The Neurological and Psychiatric Crossover of Epilepsy Research

Stephanie Chen, MSN, MPH, NP-C, Barrow Neurological Institute, also discussed goals of The VA Epilepsy Centers of Excellence, a national consortium aiming to provide high quality epilepsy care and educational resources to patients and their caregivers.

She highlighted that primary care physicians are often on the front line — they’re the first clinicians that patients go to when they have a seizure. As such, it’s crucial for a clinician to know how to work up a seizure and which medications to start. For instance, several patients are started on really old seizure medications that have a lot of side effects than the newer medications. “The VA Epilepsy Centers want to have more educational opportunities for primary care to learn about the standards of care of epilepsy.”

As education is key, Chen believes a huge unanswered question is the exact cause in about 60% of patients with epilepsy. “In some patients, we know it’s the stroke they had, the traumatic brain injury, or genetic malformation.” Research is needed on the genes that cause epilepsy or even certain biomarkers that may point to a seizure medication that may be better for one patient over the other.

Currently in epilepsy monitoring units, about 15-20% of patients actually have psychogenic non-epileptic seizures — seizure-like vents that actually have no EEG correlate, meaning their brain waves are normal during their event. They’re caused by a history of PTSD, abuse, depression, and anxiety. Chen emphasized that they are not doing it on a conscious level; their bodies are unable to deal with these past stressors and become overwhelmed and presents as something that looks like a seizure. But, it’s not epilepsy, so these patients don’t need treatment with epilepsy medications; what they need is to be connected to a psychiatrist for cognitive behavioral therapy.

“I think really interesting research right now is finding how we can better help these patients. Unfortunately, mental health is really limited in a lot of communities, and these patients aren’t getting the proper treatment. So, even though it’s not a neurological disorder, it’s a psychiatric disorder, I love the crossover and think these patients need more help,” Chen concluded.