An excellent debate took place this morning at the International League Against Epilepsy's 10th European Congress on Epileptology. Organised by drug manufacturer Eisai, the debate was entitled Should we treat mood over seizures in people with epilepsy?
Chaired by E Trinka (Austria), the debate centred around presentations from Prof Mike Kerr (UK) and Phillippe Ryvlin (France). Prof Kerr presented an excellent case for prioritising the treatment of mood disorders over seizures. He quoted several studies supporting the idea that improving mood has a much greater positive impact on quality of life than treating seizures. In fact, he suggested that the treatment of mood may also improve the ultimate treatment of epilepsy. He demonstrated that improved mood leads to a greater degree of success when using seizure interventions.
Prof Kerr also quoted some concerning statistics from a recent research study of 193 people with epilepsy in tertiary clinics. Of those people, 11.9 per cent had had suicidal thoughts within the previous two weeks. Prof Kerr concluded: "It may be simplistic to polarise a debate on the treatment of depression rather than seizures. I would ask you to support the motion as it emphasises the importance of treating both."
Phillipe Ryvlin disagrees, however. Making an equally strong case, he began his rebuttal by quoting a study by Jacoby et al, demonstrating that quality of life is in fact largely dependent on seizure freedom.
Moreover, he made a very convincing case that relied on the risks of uncontrolled epilepsy. Aside from the risk of sudden unexpected death in epilepsy, Dr Ryvlin also cited a research study demonstrating a cumulative risk in adults whose epilepsy developed during childhood. Twenty per cent of people in this category may die before the age of 45.
Dr Ryvlin closed his presentation by explaining the idea of so-called 'deprelepsy' - depression and epilepsy in the same patient that share common causes.
Both cases were made so well that by the end of the debate, audience members were split as to whether the motion was carried or not. Research continues in this field, but debates such as this one underscore the importance of cross-discipline working when effectively treating both seizures and their comorbidities.
Epilepsy and depression
It is well documented that many people with epilepsy experience psychiatric disorders alongside their seizures, disorders such as depression or bipolar disorder. It has commonly been assumed that epilepsy leads to depression, since low mood can be a natural result of living with the condition.
Recently, however, several leading researchers have been exploring the idea that mood disorders and epilepsy may share some common causes. Rather than epilepsy leading to depression, it has been discovered in several studies that in many cases that relationship is reversed. In truth, depression may represent a risk factor for epilepsy.