Brain Health Care Clinic

Epilepsy is a neurological condition in which the brain produces sudden bursts of electrical activity, leading to seizures. Seizures can vary widely in type and severity—ranging from brief moments of staring or confusion to convulsions and loss of consciousness. Some people experience warning signs before a seizure, such as unusual sensations, emotions, or smells, while others may have no warning at all. Epilepsy can begin at any age and may have many different causes, including genetic factors, brain injury, or structural brain changes.

Although epilepsy is often thought of as a seizure disorder, it is increasingly recognized as a condition that can also affect mood, behavior, cognition, and quality of life. Many people living with epilepsy experience depression, anxiety, irritability, or emotional instability. These symptoms may occur independently, as part of the seizure disorder itself, or in reaction to its impact on daily life. Cognitive difficulties—such as problems with attention, memory, or processing speed—are also common and may be related to the underlying brain condition, seizure activity, or the effects of medications.

A neuropsychiatric assessment is especially helpful when someone with epilepsy is also experiencing emotional, behavioral, or cognitive changes. These symptoms may fluctuate over time, worsen with stress or illness, or appear in relation to seizure patterns. Some symptoms occur around the time of seizures (periictal), while others may persist between seizures (interictal), or emerge unexpectedly when seizures improve or stop altogether (paraictal). In some cases, psychiatric symptoms may even be the first sign of seizure activity.

A neuropsychiatric approach focuses on identifying the pattern and cause of symptoms, their relationship to the seizure itself whilst taking into account the  type of epilepsy, neurological findings, medication side effects, and broader life context. This helps to avoid misdiagnosis, unnecessary psychiatric labels, or inappropriate medication. Psychiatric treatments are used carefully, considering how they may interact with seizure control. In many cases, subtle changes in treatment  can significantly improve both mental health and overall stability.

What about  Non-Epileptic Seizures (pseudo seizure)  in People with Epilepsy?

Not all seizures in people with epilepsy are caused by abnormal electrical activity in the brain. In fact, up to 10–30% of individuals with epilepsy also experience non-epileptic seizures, which can resemble epileptic events but have different underlying causes. These are often referred to as dissociative seizures or psychogenic non-epileptic seizures (PNES), though the term pseudoseizures is now discouraged due to its stigmatizing tone.

In individuals who already have epilepsy, non-epileptic seizures are often under-recognized or misdiagnosed as breakthrough seizures. Unlike cases where dissociative seizures occur without epilepsy—often linked to psychological trauma—those occurring alongside epilepsy are not always trauma-related. They may be triggered by a range of factors, including emotional distress, sleep disruption, or may in fact be similar to a panic attack but with less physical symptoms and predominant feeling of detachment. These episodes may occur in specific settings, often without EEG evidence of a seizure, and may follow a different pattern than the person’s typical epileptic seizures; however often they are very difficult to differentiate from epileptic seizures. 

A neuropsychiatric assessment can help to   distinguish between epileptic and non-epileptic events by reviewing the semiology, timing, emotional context, and neurological findings. Video EEG monitoring is the gold standard for diagnosing non epileptic seizures. However only if the seizure in question appears during monitoring. A normal EEG does not rule out an epileptic seizure. On the other hand, it is not uncommon for  EEG findings to be misinterpreted as seizures. This distinction is crucial for appropriate management and can often be very complex . For that reason it is highly recommended to be seen by an epileptologist , and neurologist that specializes in epilepsy.  Misdiagnosis can either lead to over treatment  or  unnecessary medication changes.  Management typically involves psychoeducation, behavioural intervention, at times medication for concurrent symptoms of anxiety and depression or  referral for psychological therapy focused on emotional regulation and stress response. Clarifying the diagnosis , in and of itself, often helps reduce the frequency of events and improves quality of life for both the person and their support network. 

Iatrogenic psychiatric symptoms refer to mental health changes caused by medical treatments, including medications commonly used for neurological conditions. Many drugs used to treat epilepsy, Parkinson’s disease, multiple sclerosis, and other disorders can have psychiatric side effects, ranging from mood disturbances to psychosis.

For example some anti-seizure medications may induce depression, anxiety, or even psychotic symptoms and suicidal thoughts. Often people assume it's because of their difficulty coping with a diagnosis of epilepsy . Whilst this might be true , it is now widely accepted that these symptoms are frequently part of the seizure disorder or the treatment. Identifying the cause is important in order to choose the appropriate treatment. Similarly  medications used in Parkinson’s disease can lead to hallucinations or even impulse control disorders such as compulsive gambling, shopping . Steroids, often prescribed for autoimmune neurological disorders ( Multiple Sclerosis , Lupus ) can trigger mood swings, mania, or severe agitation. Recognizing and managing these iatrogenic effects is essential in balancing the treatment of neurological conditions while preserving mental health.

Adults on the autistic spectrum  may struggle with sudden behavioral or emotional changes that are often misunderstood or misdiagnosed. In late adolescence and early adulthood, challenges such as changes in routine, overstimulation, health issues, or life stressors can trigger anxiety, irritability, or social withdrawal. Communication differences may make it hard for autistic individuals to express distress, and these behaviors are sometimes mistaken for psychiatric disorders without recognizing the neurological causes such as seizures which are not uncommon in individuals on the spectrum. 

At the Brain Health Care Clinic every  person’s unique communication style, sensory profile is respected .   Collaboration with families, caregivers, and referring professionals help to  understand what may be driving behavioral changes and to avoid unnecessary or harmful treatments. Medications are prescribed cautiously ,using the lowest effective doses and  avoiding use of multiple medications where necessary so as to reduce the risk of adverse side effects.  

Adults with intellectual disability are often vulnerable to psychiatric side effects from medications prescribed for mood, behavior, or neurological conditions. They may also show behavioral changes—such as aggression, withdrawal, agitation, or a loss of skills—in response to physical illness, pain, environmental stress, or mental health issues. These presentations are complex and require careful assessment to avoid misdiagnosis and overtreatment.

The neuropsychiatric assessment focuses identifying the medical, neurological, or psychiatric causes behind new or worsening behaviors. Non-drug approaches are adopted  when possible with attention to consistency, structure, and environmental support. If medication is considered necessary,  medication is commenced at very low doses and  polypharmacy is avoided , recognizing the increased sensitivity of this population to psychiatric and neurological side effects. Treatment is always guided by respect, experience, and a commitment to safety and quality of life.

Multiple Sclerosis (MS) is a condition that affects the brain and spinal cord, causing a wide range of symptoms. It occurs when the immune system mistakenly attacks the protective covering of nerve fibers (called myelin), leading to inflammation and damage. This disrupts the signals between the brain and the rest of the body, resulting in symptoms such as muscle weakness, balance problems, fatigue, vision changes, and cognitive difficulties. MS varies from person to person—some experience periods of symptoms followed by recovery (relapsing-remitting MS), while others have a gradual worsening of symptoms over time. Fortunately, there has been enormous progress in the development of multiple medications for MS, including disease-modifying treatments that help slow progression and reduce relapses, significantly improving long-term outcomes.

MS is associated with a high prevalence of depression, anxiety, and cognitive difficulties, and these mental health issues are multifactorial. They are influenced by inflammatory processes in the brain, the number and location of plaques, medication side effects, and the overall burden of disability. Inflammation and demyelination can directly affect brain regions involved in mood regulation and cognition, leading to symptoms such as memory problems, difficulty concentrating, and emotional changes. Additionally, the challenges of living with a chronic, unpredictable illness—along with physical symptoms like fatigue and pain—can contribute to psychological distress. Understanding these contributing factors is essential for providing comprehensive care that addresses both neurological and mental health needs.

Some treatments for MS, such as steroids used to manage relapses, can have psychiatric side effects. Around 20% of people experience mood changes, ranging from mild euphoria to more serious effects, including severe mood swings, suicidal thoughts, and disordered thinking. Fortunately, these symptoms can be well managed, and the most important step is ensuring that patients and their families are aware of these potential side effects before starting steroids. By recognizing symptoms early, doctors can adjust treatment or provide supportive care, ensuring both physical and mental well-being are addressed in MS management.

Migraines are a common neurological disorder, affecting approximately 10–15% of the population. They often begin in adolescence or early adulthood and tend to run in families, suggesting a genetic predisposition. Unlike typical headaches, migraines involve recurrent episodes of moderate to severe head pain, usually on one side of the head, and are often accompanied by nausea, vomiting, and sensitivity to light and sound. Some individuals experience aura—temporary neurological symptoms such as visual disturbances or tingling sensations—before the onset of headache pain.

Accurate diagnosis is crucial, as migraines can be mistaken for other headache syndromes, such as tension-type headaches or cluster headaches. Misdiagnosis can lead to ineffective treatment and unnecessary suffering. A multidisciplinary approach is often the most effective way to manage migraines, combining medication (both preventive and acute treatments), lifestyle modifications, and psychological support. Identifying and avoiding triggers, such as stress, poor sleep, and certain foods, plays a key role in reducing attack frequency.

Migraines have a significant impact on mental health. They are strongly associated with an increased risk of depression and anxiety, partly due to the unpredictability and disabling nature of attacks. Chronic migraines, in particular, can lead to frustration, social isolation, and difficulties maintaining employment. Additionally, individuals with migraines may be at higher risk of medication-overuse headaches, further complicating their condition.

Effective migraine treatment extends beyond medication and psychological support. Lifestyle factors play a crucial role in prevention and management. Maintaining good sleep hygiene, engaging in regular physical activity, reducing alcohol consumption, and avoiding other negative health behaviors can significantly improve migraine control. Stress management techniques, such as mindfulness and relaxation exercises, may also help reduce attack frequency. A comprehensive treatment plan that integrates medical, psychological, and lifestyle interventions offers the best chance of minimizing the burden of migraines.