Epilepsy is a brain disorder that's almost as common as it is misunderstood. According to a March 2012 report issued by the Institute of Medicine (IOM), one in 26 people will develop epilepsy at some point in life. One in 10 will experience a seizure. Although epilepsy is the fourth most common neurological disorder, it's still haunted by its past association with demonic possession: a "grand mal" seizure translates to "great evil," and the word epilepsy is derived from a Greek word meaning "to be attacked or seized." Medical parlance reflects the shift in attitudes toward what Hippocrates called "the sacred disease" ("grand mal" seizures are now referred to as "tonic-clonic" seizures), but there is still much to be learned regarding the disorder in general and its psychosocial repercussions in particular.
An abstract presented in New Orleans last week at the American Academy of Neurology's annual meeting concluded epilepsy is associated with a significantly increased risk of depression. "Up until recently, the coexistence of depression with epilepsy has been known, but it has not been widely discussed," says Dr. Eugene Ramsay, a neurologist at Ochsner Baptist Medical Center who specializes in epilepsy. Ramsay points out that depression can be a consequence of some of the challenges an epilepsy diagnosis brings: People with epilepsy may experience social stigma or trouble in their relationships because of their seizures; they may be unable to drive and lose their jobs; they may become more dependent on family members; they may experience side effects from medications — all are factors involved with a chronic illness that can lead to depression.
"One of the debates about depression in epilepsy is, is it cause or effect?" says Dr. Anne Foundas, professor and vice-chair of clinical research in the department of neurology at LSU Health Sciences Center. "Some people in the field used to believe that ... epilepsy might make you depressed because you have a chronic disorder."
However, animal models indicate depression and epilepsy could come from a common source in the brain: Abnormalities in the neurotransmitters associated with depression could be a common pathologic mechanism for (epilepsy and depression), Foundas says.
"In (patients with) epilepsy, the depression is much higher than you would expect from just having a chronic illness," Ramsay says. "We don't know for sure; however, the feeling is that the areas in the brain commonly involved with producing epilepsy ... are the same areas of the brain that have to do with emotion (and) depression. It may be that one area of the brain can produce both seizures and depression."
There also is evidence that depression can influence seizures, and vice versa.
"If someone is depressed and it is not treated, the chances of controlling the epilepsy are reduced," Ramsay says. "So there's some dynamic interaction between seizures and depression in both directions. If you have epilepsy, you're more likely to be depressed, and if you're depressed, your chance of controlling the epilepsy is reduced."
Foundas points out that some doctors do not consider antidepressants safe for people with epilepsy because of the drugs' potential interactions with seizure medications. However, she believes allowing depression to go untreated is a greater risk. "There is evidence that not only is (depression) common in people with epilepsy, but they also have an increased rate of suicide," she says. "The benefit of treating them (for depression) is greater than the potential risk."
This makes it even more crucial for people with epilepsy to be treated by a team of specialists: ideally, an epileptologist who knows something about psychiatry and a psychiatrist who knows something about epilepsy, Ramsay says. "The best approach is a team approach," he says. "If you do that, you're more likely to have success in both disorders."
There are many different kinds of epilepsy, and it is a spectrum disorder — meaning that some people who have seizures are highly functional, while for others epilepsy is profoundly disabling, Foundas says. Depending on what type the patient has, treatment will vary, but appropriate medications can result in complete control of seizures, Ramsay says.
"Seizure freedom is the goal," Ramsay says. "By adjusting drugs in a proper fashion, that can often be achieved. There's a misconception in people with epilepsy and in some of the non-epilepsy focused doctors that having one seizure a month isn't bad, and that's the best you're going to get."
This misconception is symptomatic of what the IOM's report, Epilepsy Across The Spectrum: Promoting Health and Understanding, identifies as "(limited) ... public understanding of epilepsy" which negatively affects quality of life for people with epilepsy. "Given the current gaps in epilepsy knowledge, care and education, the committee believes there is an urgent need to take action — across multiple disciplines — to improve the lives of people with epilepsy," the report concludes. The committee calls for improved data collection, health care and education pertaining to epilepsy. "Living with epilepsy is about much more than just seizures," the report says.
The good news is, medications make it possible for most people with epilepsy to lead productive, fulfilling lives. "Our therapies are very good, and it's turning out that some of the medications for seizures work very well for depression," Ramsay says.
"Careful use of medication can result in really successful treatment of epilepsy, so if people take their medication, they can end up being completely managed and not ever have seizures," Foundas says. "We've had some real success for some individuals."
To read the IOM's report, visit www.iom.edu/epilepsy.
What to do if you witness a seizure
Don't panic, even though it can be frightening to see someone having a seizure.
Make sure the person having the seizure is safe. If he or she is sitting up, lower him/her to the ground. Roll the person onto his or her side.
Wait until the seizure is over (most seizures last 1-2 minutes and then subside) and ask the person questions to see if he or she is oriented.
If it is a first-time seizure, or if it lasts longer than 5 minutes or is followed immediately by another seizure, take the person to an emergency facility to be evaluated, because there could be an acute neurological problem.