Page 41
Aggression......Page 42
Anxiety......Page 43
REFERENCES......Page 45
Part II - Clinical aspects......Page 51
4 The psychiatry of idiopathic generalized epilepsy......Page 53
Relation to seizure type......Page 54
Postictal psychosis......Page 56
Alternative psychosis with forced normalization of the EEG......Page 57
‘The heart of the matter’......Page 59
Lifestyle......Page 60
Sleeping habits......Page 61
Phenomenology......Page 62
Investigations......Page 63
Investigations......Page 64
Investigations......Page 66
REFERENCES......Page 68
Definitions......Page 74
Causes of learning disorders......Page 76
Classification of learning disorders......Page 77
Conclusions......Page 79
REFERENCES......Page 80
A systematic framework for assessing behaviour......Page 82
State-dependent cognitive impairment......Page 83
Frequent absence seizures......Page 84
Transitory cognitive impairment......Page 86
Frequent localized discharges......Page 87
Postictal state-dependent cognitive impairment......Page 88
Electrical status epilepticus of slow wave sleep......Page 89
Preventing cognitive and behavioural problems......Page 90
REFERENCES......Page 91
Classification of aggression......Page 93
Clinical relevance of aggression......Page 94
Neurobiology of aggression......Page 95
Aggression and epilepsy......Page 96
Intermittent explosive disorder in epilepsy......Page 98
Amygdala pathology in patients with TLE and IED......Page 99
Cortical abnormalities in patients with TLE and IED......Page 102
Dual brain pathology in patients with affective aggression and epilepsy......Page 104
Social and psychological aspects of aggression in epilepsy......Page 107
Treatment of aggression in epilepsy......Page 108
Conclusion......Page 110
REFERENCES......Page 111
Suicide and attempted suicide......Page 119
Role of the interictal and peri-ictal psychopathology in suicide......Page 121
Pathogenesis of the psychiatric disorders of epilepsy......Page 123
Preventing suicide in epilepsy......Page 124
Conclusion......Page 125
REFERENCES......Page 126
Historical background......Page 129
CASE 1......Page 130
CASE 2......Page 131
Incidence......Page 132
Lucid interval, recurrence and duration of postictal psychosis......Page 133
Patient background......Page 134
Association with temporal lobe epilepsy......Page 135
Violence and postictal psychosis......Page 138
Treatment......Page 139
Conclusion......Page 140
REFERENCES......Page 141
Part III - Cognitive aspects......Page 145
Historical aspects......Page 147
Origins of psychometry......Page 149
An issue in interpretation......Page 150
Neurological disease in which both dementia and seizures occur......Page 151
Some specific epilepsy syndromes......Page 152
Cognitive effects of EEG discharges......Page 153
Treatment effects......Page 154
Some observations in temporal lobe epilepsy......Page 155
Temporal Gate hypothesis......Page 156
Conclusions......Page 157
REFERENCES......Page 158
Introduction......Page 164
Cross-sectional studies......Page 166
Conclusions......Page 169
REFERENCES......Page 172
Introduction......Page 176
Frontal lobe and behaviour disorders......Page 177
Epilepsy and behaviour disorders......Page 178
The neuropsychology of frontal lobe epilepsy......Page 180
Ictal behaviour in frontal lobe seizures: ‘positive’ and ‘negative’ phenomena......Page 183
Behavioural correlates of frontal lobe epilepsy......Page 187
Academic achievement and employment in frontal lobe epilepsy......Page 191
Trait or state......Page 192
REFERENCES......Page 193
Part IV - Nonepileptic attacks......Page 199
What is dissociation?......Page 201
Dissociation as nonintegrated mental modules or systems......Page 202
Dissociation as a defence mechanism......Page 205
Epilepsy and dissociation......Page 206
Nonepileptic seizures and dissociation......Page 209
Dissociative mechanisms of nonepileptic seizures......Page 212
Summary......Page 218
REFERENCES......Page 219
Introduction......Page 222
REFERENCES......Page 235
Epilepsy......Page 238
Panic disorder......Page 239
Biochemical pathophysiology......Page 240
EEG studies......Page 241
Event-related potentials......Page 244
Structural and functional imaging......Page 245
Experimental models of anxiety......Page 246
The biological significance of phenomenological similarities between PD and epilepsy......Page 247
REFERENCES......Page 248
Part V - Treatment complications......Page 251
Introduction......Page 253
Classical antiepileptic drugs......Page 254
Vigabatrin......Page 256
Felbamate......Page 258
Topiramate......Page 259
Idiosyncratic, dose-unrelated effects......Page 260
Forced normalization......Page 261
Positive psychotropic effects of AEDs in epilepsy patients......Page 262
REFERENCES......Page 264
Cognitive side effects of antiepileptic drugs......Page 268
Short-term or acute effects......Page 272
Long-term (irreversible?) effects......Page 273
Conclusion; seizures and drugs......Page 274
REFERENCES......Page 275
Introduction......Page 278
Psychiatric disorders in the context of temporal lobe resections......Page 279
Total psychiatric morbidity in patients with temporal lobe surgery......Page 280
Postictal psychoses......Page 281
Chronic interictal psychoses......Page 282
Postoperative psychoses......Page 283
Affective disorders and anxiety......Page 284
Nonepileptic attacks (nonepileptic seizures)......Page 287
Personality disorders – a gateway to an individual understanding of patients......Page 288
How could the development of personality disorders and their neuronal basis be explained?......Page 289
CASE REPORT......Page 290
REFERENCES......Page 291
Introduction......Page 295
Mood improvements by VNS in epilepsy patients......Page 296
VNS as an antidepressant treatment in nonepileptic patients......Page 299
Cerebral mechanisms of action......Page 300
GABA and glutamate......Page 301
Peripheral mechanisms......Page 302
REFERENCES......Page 304
Part VI - Treatment......Page 309
Animal data......Page 311
Clinical data......Page 312
Newer antidepressant drugs......Page 314
New antidepressant drugs and seizures......Page 316
Conclusions......Page 317
Antipsychotic drugs......Page 318
CASE REPORT......Page 320
Conclusions......Page 321
Conclusions......Page 322
REFERENCES......Page 323
Introduction......Page 325
FOUR CASE REPORTS......Page 327
Discussion......Page 331
Questions of indication and contraindication......Page 332
Effective or only well-intended?......Page 333
REFERENCES......Page 334
Types of QOL measure......Page 335
Individualized, patient-driven QOL assessment techniques......Page 336
Surgery......Page 337
The QOLAS......Page 338
The EuroQol EQ-5D......Page 339
Drug study: seizure reduction......Page 340
Drug study: EQ-5D profile scores......Page 341
Surgery: subjects and methods......Page 343
QOLAS scores......Page 344
EQ-5D......Page 345
Discussion......Page 347
Ability of the QOLAS and the EQ-5D to detect change in HRQOL......Page 348
Acknowledgements......Page 349
REFERENCES......Page 350
Appendix 22.1. QOLAS qualitative data.......Page 353
Index......Page 355