People living with epilepsy (PWE) experience higher rates of depression compared with the general population. Depression in PWE is associated with increased seizure burden and reduced quality of life. We aimed to examine clinical and demographic correlates of depression severity using the nine-item Patient Health Questionnaire in PWE experiencing negative health events in the past 6 months.

1. (a) To assess how depressive severity correlated with seizure frequency;

2. (b) To examine how outcomes such as quality of life are influenced by depressive severity;

3. (c) To investigate how demographic factors affect depressive severity.

Depressive severity was defined as a score of 0–9 for no depression to mild symptoms (NMD), 10–19 for moderate depression (MOD) and 20–27 for severe depression. Continuous variables were analysed using the Kruskal–Wallis equality-of-populations rank test, and categorical variables were compared using Fisher’s exact test. Baseline data were taken from Sequential, Multiple Assignment Randomized Trial no. NCT04705441.

The sample of 159 participants had a mean age of 39.46 years (s.d., 12.15), with the majority (n = 131, 82.4%) identifying as White. A total of 48% (n = 76) of participants met the criteria for NMD, 41% (n = 65) met those for MOD and 11% (n = 18) met those for severe depression. The severe depression group had significantly more seizures in the past 30 days, as well as greater perceived stigma, lower social support and lower quality of life, compared with the other groups. Race was found to correlate with depressive severity in NMD and MOD versus the severe depression group.

Among adults with epilepsy, depressive severity was positively correlated with seizure frequency and stigma and negatively correlated with quality of life, social support and overall functioning. These results highlight the importance of routine screening for depression, and of providing management of these symptoms in comprehensive epilepsy care.

Cenobamate is a novel anti-seizure medication (ASM) in the alkyl carbamate family with a dual mechanism of action: targeting persistent sodium currents and positively modulating γ-aminobutyric acid type A receptors independent of benzodiazepines. Approved by Health Canada in June 2023, it offers an additional treatment option for seizures. This study’s objective was to review the real-world experience with cenobamate in a Provincial Comprehensive Epilepsy Program, soon after its availability in Canada.

A retrospective study of all patients prescribed cenobamate from June 2023 to May 2025.

The study population comprised 36 patients with a median age of 18 years (range: 8–23 years). Seizure etiology was structural (n = 18) and genetic (n = 13). Prior to starting cenobamate, patients had tried a mean of 10 ASMs. Additionally, 19 (53%) had undergone epilepsy surgery, 3 (8%) had failed the ketogenic diet and 11 (31%) were treated with neuromodulation. Following a mean duration of 10.5 months of treatment with cenobamate, 50% (18/36) had a > 50% seizure reduction, and 20% (7/36) had a 25%–50% reduction of seizures. Fourteen percent (5/38) of patients were seizure-free at the most recent follow-up. The median dose was 200 mg (range: 62.5–400 mg). Eighteen patients (50%) experienced adverse effects (AEs), including dizziness, drowsiness, nausea and vomiting. However, only two patients discontinued cenobamate due to AEs. No patients discontinued cenobamate due to a lack of efficacy.

This real-world study demonstrates the efficacy and tolerability of cenobamate in patients with highly drug-resistant epilepsy

Epilepsy is frequently accompanied by psychiatric symptoms, including mood disturbances such as depression, irritability and euphoria. Interictal dysphoric disorder (IDD), characterised by depressive and affective symptoms, is typically managed with psychiatric treatment. However, persistent symptoms, despite adequate psychiatric intervention, may indicate an underlying epileptogenic mechanism.

To highlight the importance of recognising epileptogenic contributions to persistent psychiatric symptoms, even in patients with apparently well-controlled epilepsy.

We present a case report of a Japanese woman in her 40s with well-controlled epilepsy; however, she developed enduring psychiatric symptoms. Clinical features, psychiatric treatments, neurological evaluation and therapeutic outcomes are described.

The patient experienced anxiety, depression, irritability and fear, leading to an initial diagnosis of IDD. Treatment with escitalopram and olanzapine achieved only partial symptom relief. Residual symptoms prompted further investigation, which revealed symptoms suggestive of temporal lobe epilepsy auras. Adjustment of anti-seizure therapy with lacosamide resulted in complete resolution of psychiatric symptoms, marked functional recovery and a reduction in her Hamilton Depression Rating Scale (HAMD-17) score improved from 23 to 6.

This case highlights that even in apparently well-controlled epilepsy persistent psychiatric symptoms may indicate an underlying epileptogenic mechanism rather than a primary psychiatric disorder. Careful evaluation and appropriate optimisation of anti-seizure medication can yield substantial psychiatric and functional improvements, underscoring the importance of multidisciplinary assessment in such presentations.

The prevalence of psychiatric disorders in people with epilepsy is as high as 43% and, among them, psychoses represent a severe comorbidity.

This is a narrative review discussing the interplay between epilepsy and psychosis and identifying challenges in diagnosing and managing psychotic symptoms in epilepsy, focusing on the past 10 years.

Articles published between June 2014 and December 2024 were identified through searches in PubMed using the search terms ‘psychosis’, ’seizure, epilepsy and convulsion’, ‘epile*’, ’seizure*’ and ‘convuls*’.

The association between epilepsy and psychosis was shown to be bidirectional, with people with psychosis being at increased risk of epilepsy. In epilepsy, psychotic symptoms may occur in three clinical scenarios, with clinical presentation and management varying in relationship to these: seizure-related (peri-ictal), treatment-related or independent of the former.

There are no guidelines for the management of psychotic symptoms in epilepsy, but it is possible to apply policies for the treatment of psychoses, taking into account the peculiarities and needs of people with epilepsy.

Epilepsy is a relatively common condition that affects approximately 4–5 per 1000 individuals in Ontario, Canada. While genetic testing is now prevalent in diagnostic and therapeutic care plans, optimal test selection and interpretation of results in a patient-specific context can be inconsistent and provider dependent.

The first of its kind, the Ontario Epilepsy Genetic Testing Program (OEGTP) was launched in 2020 to develop clinical testing criteria, curate gene content, standardize the technical testing criteria through a centralized testing laboratory, assess diagnostic yield and clinical utility and increase genetics literacy among providers.

Here we present the results of the first two years of the program, demonstrating the overall 20.8% diagnostic yield including pathogenic sequence and copy number variation detected by next-generation sequencing panels. Routine follow-up testing of family members enabled the resolution of ambiguous findings. Post-test outcomes were collected as reported by the ordering clinicians, highlighting the clinical benefits of genetic testing.

This programmatic approach to genetic testing in epilepsy by OEGTP, together with engagement of clinical and laboratory stakeholders, provided a unique opportunity to gather insight into province-wide implementation of a genetic testing program.