Temporal Lobe Epilepsy and Psychiatric Comorbidity

Abstract

Most focal seizures originate in the temporal lobe and are commonly divided into mesial and lateral temporal epilepsy, depending upon the neuronal circuitry involved. The hallmark features of the mesial temporal epilepsy are aura, unconsciousness, and automatisms. Symptoms often overlap with the lateral temporal epilepsy. However, the latter present a less evident psychomotor arrest, frequent clones and dystonic postures, and common focal to bilateral tonic-clonic seizures. Sclerosis of the hippocampus is the most frequent cause of temporal lobe epilepsy (TLE). TLE is among all epilepsies the most frequently associated with psychiatric comorbidity. Anxiety, depression, and interictal dysphoria are recurrent psychiatric disorders in pediatric patients with TLE. In addition, these alterations are often combined with cognitive, learning, and behavioral impairment. These comorbidities occur more frequently in TLE with hippocampal sclerosis and with pharmacoresistance. According to the bidirectional hypothesis, the close relationship between TLE and psychiatric features should lead to considering common pathophysiology underlying these disorders. Psychiatric comorbidities considerably reduce the quality of life of these children and their families. Thus, early detection and appropriate management and therapeutic strategies could improve the prognosis of these patients. The aim of this review is to analyze TLE correlation with psychiatric disorders and its underlying conditions.

Keywords: antiseizure medications (ASMs); bi-directional hypothesis; hippocampal sclerosis; psychiatric comorbidity; temporal lobe epilepsy.

Figure 1

Neuroanatomical representation of the temporal lobe and related seizure symptoms and psychiatric symptoms: (A) auditive hallucinations; (B) visual hallucination; (C) visceral-sensory or autonomic symptom; (D) depression; (E) anxiety disorders, depression; (F) avoidance behavior and fear response.