2 Neuroscience2.11 Integrated neurobiology of syndromes and states
2.11.17 Seizures and psychiatric symptoms
2 min read1 figure
Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
Networks and excitability
An epileptic seizure is a brief clinical event caused by abnormal neuronal activity that is excessive or synchronous (many neurons firing together).
Epilepsy means an enduring tendency to have seizures. A single provoked seizure during an acute metabolic disturbance does not, on its own, establish epilepsy.
The brain works by keeping excitation and inhibition in balance. Ion channels, transmitter systems and the way networks are organised all help set this balance. Genetic, structural, immune and metabolic causes can disturb it.
Focal seizures start within a limited network. They may cause sensory, emotional, autonomic or cognitive symptoms before any obvious motor activity appears.
Timing matters
The same symptom can mean different things depending on when it happens in relation to seizures.
Relationship to seizures | Possible psychiatric presentation |
|---|---|
Ictal (during the seizure) | Brief, stereotyped fear, experiential symptoms or altered awareness |
Immediate postictal period | Confusion, agitation or short-lived cognitive impairment |
Postictal psychosis | Psychosis after seizures, sometimes following a lucid interval |
Interictal period | Depression, anxiety or persistent psychotic symptoms between seizures |
Treatment-related | Cognitive or behavioural side effects of antiseizure medication |
Assessment
A brief, stereotyped episode with altered awareness suggests a different explanation from persistent anxiety. Even so, no single symptom proves epilepsy.
The history and a witnessed description of the events guide investigation.
Electroencephalography (EEG) can support the diagnosis and help classify the seizures. A normal routine recording does not exclude epilepsy.
Electrocardiography (ECG) and metabolic tests look for important mimics or precipitants (triggers).
Traps
Functional seizures are real, involuntary events. They need a positive assessment, not just the absence of epilepsy. They can occur in the same person as epilepsy.
If someone's mental state stays altered after an apparent seizure, consider non-convulsive status epilepticus and other medical causes. Do not automatically put it down to a psychiatric cause.