Psychiatric Comorbidity in Epilepsy: New Evidence from AES 2025

Ali Rafati (00:00): 

I am Ali Rafati, MD, MPH. I'm a postdoctoral research fellow at the School of Medicine, Department of Neurology at Johns Hopkins University. And my research involves assessing the psychiatric comorbidities of patients with epilepsy. 

Churl-Su Kwon (00:14): 

Hi, my name is Churl-Su Kwon, MD, MPH. I'm faculty at Columbia University in the Departments of Neurology, Epidemiology, Neurosurgery, and the Sergievsky Center. My role there is essentially looking at, epilepsy being the bread and butter of my research, but using big data to look at outcomes, comorbidity data, health services research, and looking to see how best to improve the care that we give to our patients. 

Ali Rafati (00:47): 

So our systematic meta-analysis showed that people with depression face roughly 2.5 times higher risk of developing epilepsy later in life. And this is really important highlighting the shared mechanisms depression and epilepsy have. There are tons of evidence that show the probable link within psychiatric disorders and epilepsy. And our previous work actually was a comprehensive systematic review and meta-analysis showing the prevalence of psychiatric comorbidities in patients with epilepsy, which was higher in people with epilepsy than people without epilepsy. And specifically depression was 2.5 times higher in people with epilepsy compared to people without epilepsy. 

(01:41): 

In this particular study, our current study, it looks at the opposite angle. People with depression also are at higher risk of developing epilepsy. All these show that epilepsy and depression have a shared underlying pathophysiology and mechanism that makes these two interrelated. So it is crucial for healthcare professionals, specifically psychiatrists and neurologists dealing with people with epilepsy, to screen at the baseline visits and all the follow-up visits, all the psychiatric and mental health screenings to get the best care for people affected. 

Churl-Su Kwon (02:31): 

There are studies out there that have shown this bidirectional relationship between psychiatric disorders and epilepsy. And the things that we also are looking into are things like anxiety, psychosis, suicide, developmental disorder, which are all very interlinked and intertwined. And the reason why we're doing this study to elucidate why does this happen, to what degree does this happen, and what measures then do we need to put into place within our clinical practice and to screen better so that we can catch the diseases better and obviously then implement the treatment necessary earlier on rather than later. 

Ali Rafati (03:26): 

Patients need to know that psychiatric comorbidities are a part of epilepsy. The healthcare professional should talk to patients that these are the side effects, these are the comorbidities seen with epilepsy, and it is normal if you experience them. So the thing is that we screen you, and we take action and prescribe the medications needed or implement the therapy that is needed for you. And it is normal for your condition. And the thing is that we need to first identify it and treat it. 

Churl-Su Kwon (04:07): 

I think another important aspect to the holistic treatment of a patient is if you listen from the patient's perspective on living with these diseases such as epilepsy and depression or anxiety, you find that there's a stigma associated with it. And it's often very hard for them to bring this out when living with these symptomologies as well. And I think physicians need to bear this in mind and be willing to have this conversation and be integrating things like screening tools which have been validated within our clinical practice to then open the conversation of, oh, okay, on top of the seizures that you're having or on top of the depressive symptoms that you're having, are you also experiencing low mood? Or are you experiencing states of confusion, for example, if you are having seizures? I think it's about bringing that conversation and bringing those patients where they're comfortable discussing these things because ultimately that's what you're trying to treat.