The link between epilepsy and schizophrenia

Epilepsy and schizophrenia are two distinct disorders. However, people with epilepsy have an increased risk of developing schizophrenia.

Epilepsy is a condition involving repeated seizures due to atypical electrical activity in the brain. In contrast, schizophrenia is a severe mental disorder that affects thoughts, emotions, and behavior.

While they seem unrelated, research suggests a link between the two conditions. Some symptoms and genetic factors may overlap, and epilepsy-related psychosis can resemble schizophrenia.

The relationship between epilepsy and schizophrenia is a subject of ongoing debate. Research suggests that epilepsy is more common in people with schizophrenia, occurring four to five times more often than in the general population.

Individuals with epilepsy also have a higher risk of developing schizophrenia-like symptoms, particularly in the form of postictal and interictal psychosis. Postictal psychosis occurs after a seizure or cluster of seizures, while interictal psychosis refers to psychotic episodes that occur between seizures. There may be a genetic overlap between the two conditions, although the structural and functional brain changes in epilepsy may contribute to psychotic symptoms.

What is epilepsy?

Epilepsy is a neurological disorder involving symptoms of recurrent seizures. These seizures occur due to disruptions to the electrical activity in the brain and can vary in severity and presentation.

Some individuals experience convulsions, while others may have brief lapses in awareness. Epilepsy can result from genetic factors, brain injuries, infections, or developmental disorders.

Learn more about epilepsy.

What is schizophrenia?

Schizophrenia is a chronic psychiatric disorder that affectsTrusted Source a person’s perception of reality. Symptoms include hallucinations, delusions, disorganized thinking, and impaired social functioning.

The exact cause remains unclear, but genetic factors, imbalances in brain chemistry, and environmental factors contribute to its development.

Learn more about schizophrenia.

Symptoms of epilepsy

Epilepsy symptoms vary based on seizure type and severity, but common symptoms includeTrusted Source:

• recurrent convulsive or non-convulsive seizures
• a loss of awareness or consciousness
• confusion or memory lapses
• sensory disturbances such as unusual smells or visual distortions
• emotional changes, including fear or sudden mood shifts

Shared symptoms of epilepsy and schizophrenia may include:

• cognitive (thinking) impairments, such as difficulty with memory and attention
• changes in perception, including hallucinations in some cases
• mood disturbances, such as anxiety or depression

Symptoms of schizophrenia

Clinicians categorize schizophrenia symptomsTrusted Source into positive, negative, and cognitive symptoms:

• Positive symptoms: These include hallucinations, delusions, disorganized speech and behavior.
• Negative symptoms: These include social withdrawal, lack of motivation, and reduced speech.
• Cognitive symptoms: These include impaired memory, difficulty concentrating, and disorganized thinking.

Postictal psychosis

Postictal psychosis occurs after a seizure or cluster of seizures. It develops within 7 days, most often within 1 to 3 days after seizure activity.

Symptoms include:

• hallucinations and delusions
• confusion and disorientation
• agitation or aggression
• paranoia
• mood disturbances

Interictal psychosis

Interictal psychosis refers to psychotic episodes that occur between seizures. Unlike postictal psychosis, these episodes are more chronic and can resemble schizophrenia.

Symptoms include:

• persistent hallucinations and delusions
• disorganized thinking
• emotional instability
• social withdrawal
• sudden mood changes
• catatonic states

Schizophrenia-like psychosis of epilepsy

Some individuals with epilepsy develop a chronic psychotic disorder resembling schizophrenia, known as schizophrenia-like psychosis of epilepsy (SLPE). Unlike typical schizophrenia, SLPE often has a later onset and may present with:

• paranoid delusions
• auditory and visual hallucinations
• memory deficits
• disorganized thought processes
• a lack of negative symptoms

Prevalence of both

Epilepsy affects approximately 50 million peopleTrusted Source worldwide, accounting for a significant portion of neurological disease. Schizophrenia, on the other hand, affects about 24 million individualsTrusted Source globally, which equates to roughly 1 in 300 people.

Research indicates that individuals with epilepsy have a higher likelihood of developing psychotic disorders, including schizophrenia-like psychosis. A 2024 meta-analysis noted that the overall prevalence of psychosis among those with epilepsy is 7.8% and that epilepsy has a threefold increase in the risk of psychosis.

Causes of both

The causes of epilepsy and schizophrenia are complex, involving a mix of genetic, neurological, and environmental factors. While the two conditions are distinct, some overlapping mechanisms may explain why individuals with epilepsy are at a higher risk of developing schizophrenia-like symptoms. These mechanisms can include genetic factors and brain structure development issues,

Epilepsy can arise from various causesTrusted Source. These include:

• a genetic factors
• brain injuries such as trauma, stroke, or tumors
• neurodevelopmental conditions, including autism and cerebral palsy
• infections affecting the brain, such as meningitis and encephalitis

Schizophrenia is primarily linked toTrusted Source genetic causes, with a higher risk observable in individuals with a family history of the disorder. Other potential causes include:

• neurochemical imbalances with dopamine and glutamate dysfunction
• brain structure development issues
• environmental triggers such as prenatal infections, stress, and substance use

Although epilepsy and schizophrenia have different primary causes, shared genetic, neurochemical, and structural factors suggest a possible link between the two conditions.

Treating both

Managing epilepsy and schizophrenia requires a comprehensive approach that combines medication, therapy, and lifestyle adjustments to improve overall well-being.

Treating and managing epilepsy

For epilepsy, antiepileptic drugs (AEDs) such as levetiracetam, valproate, and carbamazepine are common medications to help controlTrusted Source seizures. In cases where seizures are resistant to drugs, surgery may help reduce their frequency.

Lifestyle management is also crucial, involving sleep regulation, stress reduction, and avoiding known seizure triggers.

Treating and managing schizophrenia

Schizophrenia treatment typically involves antipsychotic medications such as risperidone, olanzapine, and clozapine to manage psychotic symptoms. Therapy and psychosocial support, including cognitive behavioral therapy (CBT) and rehabilitation programs, can help individuals maintain daily functioning.

In severe cases involving acute psychosis or a risk of suicide, a person may need hospitalization for safety and stabilization.

When managing both conditions simultaneously, prescribing the appropriate medication is crucial. Doctors prefer clozapine due to its lower risk of triggering seizures compared to other antipsychotics.

Additionally, some antipsychotic medications can increase the risk of seizures. This makes regular neurological and psychiatric follow-ups essential to monitor treatment effectiveness and adjust medications as necessary.

Outlook for both

The long-term outlook for epilepsy and schizophrenia depends on factors such as severity, treatment adherence, and individual health.

With proper treatment, many people with epilepsy can lead typical lives, though some may continue to experience persistent seizures. Conversely, schizophrenia is a chronic condition where full recovery is uncommon. However, medication and therapy can significantly improve symptoms and quality of life, making long-term management essential.

For individuals living with both conditions, specialized care is crucial. They may face more significant cognitive challenges and social difficulties, requiring a tailored approach that addresses neurological and psychiatric needs.

Summary

Epilepsy and schizophrenia, though distinct disorders, share certain neurological features and symptoms. The former primarily affects brain activity through seizures, and schizophrenia affects cognition (thinking) and perception.

Individuals with epilepsy have a higher risk of developing psychotic symptoms, particularly postictal and interictal psychosis.

Proper medication management, lifestyle changes, and comprehensive psychiatric care can help individuals with these conditions achieve a better quality of life.

Source: https://www.medicalnewstoday.com/articles/epilepsy-and-schizophrenia#is-there-a-link-between-the-two