High Prevalence of Psychiatric Disorders in Epilepsy Highlights Need for Integrated Care: JAMA

The findings, published in JAMA Neurology, emphasize the substantial burden of mental health challenges faced by persons with epilepsy (PWE), calling for a more integrated approach to care.

Previous research has shown that several psychiatric disorders are more common in persons with epilepsy than in those without the condition. Building on this understanding, Churl-Su Kwon, Department of Epidemiology, Columbia University Irving Medical Center, New York, New York, and colleagues set out to analyze and summarize the prevalence of 20 psychiatric disorders in PWE compared to individuals without epilepsy.

For this purpose, the researchers conducted a comprehensive search of records from inception to February 2024 using online databases. They systematically reviewed published epidemiological studies that examined the prevalence of psychiatric disorders in persons with epilepsy compared with those without epilepsy, with no restrictions on language or publication date. Abstracts were reviewed in duplicate, and data were extracted using a standardized electronic form to ensure accuracy and consistency. The analysis included descriptive statistics and meta-analyses to summarize findings.

The main focus was on the prevalence of 20 psychiatric disorders in PWE compared to individuals without epilepsy. Meta-analyses were conducted alongside descriptive analyses to provide a clearer understanding of the data and to quantify differences in prevalence rates between the two groups.

• The following were the key findings of the study:
  • The systematic search reviewed 10,392 studies, with 27 meeting the eligibility criteria.
  • Meta-analyses included data from 565,443 persons with epilepsy and 13,434,208 persons without epilepsy.
  • The odds of several psychiatric disorders were significantly higher in PWE compared to those without epilepsy:
    • Anxiety: OR 2.11.
    • Depression: OR 2.45.
    • Bipolar disorder: OR 3.12.
    • Suicidal ideation: OR 2.25.
    • Suicide attempt: OR 3.17 (not significant).
    • Psychotic disorder: OR 3.98.
    • Schizophrenia: OR 3.72.
    • Obsessive-compulsive disorder: OR 2.71.
    • Posttraumatic stress disorder: OR 1.76.
    • Eating disorders: OR 1.87.
    • Alcohol misuse: OR 3.64.
    • Alcohol dependence: OR 4.94.
    • Alcohol abuse: OR 2.10 (not significant).
    • Substance use disorder: OR 2.75.
    • Autism spectrum disorder: OR 10.67.
    • Attention-deficit/hyperactivity disorder: OR 3.93.

This systematic review and meta-analysis revealed that most psychiatric comorbidities are significantly more common in persons with epilepsy (PWE) than in those without the condition, highlighting the substantial burden of mental health challenges in this population.

"The findings suggest that epilepsy care should integrate validated psychiatric screening tools into the training curriculum. Moreover, neurology specialists treating individuals with epilepsy should have easy access to resources for information and referral related to conditions such as PTSD and substance use disorders," the researchers concluded.

Reference:

Kwon C, Rafati A, Ottman R, et al. Psychiatric Comorbidities in Persons With Epilepsy Compared With Persons Without Epilepsy: A Systematic Review and Meta-Analysis. JAMA Neurol. Published online November 25, 2024. doi:10.1001/jamaneurol.2024.3976