Affective and conversion (dissociative) disorders in patients with epilepsy

Background. Comorbid disorders in epilepsy are an urgent problem in modern epileptology. In clinical practice, specialists encounter various psychopathological disorders in patients with epilepsy, among which anxiety and depressive states are especially common. No less significant are conversion (dissociative) disorders. These violations seem difficult to resolve due to the presence of a complex of factors leading to their development.

Objective. The aim is to study the prevalence of affective and conversion disorders and their treatment methods in patients with epilepsy.

Materials and methods. The analysis of scientific studies on the relationship between epilepsy, affective and conversion disorders and their treatment methods has been carried out.

Results. Despite the wide diagnostic and therapeutic possibilities, 25-30% of patients do not achieve seizure control with the help of pharmaco therapy. In 60-80% of patients, seizures persiston the background of antiepileptic therapy (PET). It is known that 60% of patients with persistent seizures have affective disorders. Depressive symptoms occupy a leading place and occur in 7.6-41.4% of patients, and with pharmacoresistance – up to 86%. Also, patients with pharmacoresistant epilepsy (PE) have conversion (dissociative) disorders, manifested in the form of psychogenic non-epileptic seizures (PNEP). However, patients with PNEP have "pseudo pharmacoresistance" – patients are prescribed PET, which does not have the desired effecton PNEP, worsening the clinical prognosis. Up to 40% of patients admitted to clinics with a diagnosis of "pharmacoresistant epilepsy" have a combination of epileptic seizures and NEP.

Conclusion. When choosing PET, you should considernotonly the types of seizures, but also the concomitant mental disorders. Anticonvulsant drugs with anormothymic effect, for example, lacosamide, are the most preferred for affective and conversion disorders. This drug has a wide range of effects in epileptic seizures and has a pronounced normothymic effect.

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