Asked by Susan, St. Louis, Missouri
My 9-year-old daughter with a diagnosis of childhood absence epilepsy (currently treated with Depakote) has had two separate episodes, six months apart, where she heard voices telling her to hurt herself and run away. Each episode lasted two weeks. Would the only possible causes for hallucinations be depression/bipolar, or can you list some other possibilities?
Mental Health Expert
Dr. Charles Raison
Emory University Medical School
Susan, your question is an important and insightful one. I spent a number of years working as the psychiatrist for the seizure service at the UCLA Medical Center, so I have had a good deal of experience with the many psychiatric effects that seizures can have. Here is the short answer to your question: NO! Most definitely depression and bipolar disorder are not the only causes for psychotic episodes that you describe your daughter experiencing. The second part of the answer is that seizures can cause any and all psychiatric symptoms.
So even though I don't know anything about your daughter's case other than your very short question, the first thing I would suspect is that the seizure disorder may well have caused the two psychotic episodes you describe. Why do I say this? First and foremost because the episodes were so short lived and (I gather) completely resolved. This is a fairly common pattern for seizure-related psychotic symptoms. The other reasons I would suspect the seizure disorder is that psychotic symptoms as you describe are pretty uncommon in children before puberty (although not unheard of, unfortunately). Because psychotic symptoms are uncommon in children but fairly common in seizure disorder, it is pretty much a no-brainer that this is the most likely explanation for your daughter's symptoms.
The only thing that doesn't fit so well is that absence seizures are not as typically associated with psychiatric symptoms as is another type of seizure condition called complex partial seizures. These types of seizures occur when only one part of the brain cortex seizes without the activity spreading to include the whole brain. I have seen many patients become psychotic while having a complex partial seizure.
I will never forget a woman with complex partial seizures who showed up at the emergency room convinced that people in a fast food restaurant were trying to kill her. She was completely normal otherwise, and I had a hard time convincing the other doctors to get an EEG (an electroencephalogram, which measures brain wave activity) on her. But eventually they did and she was shown to be having a seizure while she was talking to me. When we gave her a big dose of anti-seizure medicine the seizure stopped and her psychotic symptoms went away immediately.
So the practical point of all this is that I would highly recommend your daughter get a more complete workup at a medical center that has expertise in diagnosing and treating the more subtle manifestations of seizure disorders. It is especially important to have her examined if she has another psychotic episode because sometimes the EEG machine will pick up the seizure activity. At other times, a patient will have a seizure and then have psychotic symptoms after the seizure. In either case, getting the right diagnosis is extremely important because if the seizures can be better controlled your daughter would be much less likely to have more psychotic episodes.
I can't emphasize how important it is to really try to get the best seizure care you can for your daughter. I say this because we know that sometimes patients with seizures will sustain enough brain damage that the psychotic symptoms become permanent, which is something you really want to avoid.
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