Epilepsy spectrum disorders: A concept in need of validation or refutation

Area of Science:

• Neuroscience
• Psychiatry
• Epileptology

Background:

• Episodic psychiatric symptoms like panic attacks or violent acts are common.
• Some patients may exhibit focal cortical/subcortical hyperexcitability.
• This suggests a potential epilepsy spectrum disorder (ESD) with treatment implications.

Purpose of the Study:

• To propose that subthreshold neural hyperexcitability can cause observable phenotypic changes.
• To explore the relationship between hyperexcitability, location, and manifestation of symptoms.
• To suggest diagnostic and treatment approaches for this proposed condition.

Main Methods:

• Review of existing evidence, primarily electroencephalography (EEG) studies.
• Analysis of clinical reports on responses to anti-epilepsy treatments.
• Proposal of methods to further investigate the hypothesis.

Main Results:

• Milder neural hyperexcitability, below seizure threshold, may manifest as psychiatric symptoms.
• Phenotypic presentation depends on the degree and location of hyperexcitable neural tissue.
• Anatomical connectivity influences the range of observed manifestations.

Conclusions:

• Episodic psychiatric symptoms may arise from a spectrum of neural hyperexcitability.
• Further research is needed to define this condition, its prevalence, and appropriate workup.
• Anti-epilepsy treatments may be beneficial for a subset of patients with these symptoms.