Therapy for cognitive and behavioral disorders in patients with epilepsy treat symptoms, not the underlying seizures or epilepsy. Our symptom-based therapies reflect the limits of our understanding of epilepsy pathogenesis and progression, of ways to translate known mechanisms into therapy, and of strategies to reverse the physiological or structural changes that underlie the epilepsies. Moreover, health care providers often underestimate the impact of patients’ stressors, environment, family, and fears. Therapeutic opportunities are thereby missed. Diagnosis and therapy must be balanced, with emphasis on the patient and their mental and emotional world, as well as the underlying neurobiology.

Therapy for cognitive and neurobehavioral symptoms is similar across neurologic disorders. Anxiety, depression, aggression, and psychosis appear to respond to the same pharmacotherapies regardless of whether the patient has epilepsy, stroke, or multiple sclerosis.

Clinical features such as the patient’s age, comorbid disorders (e.g., cardiac arrhythmia, migraine), concurrent medications, and response to prior therapies may be more important therapeutic guides than the specific neurologic disorder. Adverse-effect profiles are very relevant, with concerns regarding the effects of psychotropic drugs on seizure threshold and interactions with AEDs.

Reproduced and adapted with permission from Orrin Devinsky, M.D. and Epilepsia.

Topic Editor: Steven C. Schachter, M.D.
Last Reviewed:12/15/06