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Persistent psychiatric symptoms in apparently well-controlled epilepsy: case report
Masahiro Hata1, Rei Sakagami1, Shun Takahashi1,2,3,4
1Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan.
Bjpsych Open
|September 15, 2025
Summary
Persistent psychiatric symptoms in epilepsy patients may stem from underlying seizures, not just mood disorders. Optimizing anti-seizure medication can resolve these symptoms and improve function.
Area of Science:
- Neurology
- Psychiatry
Background:
- Epilepsy often presents with psychiatric symptoms like depression and irritability.
- Interictal dysphoric disorder (IDD) is a common diagnosis, usually treated with psychiatric interventions.
- Persistent symptoms despite treatment may signal an underlying epileptogenic cause.
Purpose of the Study:
- To emphasize the link between epilepsy and persistent psychiatric symptoms.
- To highlight the role of epileptogenic activity in psychiatric manifestations.
- To advocate for considering epilepsy in treatment-resistant psychiatric cases.
Main Methods:
- Case report of a woman in her 40s with epilepsy and persistent psychiatric symptoms.
- Detailed description of clinical features, psychiatric treatments, and neurological assessments.
- Evaluation of therapeutic outcomes following medication adjustments.
Main Results:
- Patient initially diagnosed with IDD, showing partial response to psychiatric medications (escitalopram, olanzapine).
- Further investigation revealed temporal lobe epilepsy aura symptoms.
- Adjusting anti-seizure therapy (lacosamide) led to complete resolution of psychiatric symptoms and functional recovery.
Conclusions:
- Persistent psychiatric symptoms in well-controlled epilepsy can indicate an epileptogenic mechanism.
- Optimizing anti-seizure medication is crucial for psychiatric and functional improvement.
- Multidisciplinary assessment is vital for accurate diagnosis and effective management.
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