EPILEPSY IN CHILDREN AND ADOLESCENTS: WHAT A PSYCHIATRIST SHOULD KEEP IN MIND

Epileptic seizures can be mistaken for psychiatric disorders. Complex partial seizures may present with changes in autonomic nervous system function, somatosensory auras, difficulties in speech attention or movement, stupor, intense motor behavior, posturing, aimless wandering, changes in perception of place time or persons, illusions and hallucinations. These phenomena are not usually accompanied by loss of consciousness. Temporal epilepsy exhibits symptoms, such as headache, irritability, insomnia, personality changes, auras, déjà vu jamais vu, dreamy states, feelings of fear and strangeness, automatisms, tonic-dystonic posturing of extremities, transpiration, dizziness, faintness, tachycardia, hypoxia, disordered consciousness. The seizure may be followed by confusion, tiredness, disorientation, headache, automatisms, impaired attention, memory and learning, hyperactivity, oppositionality, panic attacks, dissociation, and obsessive-compulsive symptoms. In frontal lobe epilepsy, three types of seizures may be mistaken for psychiatric problems: hyperkinetic seizures, tonic seizures of complementary movement area, and absences. The complex and emotionally charged behavior of hyperkinetic seizures, and occasionally of tonic seizures, combined with a normal EEG, may lead to the misdiagnosis of a psychiatric disorder such as psychosis, dissociation, conversion disorder, or panic attacks. In parietal and occipital seizures, visual hallucinations and distortion of visual perception may be mistaken as psychotic symptoms. Sensory auras resemble simple hallucinations. Psychic auras are complex hallucinatory experiences that comprise autoscopic phenomena, a sense of someone’s presence, déjà vu – jamais vu, fear and elation. Limbic seizures are associated with the emergence of psychiatric symptoms. Non-convulsive status epilepticus (NCSE), can last for hours, days, or weeks and presents with change in behavior and mental status that ranges from mild changes, to psychiatric manifestations, delirium or coma. Antiepileptic drugs also have an impact on mental functioning and mood. Child and adolescent psychiatrists need to be informed about epileptic semiology that imitates psychiatric disorders. I n t r o d u c t I o n The boundaries between neurological and psychiatric disorders are not always clear, while comorbidity is high. Moreover, certain epileptic phenomena with an unusual clinical presentation can be mistaken for a psychiatric disorder. Many Child and Adolescent Psychiatrists have observed cases with atypical clinical presentation, rEVIEW Child and Adolescent Psychiatrist, Director, Community Mental Health Center, Evangelismos General Hospital of Athens, Greece HOSPITAL CHRONICLES 2017, 12(1-4): 15–22 Correspondence to: Kalliopi Prokopaki, MD, 5 O. Makri street, 15234 Halandri, Greece; Tel. : +30 6987 880821 E-mail: kallprok@yahoo.gr Manuscript received March 22, 2017; revised manuscript received September 11, 2017; Accepted July 12, 2018 KEy Words: adolescent; auras; autonomic; children; epilepsy; seizures; status epilepticus; psychopathology; psychiatric AbbreviAtions: EEG = Electroencephalogram ILAE = International League Against Epilepsy NCSE = Non Convulsive Status Epilepticus CSE = Convulsive Status Epilepticus Conflict of Interest: none declared