Post-seizure psychotic episodes linked to future mental health risks

Some people with epilepsy experience delusions, hallucinations, paranoia and confusion after a seizure. While these episodes usually last only days, a new study led by researchers at Carilion Clinic suggests they may place patients at significantly higher risk of developing psychiatric disorders later.

The study, published in BMJ Neurology Open, examined the relationship between the post-seizure episodes and longer-term mental health disorders. Using information from patients’ medical records, researchers compared the outcomes of patients who experienced temporary psychotic symptoms after a seizure with similar patients who did not.

For years, we’ve known these episodes can happen after a seizure, but we didn’t know what they might mean for a person’s long-term mental health. Our findings suggest they shouldn’t simply be viewed as something that comes and goes. They may identify patients who would benefit from closer follow-up.”

Varsha Nandwana, MD, neurologist at Carilion Clinic and lead author of the study

While the study did not confirm that these episodes cause mental illness, the findings show a strong link between the two conditions and could change the way doctors care for patients with epilepsy. Rather than ending treatment once the symptoms disappear, clinicians may consider monitoring patients’ mental health more closely in the months and years that follow. Earlier recognition of psychiatric symptoms could lead to earlier treatment and support.

“This study reminds us that epilepsy can affect more than neurological function, it can also affect mental health. By paying attention to these warning signs, we may be able to identify patients who need additional care sooner and perhaps understand the origin of mental illness better,” said Aashit Shah, MD, chief of neurology at Carilion and professor of medicine at the Virginia Tech Carilion School of Medicine, a collaborator on the study.

The study was led by Nandwana in collaboration with Shah and Anita Kablinger, MD, vice chair of research for Carilion Clinic’s Department of Psychiatry and Behavioral Medicine; Geetika Bajpai, assistant professor of neurology at the University of North Carolina at Chapel Hill; and Ching-Fang Sun, child and adolescent psychiatry fellow at the University of Washington School of Medicine and Seattle Children’s Hospital.

The study was funded by the Carilion Clinic Department of Medicine.