How Epilepsy And Its Medications Affect An individual’s Mood

DRAFT

    Epilepsy is one of the most widespread serious neurological disorders in the world. (Bautista, R. E. D; 2012) There isn’t a sufficient amount of education provided  on the extent of this illness, and all of its effects on an individual’s brain; or how it affects one’s quotidian routine. 

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    To give a bit of background on the neurological disorder, in the early 1900s, epilepsy was a disease that was considered disturbing and unwanted. The first most widely used treatment was an anticonvulsant, bromide, until phenobarbitone and phenytoin were used until the 1950’s. In addition to this, there was still such a tremendous lack of knowledge and education surrounding epilepsy, that as many as 18 states in the U.S. had passed laws allowing for the forced sterilization of epilepsy patients and ordinances; forbidding the marraige of individuals with epilepsy. Something that was only repealed with finality in 1980. (Bautista, R. E. D; 2012) It is evident how much fear the disorder had caused at the time simply because there was not enough known about it. 

In order to understand it, the basic science of the disorder needs to be explained. Epilepsy is a diverse group of syndromes, or a diverse group of symptoms, that can be caused by a variety of inter cranial structural, cellular or molecular conditions. These conditions can manifest themselves in many different ways. (Bautista, R. E. D; 2012)  Regardless of the aetiology, the underlying cause of the disorder, the epileptic seizure always reflects abnormal hypersynchronous electrical activity of neurons. In somewhat simpler terms, when a large population of neurons fire rhythmic epileptic discharges, it can cause an imbalance in the nervous system; in turn, causing seizures. Although seizures are one of the biggest aspects of epilepsy, it is not the only one. Patients with epilepsy can experience medical, metabolic, neuroendocrinal as well as cognitive and behavioral problems which can have ramifications on their day to day lives. (Hamed, S. A. 2009) However, the majority of information available about epilepsy mostly include seizures as symtoms. When it comes to seizures, they can be divided into 3 categories. Simple partial, complex partial, and generalized. A simple partial seizure is localized and one is able to maintain consciousness. This type of seizure rarely invloves both hemispheres of the brain, so it’s usually restricted to just one. A complex partial seizure is also localized but conscoiusness is imapired. In contrast to simple partial seizures, complex partial seizures frequently involve bilateral hemispheric activation. This seizure affects both sides of the brain. Lastly, generalized seizures have no evidence of localized onset. They also don’t normally come with a warning, and can either be convulsive or non- convulsive. In one sole patient, patients may be prone to more than one type os seizure which allows for combinations of different types of seizures to occur. (Bautista, R. E. D; 2012) Once the type of seizure(s) is figured out, a physician or neurologist can then proceed to determine whether the epilepsy is idiopathic, symptomatic, or cryptogenic. If it is idiopathic, epilepsy itself is the primary disorder. It is also thought to be genetic and have no other known cause, other than something that can arise from a hereditary condition. If symptomatic, the epilepsy itself is a secondary disorder. It’s caused by acquired brain pathology after birth, such as infection, or trauma, or complications before birth. Cryptogenic epilepsy is normally when the origin has not been diagnosed, or determined. (Bautista, R. E. D; 2012) This is not as likely anymore due to  the way biomedical technology has evolved and advanced where there are more resources available to reach an accurate diagnosis. With the type of seizure and epilepsy determined, the last step is to figure out the optimal form of treatment or therapy that can be administered.

Epilepsy can be treated in two ways, through surgery, which is not as common because it involves a more complicated procedure, and through medication. Surgery can be different for every patient, depending on the area of the brain that is most affected, and on the kind of seizure they suffer from. Anti epileptic medications, or AEDs are the most common treatment for epileptic seizures. Similar to surgery as a treatment, the choice of AED is also dependent on one’s seizure type. The primary aim of this treatment is to reduce the frequency and severity of seizures, while also minimizing the level of side effects. AED therapy allows approximately 60% of people with epilepsy to become seizure free. (Bautista, R. E. D; 2012) 

While anti epileptic drugs are meant as a treatment to help individuals deal with the disorder, there are side effects to these kinds of medications. They have both positive and negative effects regarding cognitive and behavioral function. In an experiment done in the journal of Epilepsy and Behavior, 40 patients with epilepsy and persistant mild depression were treated with an AED called Oxcarbazine. Another 40 patients, also with epilepsy and persistent mild depression, were used as a control group and were treated with AEDs other than Oxcarbazepine. Over a time of three months, all 80 patients’ depressive symptoms and anxiety were assesed by clinical interview using the hamilton Depression Rating scale (HDRS), the Cornell Dysthymia Rating Scale (CDRS), the Beck Depression Inventory (BDI), and the Hamilton Anxiety Rating Scale (HARS). Twenty eight of forty Oxcarbazine treated patients demonstrated effective improvement in which the treatment had anti-depressive effects. Thus supporting a hypothesis made that that specific AED improves mood. (Mazza, M., Della Marca, G., Di Nicola, M., Martinotti, G., Pozzi, G., Janiri, L., Bria, P., & Mazza, S. 2007) This case is a case that highlights the positive cognitive effects that an AED can have on an individual, while also treating their epileptic seizure; the primary concern when treating epilepsy. Newer anti epileptic medications like levetiracetam and lamotrigine, are also one of the few that are least likely to interfere with cognitive processes and can sometimes allow for motivation and a heightened sense of alertness, which does not have a negative effect on mood. (Bautista, R. E. D; 2012) 

However, there are also negative effects on one’s mental health and on one’s moods when it comes to certain older AEDs. There are some sedating AEDs like phenobarbital and valproate that result in cognitive slowing and drowsiness due to GABA inhibitory transmission. GABA is a neurotransmitter that is responsible for calming our nervous system, so if there’s too many signals coming from that neurotransmitter, drowsiness and slowing down cognitively is inevitable. Moreover, Phenobarbital specifically, is linked to worse symptoms like irritability, agitation, confusion, anxiety, insomnia and depression. (Bautista, R. E. D; 2012) According to the current medical research and opinion journal, depression actually has a 23.1% prevalence in people with epilepsy, particulalry in women. This is about 4-5 times higher than that in the general population. (Mesraoua, B., Deleu, D., Hassan, A. H., Gayane, M., Lubna, A., Ali, M. A., Tomson, T., Khalil, B. A., Cross, J. H., & Asadi-Pooya, A. A. 2020) In addition to this, in 2008, the US Food and Drug Administration (FDA) issued an alert about an increased risk of suicide ideation and behavior in patients treated with AEDs. Although some AEDs have been associated with treatment- emergent psychiatric disorders, that can lead to thoughts of suicide and self- harm, the actual risk of suicide seems to be very low. The negative effects of AEDs that cause mental illness and extreme chnages in mood, are often overlook and improperly treated in people with epilepsy. Routine and periodic screening for these illnesses, in addition to the neurological disorder is indespensible; especially for women. (Mesraoua, B., Deleu, D., Hassan, A. H., Gayane, M., Lubna, A., Ali, M. A., Tomson, T., Khalil, B. A., Cross, J. H., & Asadi-Pooya, A. A. 2020). To conclude how AEDs can have negative mental health effects, another example is shown by a study done by The Official Journal of the International League Against Epilepsy. It was a composite international diagnostic interview administered to 192 individuals from 60 families that had different types of epilepsy. Standardized prevalence rates were used to compare prevalence of mood disorders during their lifetime. Compared with the general population, mood disorders were significantly increased in individuals with focal epilepsy. This is an epilepsy where seizures stem from one part of the brain, on one hemisphere. Although whether or not they took AEDs was not made clear, it still emphasizes how individuals with epilepsy can go through extreme mood changes.

Individuals dealing with a neurological disorder, possibly along with other health/ mental health issues as well, should have physicians and medical staff available to them who can provide the best care possible. Along with treatment for epileptic patients, it’s important for  physicians to take the time to listen to their patient, making them feel like a priority and not just like any other case. While this research specifically included people with epilepsy, this goes for any patient in need of any type of care. 

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