Questions to ask about Seizures and Antipsychotic Medications

This week, Dr. Sirven presented findings about the chance that antipsychotic medicines may cause or contribute in some way to convulsions. The article found that some of the newer antipyschotic medicines were more likely to affect convulsions than the older drugs. So what does this information mean for people with epilepsy? What types of questions need to be asked?

What is psychosis or psychotic symptoms? Psychotic symptoms involve changes in a person’s thoughts, behaviors and mood so that they are ‘out of touch with reality’. People may have hallucinations, for example see or hear people or things that aren’t really there, mood swings or changes out of context to what is going on around them, or thoughts that don’t made sense to others.

Psychotic symptoms can be mistaken for partial seizures. For example, some partial seizures consist of hallucinations or changes in feelings or perceptions, but the symptoms occur as a result of electrical discharges in the brain. In these situations, treating the symptoms with epilepsy medicines is needed. Psychotic symptoms can also occur after convulsions (tonic clonic seizures) or prolonged seizures. In these situations, antipsychotic medicines may be needed to stop and control the psychotic symptoms. Usually these are temporary and long-term antipsychotic treatment may not be needed.

Psychotic symptoms may also occur unrelated to epilepsy. They may be seen with mood disorders or other psychiatric conditions, such as schizophrenia. These problems are thought to be due to changes in the substances that send messages within the brain. The antipsychotic medicines are used long-term to correct the imbalances and control the symptoms. They do not cure the underlying problem, however.

If antipsychotic medicines can increase the risk of seizures, why are they used in people with epilepsy? While some medicines may increase the risk of convulsions, the benefits of using them to control other symptoms is important to weigh against any risks. Psychotic symptoms that are not treated can put a person at risk of injury in many ways and can be life-threatening. While the risk of seizures may be present, it’s important to remember that the person with epilepsy is likely already being treated with seizure medicine.

If my doctor recommends an antipsychotic medicine, how do I know whether to take it or not and which one is best? First of all, it’s important to make sure that the diagnosis is clear and that the psychiatrist and neurologist talk with the person with epilepsy and their family about the reasons for the medicine, benefits, and risks. There is no one ‘best medicine’. Choosing psychiatric medicines is similar to choosing epilepsy medicines – they need to be tailored to each person and monitored carefully.

How do I know if it changes my seizures? Whenever a change in treatment is made, whether it’s a treatment for seizures, mood, or other medical problems, it’s important to note the changes in a seizure diary. Note what medicine is started, changed, or stopped and what dose is used. Then continue to track and record seizures – when they occur, what type, if they are different than usual, how long they last and if there is any change in pattern. Write down if there are other triggers too, so a medicine is not blamed for triggering a seizure when it could be due to missing seizure medicine, not sleeping, or other triggers. Sorting out if the seizures are related to using a new medicine is often hard to do. Sharing the information from a seizure diary with your doctors can help them look at changes in seizures before and after the medicine is used.

What type of follow-up is needed? Everyone being treated for seizures should have regular follow-up with a neurologist. If seizures are uncontrolled or if other problems, including psychotic symptoms or other mood or behavioral problems are present, people should consider seeing an epilepsy specialist to re-evaluate symptoms and treatment options. Here are a few other important follow-up tips.

• Keep up regular appointments with the neurology/epilepsy team as well as mental health providers. Missed appointments may lead to gaps in care – people don’t get the care they need and problems, such as changes or side effects may be missed.

• Make sure all medicines are taken as prescribed. Certain medicines must be taken at specific times – make sure to go over how to take the medicines with your doctors and nurses at each visit.

• Use a seizure diary to record changes in symptoms, seizures, and other problems. See My Epilepsy Diary if you want to start on online diary!

• Ask your epilepsy doctor and psychiatrist what to do if changes in mood, thoughts or behavior are seen. This may involve when to take medicines, call the doctor, or be seen urgently in an emergency situation.

• Make sure family members and close friends understand what is going on and what to do. If a person is confused or not thinking clearly, they may not be able to take action when they need it most and will need to rely on help from family and friends.

• Don’t be afraid to talk about what’s going on! Some people find it hard to talk about epilepsy or emotional problems for fear that others won’t understand them or think differently of them. Yet not talking about the problems is worse! People then don’t get the help they really need and others think that the symptoms are something to be afraid of.

I hope this information helps people think about their symptoms differently, with a focus on questions to ask and how to talk to their health care providers and families about their concerns.

This is a difficult topic to address. These tips just begin to address important issues. Please make sure you talk to your health care team about your personal situation and how all of you can best work together to manage your health and daily life. Please remember that if you or your loved one are feeling unsafe in any way, noticing changes that are of concern, or are not sure how to manage your thoughts and moods, be sure to contact your psychiatrist right away or seek emergency care.

Best wishes for a safe and healthy new year!

The information in this column is for general educational purposes only. Only a doctor or a licensed health care practitioner who has reviewed medical records and examined someone within their scope of practice can provide individual medical advice.