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January 25, 2012
Letter to the Editor

Hospitalization for psychiatric disorders before and after onset of unprovoked seizures/epilepsy

February 7, 2012 issue
78 (6) 396-401



To study hospitalization for psychiatric disorders before and after onset of unprovoked epileptic seizures/epilepsy.


In this population-based case-control study, the cases were 1,885 persons from Stockholm with new onset of unprovoked seizures from September 1, 2000, through August 31, 2008, identified in the Stockholm Epilepsy Register. Controls, in total 15,080, were randomly selected from the register of the Stockholm County population. Odds ratios (ORs) were calculated to assess the risk of developing unprovoked epileptic seizures before and after hospitalization for a psychiatric diagnosis defined as a psychiatric hospital discharge diagnosis using International Classification of Disease codes from the Swedish Hospital Discharge Registry.


The age-adjusted OR (95% confidence interval) for unprovoked seizures was 2.5 (1.7–3.7) after a hospital discharge diagnosis for depression, 2.7 (1.4–5.3) for bipolar disorder, 2.3 (1.5–3.5) for psychosis, 2.7 (1.6–4.8) for anxiety disorders, and 2.6 (1.7–4.1) for suicide attempts. The risk of developing unprovoked epileptic seizures was highest less than 2 years before and up to 2 years after a first psychiatric diagnosis.


The increased rate of psychiatric comorbidity predating and succeeding seizure onset indicates a bidirectional relationship and common underlying mechanisms for psychiatric disorders and epilepsy.

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Letters to the Editor
17 February 2012
Looking at epilepsy through myopic eyes
Nitin K. Sethi, Assistant Professor of Neurology

Adelow et al. [1] correctly relate the chicken or the egg causality dilemma to their current study regarding seizure disorder and psychiatric condition. Epilepsy may mimic psychosis and vice versa, which may lead to misdiagnosis and incorrect treatment. I recently encountered a patient with a diagnosis of psychosis not otherwise specified. She lived in a shelter, was under the care of a psychiatrist, and was taking psychotropic medications. A typical psychotic episode was described as extremely agitated and bizarre behavior where the patient would suddenly get up and run into other inmates' rooms. An acute decompensation of her "psychosis" led to a visit to our emergency room. A typical event captured on video EEG showed ictal discharge originating in the left temporal lobe and spreading to the right. On camera, the patient exhibited her typical psychotic episode with sudden onset of agitated and restless behavior of biting the telephone cord, pulling the electrodes off her head, and running out of her room. To the authors' conclusions, I would like to add that both neurologists and psychiatrists are looking at epilepsy through myopic eyes.

1. Adelow C, Andersson T, Ahlbom A, Tomson T. Hospitalization for psychiatric disorders before and after onset of unprovoked seizures/epilepsy. Neurology 2012; 78:396-401.

For disclosures, contact the journal office at [email protected].

Information & Authors


Published In

Volume 78Number 6February 7, 2012
Pages: 396-401
PubMed: 22282649

Publication History

Received: July 5, 2011
Accepted: September 29, 2011
Published online: January 25, 2012
Published in print: February 7, 2012


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Dr. Adelöw, T. Andersson, and Prof. Ahlbom report no disclosures. Prof. Tomson serves as an Associate Editor for Epilepsia and on the editorial boards of Epilepsy Research and Epileptic Disorders; has received funding for travel and speaker honoraria from UCB; and receives research support from Eisai Inc., GlaxoSmithKline, Johnson & Johnson/Janssen, Novartis, sanofi-aventis, Pfizer Inc, UCB, ALF (Stockholm County Council), and CURE.


Affiliations & Disclosures

Cecilia Adelöw, MD
From the Department of Clinical Neurosciences (C.A., T.T.) and Institute of Environmental Medicine (T.A., A.A.), Karolinska Institutet, Stockholm, Sweden.
Tomas Andersson, BS
From the Department of Clinical Neurosciences (C.A., T.T.) and Institute of Environmental Medicine (T.A., A.A.), Karolinska Institutet, Stockholm, Sweden.
Anders Ahlbom, Prof
From the Department of Clinical Neurosciences (C.A., T.T.) and Institute of Environmental Medicine (T.A., A.A.), Karolinska Institutet, Stockholm, Sweden.
Torbjörn Tomson, Prof
From the Department of Clinical Neurosciences (C.A., T.T.) and Institute of Environmental Medicine (T.A., A.A.), Karolinska Institutet, Stockholm, Sweden.


Correspondence & reprint requests to Dr. Adelöw: [email protected]
Study funding: Supported by the Stockholm County Council and AFA Försäkring.

Author Contributions

Dr. Adelöw: drafting/revising the manuscript, analysis or interpretation of data, acquisition of data. T. Andersson: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, statistical analysis. Prof. Ahlbom: drafting/revising the manuscript, study concept or design. Prof. Tomson: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, study supervision, obtaining funding.

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