Of course, a neurologic disorder.

Well Prof. Madhav,

I will ask you another question, are psychiatric disorders are of neurological basis or not ?

The answer is already known, yes they are; decades away psychiatry was considered a disorder of mind not of brain, but recent studies link psychiatric disorders to neural circuits damage as well as disconnection along synapses and neurotransmitters and papers are now discussing how schizophrenia for example is associated with atrophy of certain cortical areas and they are trying further to check the brains of psychiatric patients by fMRI and more recent imaging advances in neuroradiology field.

So I think we are currently in the era of shifting psychiatric disorders to be linked to neurological basis rather than trying to link a well known neurological disorder (epilepsy) to psychiatry.

Yet as a classification, if seizures semiology is confirmed and further investigations like video EEG and MRI epilepsy protocol further confirm the presence of a focus from which the electrical activity ordinate (like cortical dysplasia or mesial temporal sclerosis) then for sure epilepsy is organic neurological disorder even if it is presenting in a psychic fit.

On the other hand some seizures are totally fake (pseudo seizures) which by the way can happen in a patient that is well known to be epileptic and these are a form of somatization, factitious, or malingering disorders and these you can consider of psychiatric nature.

best regards

Thanks dear Ali Akhadar & Tamer Roushdy.

Yes, it is very well acknowledged traditionally that epilepsy is an neurological disorder. But now days, without intervention from a psychiatrist many a epileptic patients can not be fully treated. In fact; I happen to treat some epileptic patients who could not get relief from neurologists. But such experience does not make an epilepsy a psychiatric disorder; I agree.

But what would you respond when someone brings the point that in many a cases no definite center of electrical activity can be detected in any of the advanced radio-logical investigation/s. For exam., in case of Temporal lobe epilepsy, petit-mal epilepsy (Drop epilepsy/absence seizure epilepsy), alcohol withdrawal syndrome induced epilepsy, etc.

Another point: what would you say; when depression or alcohol addiction are co-morbid conditions with epilepsy?

Would you even then say, of-course; epilepsy is an neurological disorder and not a psychiatric disorder?

Please don't feel offended by my reply/words; in no way I intend to refute your point of view.

With due respect to your expertise, intelligence, skills, & experience; I am simply trying to expand or role on the discussion. Hope you reply back with enthusiasm.

And readers too participate actively to make this question more alive.

Thanks.

Well Prof. Madhav

I agree that psychiatists has a role in dealing with some epileptic patients within the context of multidisciplinary team .. and this for instance may be peesent in pseudo seizures that are along true seizures ..

As a neurologists I think we refer such patients with pseudo and true fits to a psychiatrist together we manage the patient.

Also I preoperative plan for epilepsy surgery some may refer for psychiatry to be sure that operation and its post operative recovery will go smooth.

But this does not mean that epilepsy is a psychiatric disorder .. psychiatrists can help in it like they can in cancers .. and aiding in cancer does not make cancer a psychiatric disorder.

As for the example like absence epilepsy .. radiology won't help as you stated but neurophysiology do .. absence has a unique picture in EEG and in its provocation hyperventilation spike waves 3 Hz .. and it can not be psychiatric in origin .. it is one of few type that is mentioned as a diagnosis in the EEG report (idiopathic generalized epilepsy - absence) the rest are left for clinical correlation.

So to reach a common point in our discussion yes psychiatry can aid in epilepsy management yet can't cure true disorders and so for my aforementioned cancer as an example.

Dear Sir Tamer Roushdy,

Your style of putting things to gather is really good.

However, please share your take on Temporal lobe epilepsy, where all investigations are negative and diagnosis is purely made on clinical picture. Treatment or recovery ascertains the diagnosis later on.

Now this is picture I trying to uncover where psychiatric presentation overwhelms the occurrence of seizures. Seizures are experienced there but large part of clinical scenario is of psychiatric nature.

I am sure you must have seen & treated many such patients in your career like me; so your first hand experienced-based opinion matters much.

Thank you Prof. Madhav for your nice comment.

For sure temporal lobe epilepsy is deceiving for many especially its auras types .. and I will not mention here that since antiepileptics control it then it is organic .. as the answer already known that antiepileptics are also mood stabilizers so may control depression that cause psychosomatic manifestations..

But although rarely ordered and rarely detect issues but sometimes it succeeds .. I mean the long term video EEG .. where presenting symptoms may be recorded by video and successfully detected at the sametime by EEG .. in such case I think considering it a neurological disorder is a must.

By the way I think being a psychologist you intended to place this question in such a way to exercise neurologists patience in defending their careers 😀

May be you won't have received the same response if you mentioned the question as ..

Epilepsy as a neurological disorder .. yet how can psychiatry help ?

Or

Epilepsy as a neurological disorder .. yet doesn't psychiatry has its share in it ?

Have a pleasant day Sir .

😀 😀.

That's lighter side of the issue at hand.

But my contention is that epilepsy is a neuro-psychiatric disorder!

Isn't it?

To a large extent I agree that it is neuropsychiatric disorder ..

Neurology can not do it alone unless the patient is fully open minded that his illness resembles any other illness .. and doesn't go into denial .. anger issues of illness and why me ?!! and also does not have pseudo seizues ..

And at the sametime psychiatry can not deal with from the start .. it can help yet with neurology the main cornerstone ..

Pardon - not wanting to distract from your point: But aren't there more and more imaging techniques which enable to spotting an epileptic disorder's organic root(s)? What about exploiting these techniques to the full? Haven't there always been cerebral symptoms occupying zones of transition between neurology and psychiatry?

Epilepsy is a neurological disorder given by neuronal hyperexcitation, it is equivalent to a cerebral "arrhythmia", which this can lead to death of brain cells and hence to psychiatric disorders is something other than a persistent psychiatric disorder, however, many mental diseases have the characteristics of pseudocrisis

Sorry - aren't there psychiatric disorders whose symptoms can hardly be explained otherwise than by neuronal hyperexcitation?

Dear Franz Schelling,

Question: "Sorry - aren't there psychiatric disorders whose symptoms can hardly be explained otherwise than by neuronal hyperexcitation?"

Reply: May I re frame your question for the convenience of ease. Which psychiatric disorders are caused by neuronal hyperxcitation?

Most of the psychiatric disorders are caused by genetic predisposition & psycho-social factors. Meaning there by; most of the psychiatric disorders are caused by multiple causes. Causative role of any factor differs from case to case. No single factor can be differentiated to be responsible for 90% or 30% role to cause the disease.

Secondly, many patients complain of such symptoms which appear quite subjective or may be unique to themselves only. . Meaning there by; patient/s verbalize their feelings or sufferings in their own language, in their own subjective way of expression. Such variety of symptomatic presentation cannot be titled under any one technical term like 'neuronal excitation' or hypo-campus atrophy.

Thirdly and finally, if one considers neuro-developmental or neuro-congitive disorders then also it is difficult to say that only neuronal dysfunction is a cause of all neurodevelopmental or neurocognitive disorders. Diseases like ADHD, Autistic spectrum disorders, Dementia and its types cannot be explained to be caused by only one single factor.

Hope; your query is answered to your satisfaction.

However, other experts can sure put forth their opinions to complete or amend

this answer.

Let me opine something which is of concern to many.

Psychiatric disorders are not non-organic disorders; as it is traditionally assumed. It is erroneous to assume that depression or schizophrenia or OCD or Phobia or Brief psychosis and others don't have organ-wise dysfunction. In all examples mentioned above brain certainly shows dysfunction. However organic pathology in brain cannot be demonstrated because its disorder of functional disability; though f-MRI has started showing it now-a-days. Permanent pathology cannot be observed in most of the cases (barring some now-a-days like ventricular dilatation in Schizophrenia, etc.), but absence of demonstrable pathology does not or should not compel one scientifically and logically to think that psychiatric disease has no basis of organ's involvement.

So it's time (due to advances in neuro-radio-diagnostics) to obsolete the terms likes organic or non-organic disorders!

So I conclude that it is unscientific to say that psychiatric disorders are non-organic disorders.

True, Madhav Gajananrao Raje - MRI routine misses all too many organic causes of central nervous disorders, irrespective of their manifestation as neurologically or psychiatrically traceable disorders.

Surveying all the advances currently made in the field, however, overtaxes many an imaging, neurological or psychiatric expert's spans of attention.

Epilepsy is a complex neurological disorder.

https://www.ncbi.nlm.nih.gov/books/NBK100605/

Never met with psychomotor attacks, spells of psychomotor agitation that appeared less reliably to classify, Arvind Singh?

Do mental disorders affect epilepsy?

Epilepsy is a disease of the mind, but it does not affect it in terms of madness and hallucinations

Avoiding mental disorders and anxiety is important to reduce epileptic seizures

This RG link may help you

Article Epilepsy Benchmarks Area I: Understanding the Causes of the ...

Thank's for the download, Dhifaf Zeki. But what led here to reducing the scope of epileptogenic conditions to genetics, tumors and autoimmune disorders? Forgetting about posttraumatic, postinfectious scars, vascular anomalies and malformations?

Balqees Al-Musawi, I likewise think neurologists regard many ill-understood conditions as neurological disorders ... while I'm waiting for things to be better clarified.

Dr. Raje, as for the medico-legal problems indicated in your opening of this thread, what about considering the first of the following links.

The second and especially the third link probably answer many of your remaining questions:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039355/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049807/

https://www.researchgate.net/search.Search.html?type=publication&query=Epilepsy%20AND%20psychiatry

Dr. Franz Schelling, thanks.

Links you suggested are indeed helpful in order to be included in references. Some of the information in those links facilitated and reinforced my opinion about epilepsy as a neuro-psychiatric disorder. E.g.

1) An important consideration regarding health care for people with epilepsy is the need to use a whole-patient approach—not only trying to eliminate or alleviate the seizures but also treating comorbid health conditions—which will necessitate coordinated care among a number of health professionals.

2) Localisation by John Hughlings Jackson in the 1870s, in addition to Jean Charcot’s work in Paris, had created an explicit medical link between seizures and emotional and psychological states. In particular, post-seizure states of automatism, confusion and irritability had led to a development of the idea that epilepsy was a psychological as well as neurological phenomenon. (R. Hewitt,

Centre for the Social History of Health and Healthcare, Glasgow, UK

e-mail: [email protected])

Hope these references would help professionals concerned to realize that epilepsy is indeed an neuro-psychiatric disorder and not merely a neurological disorder!

Hello everyone,

following para may throw light on and about my point of view towards epilepsy.

A Parent’s Perspective:

My son John developed epilepsy in his late teens, and despite medications, his seizures remained severe and uncontrolled.John was a talented and creative musician and a caring and thoughtful brother and son. He had many friends, and he des-perately wanted an independent life. As John’s epilepsy pro-gressed, he also experienced declining mental health. John,who was normally a very peaceful individual, had periods of severe irritability and rage. He also became very anxious at times, and this was a sign of an impending seizure. John heard voices and developed paranoia, hallucinations, and depression.Our family was told to see specialists, but we found that the communication and coordination of care between epileptolo-gists and mental health professionals was impossible, even when he was hospitalized and referrals were made. Ultimately,his mental health issues were not understood or addressed and contributed significantly to his decline. John died of sudden unexpected death in epilepsy (SUDEP) in 2012. Our family’s wish is that those around John had been more attuned to the mental health comorbidities that he was experiencing, and that his medical issues were jointly managed as the outcome for him might have been different.Significant comorbidities often accompany epilepsy and can be more debilitating than the seizures themselves. A better understanding of the underlying mechanisms of epilepsy-associated comorbidities and appropriate clinical care is critical for increased quality of life for those impacted by epilepsy and their families. ( Epilepsy Benchmarks Area I: Understanding the Causes of the Epilepsies and Epilepsy-Related Neurologic, Psychiatric, and Somatic Conditions. Available from: https://www.researchgate.net/publication/338760986_Epilepsy_Benchmarks_Area_I_Understanding_the_Causes_of_the_Epilepsies_and_Epilepsy-Related_Neurologic_Psychiatric_and_Somatic_Conditions [accessed Mar 19 2020]).

Deaths like this raises medico legal issues. medico legal issue is more complex because of inadequate information, knowledge and experience of expert doctors in the filed who may be asked by court of law to opine as an expert witness in the court room.

If all of us declare that epilepsy is a neurological disorder then court is bound to invite only neurologist as an expert witness.

Dr. Raje, thank you for calling attention to this deplorable history, robbing me of the illusion that at least psychiatrists and neurologists were effectively cooperating - and this to any patient's best. How then to extend this cooperation to neuroradiologists able to trace not only tumors but also vascular malformations and all sorts of scars that cause epilepsies of any form?

Had I such an epileptic disorder your experiences were another reason to get all sorts of mental problems in learning about such blinkered approaches to all the problems that are cropping up here.

The worst experiences I made in medicine reflected indeed a lack of colleagues to listen to one another and to orchestrate our expertise to the patient's best.

Learning from lawsuits is quite consumptive - and who benefits from the lesson so learned?