What Is the Connection Between Epilepsy And Depression?

(I) Causes of Onset

Epilepsy personality change

Epileptic personality changes A small number of patients can cause progressive personality changes after prolonged, repetitive seizures. This change has two distinct extremes, viscous and explosive. Sticky thinking, stingy speech, rigid behavior, difficult to adapt to the new environment. Due to the narrowness of intelligence, he only pays attention to the things directly related to himself and becomes self-centered. Emotional changes include emotional outburst, stubborn bad temper, resentment, sensitivity, suspiciousness, disguise, lying, and slander, hate for small things and hard to disappear, can be accompanied by self-defense, often brutal revenge.

Affected area

whole body

Related diseases

Epilepsy-associated mental disorders, mental retardation, schizophrenia, personality disorders, paranoid states, epilepsy, mental disorders

Related symptoms

Convulsions hypotension epilepsy personality changes nausea hallucinations nervous sleepwalking complexion pale wood zombie ischemia compulsive thinking emotions high mood depression sleep disorder sleep disorder dizziness chest tightness dark depression depression loss of consciousness syncope manic delirium

Affiliated Department

Department of Internal Medicine

Related inspections

Cerebrospinal fluid lactic acid

(I) Causes of Onset

Epilepsy is often classified clinically into primary and secondary. Among them, primary epilepsy is also known as true epilepsy or idiopathic epilepsy or occult epilepsy, and its etiology is not clear. Secondary epilepsy, also known as symptomatic epilepsy, can find its cause, often secondary to brain diseases, craniocerebral tumors, craniocerebral trauma, intracranial infection, cerebrovascular disease, cerebral degenerative diseases and so on. It can also occur in systemic diseases such as hypoxia, metabolic diseases, cardiovascular diseases, and toxic diseases.

The pathogenesis of epilepsy is complex and has not yet been elucidated. At present, it is mostly attributed to excessive synchronous discharge of neurons. Breakthroughs have been made in molecular genetics research. For example, the genetic mode of primary systemic epilepsy and epilepsy with mental retardation is known as autosomal recessive inheritance, while epilepsy with hallucinogenic characteristics is autosomal dominant. Heredity and so on.

Seizures are a clinical manifestation of cerebral cortical neuron dysfunction. The cause of the first seizure can be:

1. Reactive epileptic seizure caused by acute brain dysfunction, such as high fever, metabolic disorders, or structural lesions, such as central nervous system infection, cerebrovascular disease, head trauma, or brain tumor. The prognosis varies depending on the cause of the seizures. It may only be this time in life, but it may also occur after the acute phase, and seizures occur repeatedly. It is symptomatic epilepsy.

2. As there were various types of brain injuries in the past, or congenital brain injuries or deformities, although seizures did not occur at that time, seizures occurred later, and it can be inferred that the seizures are highly related to past brain injuries based on clinical examination results. Relevance. The seizure may only occur once, but the more common epileptic seizures are also symptomatic epilepsy.

3. There has not been any brain injury in the past, and according to clinical data, it is speculated that the first seizure may be idiopathicepilepsy, which is more related to genetic factors, and the seizure may be only one, but the more common will be repeated Seizures cause epilepsy.

4. Although there has not been any history of brain injury in the past, according to clinical data, it is suspected that there may still be hidden brain injury or brain dysfunction and cause seizures, called cryptogenic epilepsy (cryptogenicepilepsy).

5. Seizures only occur when they are directly exposed to external or internal stimuli, the former such as intermittent light stimulation, sound stimulation, etc., the latter such as calculation, thinking, etc., if it can avoid related incentives or receive desensitization treatment, it is more Less recurrence is called reflexepilepsy.

(Two) pathogenesis

Neuroelectrophysiology

The root cause of seizures is the abnormal discharge of brain neurons. The abnormal discharge of epilepsy can occur during the ictaldischarge or during the interictaldischarge. The causes of such abnormal discharges can be various, but so far, the nature of abnormal discharges is not well understood. With the development of science and technology, it is possible to have a clearer understanding of the causes of epilepsy. According to current research, various factors may cause abnormal depolarization of the potential of a group of brain cell membranes and synchronize to form the kindling of peripheral neurons. There are various theories of the electrophysiological abnormalities of brain neurons. They are generally considered to be related to ionic abnormalities that maintain membrane potentials, and there are also thoughts to be related to the excitatory amino acids (glutamic acid, etc.) and inhibitory amino acids (GABA, etc.) of brain neuronal media Balance. In short, seizures are the result of abnormal, over-discharged nerve cells in the brain.

2. Neuropathology

The pathogenesis of idiopathic epilepsy is very complex and has not been fully elucidated so far. The pathology of partial symptomatic epilepsy has been extensively studied. In animal experiments, cobalt hydroxide was applied to local brain tissues of monkeys, and glial ridges gradually formed around them. Partial epileptic seizures occurred after 4 to 12 weeks. The epileptic discharge of partial epilepsy usually begins immediately near the site of the epileptic lesion, but also begins at a distant site that is related or completely unrelated to the site of the lesion. If the right amygdala of a cat is damaged, it can cause a seizure of the left amygdala. Johnson et al. Found that animals with epilepsy scars had reduced convulsive thresholds in the cerebral cortex, subcortical structures, and even the entire brain. Neurons that are anatomically linked away from epileptic damage can have increased excitability, but have no organic damage. This is a very important concept, that the scattered spikes or rhythmic epileptic discharges on the EEG can be used as diagnostic evidence of partial epilepsy, but it is not certain that the epileptic damage is in the same site. It is generally believed that mental disorders associated with epilepsy patients, such as paranoid states, schizophrenia-like states, and aggressive personality disorders, are related to lesions in the dominant hemisphere of the brain, while depression is associated with non-dominant hemisphere lesions. Clinically manifested as uncontrollable strong emotional and behavioral disorders, called episodicdyscontrolsyndrome, may be related to abnormal discharge of the amygdala.

In addition to collecting detailed medical history, physical and nervous system and EEG examinations are very important. CT, MRI, and SPECT examinations of the brain can be performed when necessary.

1. Syncope: For a brief loss of consciousness, it should be distinguished from a minor attack. Some small episodes only show loss of consciousness, fall, tough body, and no convulsions throughout the body, which is quite like syncope. Syncope is usually caused by cerebral ischemia caused by unstable vasodilation, weak constitution or temporary hypotension caused by other diseases. Before the onset, symptoms such as dizziness, chest tightness, nausea, and dark eyes were common. The onset was accompanied by autonomic symptoms such as paleness, weak pulse, sweating, and hypotension, and there was no epileptic activity on the EEG.

2. Hysteria: Symptoms of patients with snoring can occur with spastic seizures and schizophrenia symptoms, such as hallucinations and disturbances of consciousness. Irregular twitching of the muscles of the body often occurs repeatedly. However, the symptoms of hysteria lack sufficient specificity. The onset of symptoms has mental factors and obvious psychological stress factors, and there is no loss of consciousness. There is no organic evidence, often accompanied by crying or shouting. The actions and postures are hysterical and dramatic. With language suggestion, variability in symptoms, rich expression, no change in pupil and tendon reflexes, no rhythm in muscle twitching, limb disturbances, seizures lasting from minutes to hours, and it is not difficult to distinguish from major seizures. A detailed inquiry about the history of previous episodes, the triggers for each episode, and suggestive treatments can help identify them. It is worth noting that some patients with epilepsy may also suffer from rickets under the influence of mental factors. Careful consideration should be given to avoiding the diagnosis and treatment of epilepsy.

3. Sleepwalking: also known as sleepwalking. It is a form of sleep disorder that is common in children. But sleepwalking in children can be awakened, and those with epilepsy are unconscious and cannot be awakened. Sleepwalking with neurosis can also be awakened, and seizure behavior is easy to be understood by people; epilepsy sleepwalking is mostly rough and dangerous movements, which often cause trauma.

4. Infectious and toxic psychosis: epilepsy delirium is not easy to distinguish from delirium state during infection and poisoning. Epilepsy delirium is episodic, with a short duration, without infection, history of poisoning, and positive EEG findings before the attack. A previous history of seizures and a detailed physical examination and EEG examination can help to distinguish from toxic delirium due to infection.

5. Schizophrenia: Chronic epilepsy schizophrenia can have symptoms very similar to schizophrenia, such as hallucinations, delusions, and forced thinking. The main points for identification are based on the diagnosis of epilepsy, such as medical history and EEG. Epilepsy stupor can be very similar to tension schizophrenia; however, the former has conscious disturbances during the onset and has amnesia after the onset, so it can be identified.

Chronic schizophrenia is similar to paranoid schizophrenia, but the former lacks introverted performance, lacks coordination between mental activities, and does not cooperate with the external environment. In addition, a history of seizures, epileptic personality changes, and EEG findings can also help with differential diagnosis. It is worth noting that patients with epilepsy have the possibility of schizophrenia, but the probability is very low.

6. Affective disorder: epilepsy pathological bad mood is different from depression. Although its mood is low, it shows depression, tension and dissatisfaction, without real depression, self-blame, slow thinking and reduced activity; epilepsy Sexual euphoria is often accompanied by tension and mischief, rather than real emotional upsurges, but also without accelerated thinking activities, vivid expressions, and flexible movements; and it occurs suddenly, with a short duration, and can be related to mania Phase identification.

In addition to collecting detailed medical history, physical and nervous system and EEG examinations are very important. CT, MRI, and SPECT examinations of the brain can be performed when necessary.

The general principle for the treatment of epilepsy is: use the drug as single as possible, encourage the doctor to take the drug, and regularly check the blood concentration. The choice of drugs depends on the type of epilepsy, and the side effects of the drugs should be considered. In the treatment of epilepsy mental disorders, drugs should be selected according to mental symptoms on the basis of treating epilepsy, and care should be taken to select drugs that have weaker epilepsy effects.

Treatment: The treatment of epileptic mental disorders should be treated differently according to different situations. For mental disorders before and after the onset of treatment, the type and dose of antiepileptic drugs should be adjusted to control the onset of epilepsy. Seizures are the same as for non-epileptic patients, but it should be noted that many antipsychotics increase seizures. Patients with intellectual disability and personality changes should strengthen education and management, and carry out rehabilitation measures such as psychotherapy and work entertainment.