Magazine article Clinical Psychiatry News

Frontal Lobe Epilepsy: Dx Can Prove Tricky

Magazine article Clinical Psychiatry News

Frontal Lobe Epilepsy: Dx Can Prove Tricky

Article excerpt

BAL HAROUR, FLA. -- Patients with frontal lobe epilepsy experience a very high incidence of psychiatric symptoms that can contribute to misdiagnosis and can unnecessarily delay treatment, Dr. Elliott Lee reported in a poster at the annual meeting of the American Neuropsychiatric Association.

And because these patients also tend to use large amounts of caffeine and nicotine, which can exacerbate their psychiatric symptoms and decrease seizure control, physicians should always evaluate their use of mood-altering substances, said Dr. Lee of the Mayo Clinic in Rochester, Minn.

"Many of these patients are on four or five antiepileptic medications, and it seems that their intake of caffeine and nicotine is an attempt to combat the sedation and general feelings of dullness that the medications induce," Dr. Lee said in an interview. "But these substances can make the psychiatric symptoms--especially sleep problems--much worse and decrease seizure control, so they need to take even more medication. They're in a vicious cycle."

Frontal lobe epilepsy can be extremely difficult to diagnose, because the atypical seizures are not always accompanied by obvious EEG changes. Accompanying psychiatric symptoms can fall into seven different clusters: mood, anxiety, aggression, sexual, somatoform, sleep, and psychosis.

"These patients can exhibit some really bizarre symptoms that are frequently misdiagnosed as psychiatric disorders," Dr. Lee said.

He retrospectively analyzed the records of 85 patients with intractable frontal lobe epilepsy who were surgically treated at the Mayo Clinic during 1987-1996. He examined psychiatric symptoms both pre- and postoperatively, along with neuropsychological testing results and surgical outcome.

The group consisted of 61% males, and the patients' average age at surgery was 28 years. Almost 70% of the group had neurocognitive testing; the average full scale IQ of these patients was 84, Dr. …

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