Epilepsy

The soul of psychiatry resides in synapses and synaptic functions and any disorder inducing synaptic dysfunction invariably will lead to psychiatric symptoms sooner or later.
(Synaptic autoimmune encephalopathies are the biggest example of it and psychiatry would forever be indebted to that catagory for this revelation)

And epilepsy always induces synaptic dysfunction. So epilepsy won't ever leave psychiatry and neither will psychiatry leave epilepsy. Not scientifically possible.

So it's up to us to change the system and build the alternate system. And unless the system is changed these problems will continue.

1) A new curriculum in psychiatry stressing neuroembryology, neuroanatomy, neuroradiology neurophysiology and genetics. MD 1st and second yrs should have to read these beside reading psychopathology.even Missing psychopathology classes might become pardonable but not missing these classes.

2) mandatory medicine posting for atleast 10 days in every month during 1st and second year. Only exemption period would be during neurology posting.

3) 6 months neurology posing and that should be divided into 2months for each yr.

There are many other areas like exposures to stem cells, immunotherapy and things.

If we can ever be able to change the system into this way then the psychiatrists growing through this system would never have to worry about the no man's land in between neurology and psychiatry. Because they themselves would bridge the no man's land then

Genetically,pathologically and neurobiologically speaking epilepsy is more a psychiatric disorder(no not speaking about philosophical psychiatry or spiritual psychiatry or psychological psychiatry They are nonmedical subjects and hence out of my speciality) than neurological disorder.

Same genetic disturbances, same tract/network system disturbances and same pathological origin of phenomenology in most cases. The most common symptoms are so called psychiatric in origin and most common complications too.
Scientifically speaking every epilepsy patient should be seen by a medical psychiatrist and a neurologist combined.
But
Science is never a guiding force in society.

So we wil continue as such. Epilepsy would stay in a no man's land and psychiatry and neurology will fight over it.

At KEM Mumbai
We did have similar rooster .
3mth Pure Neuro
3mth Medicine with ICU posting.
More beneficiary's where those student's like me who where registered with Honorary Guides at Periphery of Mumbai (those day RN Cooper hospital at Ville Parle).
After Neuro and Medicine post for next one and half years you independently treat all case's which you at KEM /or any other Premier Institute would refer to Neurologist.
Those years of independent handling of epilepsy and other borderline cases installed confidence to treat epilepsy as Psychiatrist.
As earlier posted.
We (Psychiatrist) are best to treat Epilepsy.
A Firm personal opinion.

during my stint in community psychiatry, my team attends more than 1100 cases/month of seizure disorders ranging from absence, CPS, febrile, reflex (hot water epilepsy), post-traumatic & drug withdrawal but not due to SOL. that is 13,000+ cases a year & that numbers beats many neurology opd turn over. the patient population ranges from daily wage workers, professionals to people in high risk jobs viz mining, railway drivers, passenger bus drivers. for these high risk groups, clearly warning for compliance is written in each follow-up & to refrain from duty for at least a week after the last seizures. if some cognitive impairment was apparent we suggest longer period of rest & drug optimization along with further referral to the nearest health facility or NIMHANS. having said these, there were many logistic constraints which shakes our confidence including the lack of an EEG facility in the peripheral centers & availability of medicine & at times, the caliber of our trainee. seizures due to complex etiologies are best left with neurologist/neurosurgeon, rest we can learn & treat confidently. this is purely my experience where i had 2 senior residents & 2 junior residents to ease my work

Many psychiatrists treat epilepsy in the West. There is no problem. There are a few LD Psychiatrists in UK, who see epilepsy patients predominantly, even at times exclusively. We need to streamline training issues, certifications, updatations and the legal framework. We are entering into a world where clinical skills and interests alone will be important, but unfortunately won't be enough.

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