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Epilepsy is not only a neurological issue but also a crucial psychiatric problem. In this chapter, we thoroughly examine the clinical presentation and current classification of epileptic seizures, dividing them into generalized and focal.
This section covers all key stages of patient management: from modern diagnostic algorithms and the selection of baseline treatment to the management of life-threatening status epilepticus. Special emphasis is placed on purely psychiatric manifestations of the disease. You will study specific personality changes (the so-called epileptic character) and the clinical picture of epileptic psychoses, which require a special therapeutic approach.
In practical classes and exams, instructors are most strict about emergency care algorithms for seizures and status epilepticus. You will also be required to clearly differentiate psychotic disorders in epilepsy and select medications strictly based on the seizure type. Start with the classification—it is the foundation without which moving forward is pointless.
Is a change in personality inevitable for a patient with epilepsy?
No, not necessarily. Although Emil Kraepelin considered personality changes to be an obligate (mandatory) symptom, modern specialists view them as a typical, but not strictly mandatory sign of the disease.
At what age does epilepsy most commonly begin?
In 75% of cases, the first seizure occurs in childhood or adolescence. The incidence curve is U-shaped with peaks in the first year of life and after 40–75 years.
Is there an aura before a major convulsive seizure?
If the seizure is primarily generalized, there are no auras or prodromal symptoms preceding it. An aura precedes only focal (partial) seizures.
What is concentric dementia?
This is a specific mnestic-intellectual defect in epilepsy characterized by the loss of the ability to generalize, selectivity of memory, and speech poverty (oligophasia).
What is the main difference between psychosis in epilepsy and schizophrenia?
The main difference is the complete absence of negative symptoms, which always accompany the course of schizophrenia. In addition, epileptic psychoses are short-lived and begin very suddenly.
Can an organic focus in the brain always be found in epilepsy?
No, not always. A local organic scar process (epileptogenic focus) is detected exclusively in partial seizures. If the patient has generalized seizure activity, such foci in the brain are not found.
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