Neurobehavioral disorders including fatigue, depression, anxiety, and psychosis commonly affect patients with epilepsy. People with epilepsy may also have cognitive problems that effect attention, memory, mental speed, and language, as well as executive and social functions. Cognitive and behavioral disorders often overshadow the seizures themselves and can be the greatest cause of impaired quality of life. Furthermore, these problems often go unrecognized and, even when identified, are often under treated or untreated. Patients with epilepsy frequently suffer from cognitive and behavioral disorders that range from subtle to severe. Behavior changes occur during and immediately after most seizures. However, in some cases, cognition and behavior also change for prolonged periods after individual seizures or throughout the long interictal gaps.
Aggressive control of seizures, and possibly reduction of interictal epileptiform activity and epileptogenesis, may help prevent interictal cognitive and behavioral disorders. The late 19th century view of epilepsy as a progressive disorder—in terms of both seizures and cognitive-behavioral disorders—is finding support from modern studies (1). While the best therapy for cognitive and behavioral disorders may be prevention, there is little systematic study of the phenomenon either retrospectively or prospectively.
- Sutula TP, Hagen J, Pitkanen A. Do epileptic seizures damage the brain? Curr Opin Neurol 2003;16:189–95.
Reproduced and adapted with permission from Orrin Devinsky, MD and Epilepsia.