IEC 2025 | The bidirectional relationship between epilepsy and psychiatric comorbidities
Heather Angus-Leppan, MBBS (Hons), MSc, MD, FRACP, FRCP, St Mary’s University, London, UK, discusses the bidirectional relationship between epilepsy and psychiatric comorbidities. She suggests that addressing comorbidities can improve epilepsy outcomes, and treating epilepsy can improve mood. This interview took place at the 36th International Epilepsy Congress (IEC) in Lisbon, Portugal.
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Transcript
So as I mentioned, there’s this bidirectional relationship between the epilepsy and the psychiatric comorbidities, and also cognitive function. So in a way, I think we need to view all of these things and bring in the cognitive function as well, as that’s incredibly important. And so if there is comorbidity and it’s treated, then this improves the epilepsy outcomes, the adherence...
So as I mentioned, there’s this bidirectional relationship between the epilepsy and the psychiatric comorbidities, and also cognitive function. So in a way, I think we need to view all of these things and bring in the cognitive function as well, as that’s incredibly important. And so if there is comorbidity and it’s treated, then this improves the epilepsy outcomes, the adherence. And also if you treat the epilepsy, that often improves mood. So if we think of mood disorders, they can be pre-ictal, they can be during the seizure itself, and they can be post-ictal, or they can be interictal, between the seizures. So often treating the seizures themselves will influence and improve the mood changes if there are any. And we know also that there’s been much more emphasis and research and excitement about understanding the relationship between impaired cognition in older people and epilepsy, and whether one causes the other or both. And I think probably we’re going to find that it’s both, that one can cause the other or influence the other. And certainly, that treating the epileptic seizures may improve the cognitive outcomes and treating the cognition. And especially if we can start having really early preventive treatments, that may reduce the incidence of epilepsy. And of course, mood and cognition go very much together, so there is a very big impetus to treat these psychiatric comorbidities, to be aware of them, and being aware of them and either asking people how they are, how they’re doing, what activities they’re doing, can really start the process of treating these comorbidities. And I think a big emphasis needs to be on what people are doing. Older people may be less used to talking about their feelings and about their mood. So if you get a reflection of what activities they’re taking part in, are they engaged in the things that they enjoy doing? What really brings them joy? Then you get an indication often of changes in mood that you might otherwise find more difficult to pick up.
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