[Psychopathology in medically refractory partial seizures]

Today, psychopathology in medically refractory partial seizures is well-known. Descriptive (syndromic) classifications of both epileptic syndromes and psychiatric disturbances associated with prospective psychiatric status evaluations in resective epilepsy surgery centers in order to prevent poor post surgical outcome have increased our knowledge of the mental status of these patients. Three major categories of psychiatric comorbidities are observed. 1. Specific post ictal syndromes related to seizures (post ictal psychoses and post ictal depressive disorders). 2. Interictal psychiatric disorders: depression appears to be the most prevalent psychiatric condition in medically refractory seizures followed by anxiety and psychotic states. 3. Psychiatric adverse events of antiepileptic drugs according to the numerous new available drugs. There are no published guidelines. We are challenged both as clinicians and as an academic community. We need to improve identification, better utilize existing therapies and promote the development of prospective trials devoted to the study of psychiatric status in presurgical evaluation. A psychiatrist must be included in presurgical teams.