Harvard Mental Health Letter

Epilepsy and psychiatric disorders

It may seem strange, but there was a time when epilepsy was not clearly distinguished from psychiatric disorders. Psychiatry and neurology were not distinct professions, and the nature of epileptic symptoms was not well understood. Eventually the origins of epilepsy in the brain were clarified, while psychiatry and neurology went their separate ways. People with epilepsy and their physicians were happy to have an explanation (or partial explanation) that combated the social stigma still attached, in the minds of some, to psychiatric disorders. But epileptic seizures are a brain malfunction, and so are major depression, anxiety disorders, and psychoses. Although epilepsy is not a psychiatric disorder, its psychiatric dimension is important for treatment and research.

Epilepsy basics

A seizure occurs when groups of neurons in the brain fire rapidly and uncontrollably, causing abnormal sensations, feelings, movements, or behavior. Epilepsy, a diagnosis applied after repeated seizures, affects about two million people in the United States. It has many possible causes, including tumors, infections, head injury, stroke, poisons, drug overdoses, and other neurological disorders. Often it results from genetically influenced abnormal brain development. In most cases, though, the cause is unknown. Sleep loss, alcohol, infections, and possibly stress may provoke individual seizures in a person who is vulnerable for any reason.

The most dramatic epileptic symptoms arise when uncontrolled neural activity spreads throughout the brain — a generalized (grand mal) seizure. In this case, the patient loses consciousness, has violent muscle contractions (convulsions), and falls to the ground — whence the old name "falling sickness."

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