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David Ficker

David M. Ficker MD, Associate Professor of Neurology, University of Cincinnati Neuroscience Institute, discusses comorbidities, their importance, and mood disorders as a comorbidity of epilepsy.

A comorbidity is defined as the presence of one or more additional disorders that co-occur with a primary condition. It has been increasingly recognized that there are multiple comorbid conditions associated with epilepsy. In fact, the 2007 NINDS Epilepsy Research Benchmarks included comorbidities as one of the benchmarks (Benchmarks Area III: Prevent, limit, and reverse the co-morbidities associated with epilepsy and its treatment). The Institute of Medicine also identified epilepsy comorbidities in the IOM report on epilepsy.

While any condition may be comorbid with epilepsy, examples of common comorbidities in epilepsy include psychiatric disorders, cognitive disorders, migraine, and sleep disorders. Other conditions that were identified in a recent CDC survey to be more common in people with epilepsy include cardiovascular, respiratory, some inflammatory, and other disorders. Finally, sudden unexpected death in epilepsy (SUDEP) is increased particularly in people with poorly controlled seizures.

Importance of comorbidities

It is important to understand and recognize the comorbidities associated with epilepsy because they can affect outcome. Certain comorbidities such as depression and anxiety are associated with poorer quality of life (QOL) while seizure frequency has less of an impact on QOL. A study of  people with refractory epilepsy showed that depression was an important contributor to QOL, yet seizure- related factors were not. Other studies suggest that depression or anxiety significantly impact QOL.

Comorbidities can affect treatment choice. For example, medications that have a negative impact on cognition should be avoided in people with significant cognitive dysfunction. Some antiepileptic medications can have a negative effect on mood and behavior and should be used with caution in people with depression. AEDs can also cause behavioral adverse effects, and these effects may be more commonly seen in people with coexisting behavioral comorbidities.

Mood disorders as a comorbidity

Co-morbid mood disorders are very common in people with epilepsy, with both anxiety and depression being highly prevalent. Depression and/or anxiety can be seen in 20 to 50% of people with epilepsy depending on the population studied. Despite the high prevalence, depression and anxiety are unrecognized even in epilepsy specialty clinics. Depressive symptoms are different in people with epilepsy and may not fulfill DSM criteria for major depression. At the University of Cincinnati Neuroscience Institute's Epilepsy Center, we routinely screen all of our epilepsy patients for depression and anxiety using the Neurologic Disorders Depression Inventory for Epilepsy (NDDI-E) and the Generalized Anxiety Disorders 7 (GAD-7). The Practice Committee of the American Epilepsy Society also recommends the use of practice tools for cognition and behavior in both children and adults.

This content was created through a partnership between the Epilepsy Foundation and American Epilepsy Society.

Authored By: 
David M. Ficker MD, FAAN
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Authored Date: 
03/2015