If you’ve ever gone down a rabbit hole googling epilepsy,
schizophrenia, or psychosis, you’ve probably seen headlines hinting
at a mysterious connection between seizures and serious mental illness. Some people
with epilepsy develop hallucinations or delusions. Others with schizophrenia are
later diagnosed with seizure disorders. It’s enough to make anyone ask:
Are epilepsy and schizophrenia actually linked, or is this just coincidence?
The short answer: there is a connection, but it’s complicated.
Most people with epilepsy will never develop schizophrenia, and most people with
schizophrenia will never have seizures. Still, scientists have found a real,
measurable overlap in risk, shared brain pathways, and sometimes overlapping
symptoms. Let’s unpack what we know, what we don’t, and what it means if you or
someone you love lives with either condition.
Epilepsy and schizophrenia in plain English
Epilepsy 101
Epilepsy is a chronic brain condition in which a person has a tendency to
experience recurrent, unprovoked seizures. A seizure happens
when clusters of brain cells fire in an abnormal, synchronized way, temporarily
disrupting normal brain activity. Some seizures cause dramatic convulsions;
others are much subtler and might look like brief staring spells or odd automatic
movements.
Epilepsy can arise from many causes: a prior brain injury or stroke, genetic
conditions, developmental differences in the brain, infections, or sometimes no
identifiable cause at all. Treatment typically focuses on anti-seizure
medications, and in some cases surgery, medical devices, or dietary
therapies.
Schizophrenia 101
Schizophrenia is a long-term brain disorder that affects how a
person thinks, perceives reality, and relates to others. It’s not a “split
personality” (that’s a myth), but it often involves:
- Hallucinations (hearing or seeing things other people don’t)
- Delusions (firm beliefs that don’t match reality)
- Disorganized thinking and speech
- Negative symptoms such as reduced motivation, flat or limited
emotional expression, and social withdrawal
Researchers have linked schizophrenia to changes in brain structure and chemistry,
especially in neurotransmitters like dopamine and glutamate, along with genetic
and environmental risk factors. Treatment usually includes antipsychotic
medications, therapy, psychosocial support, and help with work, school,
or daily living.
How often do epilepsy and schizophrenia overlap?
When scientists look at large populations, they consistently find that
people with epilepsy are more likely to develop psychosis and
schizophrenia than people without epilepsy. The risk isn’t sky-high for
any one person, but it is clearly higher than average.
Studies suggest that:
- Psychotic disorders (including schizophrenia and schizophrenia-like
conditions) appear in roughly 5–7% of people with epilepsy,
with somewhat higher rates in temporal lobe epilepsy. - The risk of developing schizophrenia in someone who already has epilepsy
appears to be several times higher than in the general population. - The relationship goes both ways: people with schizophrenia are also more
likely than average to later develop epilepsy.
Even with that elevated risk, most people with either condition will never
develop the other. Think of it this way: the link is real at the population level,
but for any one individual, it’s a possibility, not a prediction.
Psychosis vs. schizophrenia: important distinction
A key point: psychosis is a symptom, not a diagnosis. Schizophrenia
is one illness that involves psychosis, but there are others:
- Brief psychotic disorders
- Bipolar disorder with psychotic features
- Depression with psychotic features
- Schizoaffective disorder
- Substance- or medication-induced psychosis
In epilepsy, some people develop schizophrenia-like psychosis:
hallucinations, delusions, and changes in thinking that closely resemble
schizophrenia but have a clearer connection to seizure activity or long-standing
epilepsy. In other cases, individuals with epilepsy meet full diagnostic criteria
for schizophrenia itself. Clinically, teasing these apart can be tricky, but it
matters for treatment and prognosis.
Types of psychosis related to epilepsy
Psychosis in people with epilepsy often falls into a few main patterns, usually
grouped based on their timing in relation to seizures:
Ictal psychosis
“Ictal” means during the seizure. Ictal psychosis is actually part of the
seizure event itself. A person may appear unresponsive or confused, have odd
automatic behaviors, or experience hallucinations, and an EEG shows ongoing
seizure activity in the brain. Once the seizure ends and the brain electrical
activity returns to baseline, the psychotic symptoms usually fade as well.
Postictal psychosis
“Postictal” means after the seizure. In postictal psychosis,
hallucinations, paranoia, or bizarre behavior appear within days after a seizure or
seizure cluster. The person may have a short lucid period after the seizure, then
gradually develop psychotic symptoms. These episodes often last days to a few
weeks and then resolve, especially with treatment.
Postictal psychosis tends to occur in people who have had epilepsy for many years,
especially if their seizures are not well controlled. Prompt recognition and
treatment can help prevent the episode from worsening or recurring.
Interictal psychosis
“Interictal” means between seizures. Interictal psychosis develops
independently of recent seizure events. The person may go months or years after
the onset of epilepsy before psychotic symptoms appear, and they may persist even
when seizures are relatively stable.
Chronic interictal psychosis can look very similar to schizophrenia, with ongoing
hallucinations, delusions, or disorganized thinking. Some researchers consider
this a special subtype often called schizophrenia-like psychosis of
epilepsy.
Forced normalization (alternative psychosis)
One of the strangest patterns is called forced normalization (also
known as alternative psychosis). In this scenario, a person’s EEG and seizure
control improve dramaticallysometimes with new medication or after surgerybut
psychotic symptoms suddenly appear or worsen.
It’s rare and not fully understood, but it highlights how delicate the balance is
between seizure control, brain activity, and mood or thought changes. In some
cases, adjusting medication or treatment can improve both seizures and mental
health, but it takes careful coordination between neurology and psychiatry.
Why might epilepsy and schizophrenia be connected?
Shared brain circuits and chemicals
Epilepsy and schizophrenia both involve brain networks that handle emotion,
memory, and perception. Temporal lobe epilepsy, for example, affects areas
like the hippocampus and amygdalaregions also implicated in psychosis. When these
circuits are repeatedly disrupted by seizures, long-term changes in connectivity
and signaling may increase vulnerability to psychotic symptoms in some people.
On a chemical level, both conditions involve neurotransmitter systems such as:
- Dopamine – associated with motivation, reward, and psychosis
- Glutamate – the brain’s main excitatory neurotransmitter, involved in
seizure generation and thought-processing networks - GABA – the main inhibitory neurotransmitter that helps prevent runaway
electrical activity
When these systems are out of balance, the brain may be more prone to both
seizures and psychotic symptoms, depending on which circuits are affected and how.
Genetic and developmental overlap
Family and genetic studies suggest that at least some of the increased risk comes
from shared susceptibility factors. Certain genetic variants or
combinations of variants may subtly alter brain development, leaving a person more
vulnerable to epilepsy, schizophrenia, or both under the right environmental
pressures (like early-life complications, infections, or significant stress).
Importantly, genes are not destiny. Many people with a family history of epilepsy
or schizophrenia never develop either condition. Genetics create a background level
of risk that interacts with environment, life events, and sometimes plain chance.
Medication and treatment factors
Occasionally, medications themselves can play a role:
- Some anti-seizure drugs, in rare cases, may contribute to mood or behavior
changes, including hallucinations, especially at high doses or in people who are
particularly sensitive. - Some antipsychotic medications can lower seizure threshold, meaning they may
make seizures slightly more likely in susceptible individuals.
This doesn’t mean these medications are “bad.” It just means that when someone has
both seizure and psychotic symptoms, neurologists and psychiatrists need to
work closely together to choose the safest, most effective combination of
treatments and adjust doses carefully.
Key differences: epilepsy-related psychosis vs. schizophrenia
Despite the overlap, there are usually clear differences between psychosis related
to epilepsy and primary schizophrenia:
- Timing – Epilepsy-related psychosis may track closely with seizure
patterns (before, during, or after seizures), while schizophrenia is not tied to
seizures. - Onset – Schizophrenia typically starts in late teens to early
adulthood. Epilepsy-related psychosis might show up years after seizures begin. - Course – Postictal psychosis is usually brief and episodic. Chronic
interictal psychosis can be longer-lasting but may still show different patterns
than classic schizophrenia. - Cognitive changes – Both conditions can affect memory, attention,
and thinking, but the pattern and severity can differ. - Response to treatment – Some epilepsy-related psychoses respond
quickly to low doses of antipsychotic medication and improved seizure control.
Clinicians use a detailed history, seizure records, EEG and imaging results, and
careful mental status evaluation to sort out what’s going on in each person’s
case.
When should someone seek help?
Whether or not epilepsy is involved, any new psychotic symptoms are a big
red flag. It’s time to reach out for immediate medical help if someone:
- Starts hearing voices or seeing things others don’t
- Holds strong beliefs that clearly don’t match reality (for example, being sure
neighbors are spying via the TV) - Becomes unusually suspicious, fearful, or aggressive
- Shows severe confusion, disorganized speech, or bizarre behavior
- Talks about self-harm or harming others
If seizures are also presentor if someone with known epilepsy suddenly begins to
behave very differentlycaregivers should contact the person’s neurologist and
mental health team as soon as possible. In an emergency, calling local emergency
services or going directly to an emergency department is essential.
Information in this article is for education only and can’t replace personal advice
from a qualified health professional who knows your medical history.
How are epilepsy and schizophrenia (or psychosis) diagnosed?
Untangling these conditions usually requires a team approach:
- Neurologist – evaluates seizure history, orders EEG and brain
imaging, and manages anti-seizure treatment. - Psychiatrist or other mental health professional – performs a
full psychiatric evaluation, including questions about mood, thinking, behavior,
substance use, and family history. - Primary care provider – helps rule out other medical issues
(infections, metabolic problems, medication side effects) that can mimic psychosis
or trigger seizures.
Diagnosis often takes time. Doctors may need to observe how symptoms evolve, how
they relate to seizure activity, and how they respond to trial treatments before
reaching a firm conclusion.
Treatment: balancing seizure control and mental health
When epilepsy and psychosis (or schizophrenia) coexist, the goal is to
stabilize both seizures and mental health with the fewest side effects
possible. Treatment plans may include:
- Anti-seizure medications tailored to the type of epilepsy and the
person’s other medical conditions. - Antipsychotic medications chosen with seizure risk and drug
interactions in mind. - Therapy and psychosocial support, such as cognitive behavioral
therapy, family education, vocational programs, and housing or financial support
when needed. - Lifestyle strategies that help both conditions: getting enough
sleep, managing stress, avoiding substance use, and taking medications exactly as
prescribed.
People do best when their care teams talk to each other. A neurologist adjusting
seizure medications without knowing about worsening hallucinationsor a
psychiatrist changing antipsychotics without considering seizure historycan lead
to avoidable setbacks. If you’re a patient or caregiver, it’s absolutely okay (and
helpful!) to remind clinicians to coordinate.
Living a full life with epilepsy, schizophrenia, or both
The combination of seizures and psychosis can sound intimidating, but many people
build meaningful, satisfying lives while managing one or both
conditions. Some key ingredients:
- Education – Understanding your condition reduces fear and helps
you notice early warning signs. - Support – Family, friends, peer groups, and advocacy
organizations can reduce isolation and stigma. - Routine – Regular sleep, meals, and activity can stabilize both
seizure risk and mood. - Honest communication – Let your providers know about side
effects, mood shifts, or new symptoms early rather than waiting.
Stigma is still a huge issue for both epilepsy and schizophrenia. Pushing back
starts with accurate information and compassionate languageseeing these not as
character flaws, but as health conditions that deserve treatment and
respect.
Real-life experiences: what this link can feel like
Statistics and brain scans are helpful, but they don’t capture what it’s actually
like to live at the intersection of epilepsy and psychosis. While everyone’s
experience is unique, these composite stories (based on patterns clinicians
describe) can give a sense of what people and families may go through.
Case 1: “My seizures stopped, but my thoughts went off the rails.”
Imagine someone who has lived with temporal lobe epilepsy since adolescence. After
years of frequent seizures, they finally try a new combination of medications. The
good news: the seizures nearly disappear. The unexpected twist: over the next few
months, they begin to hear a running commentary voice and become convinced their
neighbors are sending messages through the ceiling.
At first, they keep it to themselves, worried that admitting these experiences will
make their doctors take their seizure control less seriously. Eventually, the fear
and sleep loss become overwhelming. When they finally speak up, their neurologist
and psychiatrist recognize a likely episode of psychosispossibly related to the
sudden shift in seizure activity. With an adjusted medication plan and careful
monitoring, their thinking gradually becomes clearer while seizure control remains
good. The lesson they share later: “If something feels off in your mind, don’t
wait. Tell your doctors as soon as you can.”
Case 2: “We thought it was all mental healthuntil the first seizure.”
Now picture a young adult whose first problems are classic early signs of
schizophrenia: withdrawing from friends, losing interest in school, and expressing
odd, paranoid ideas. They’re eventually diagnosed with schizophrenia and start an
antipsychotic. Things stabilize a bituntil one night, they suddenly collapse with
a convulsive seizure.
At the emergency department, the team discovers abnormal electrical activity on an
EEG and evidence of a focal seizure disorder. Suddenly, the care plan must expand:
now there’s epilepsy to manage alongside schizophrenia. The family feels shocked
and overwhelmed, wondering if they missed something years earlier. Over time, with
coordinated neurology and psychiatry follow-up, they learn to track both seizure
triggers and early warning signs of psychosis. The person returns to part-time
work, supported housing, and an outpatient program that addresses both conditions
together.
Case 3: “As a caregiver, I had to learn a new language.”
Finally, consider a parent caring for an adult child with long-standing epilepsy.
They’re used to recognizing subtle signs that a seizure is coming: a strange look,
a few repeated words, a vague complaint of déjà vu. But when their child starts
talking about hearing the TV “whisper instructions” all day and insists the
neighbors have installed cameras in the vents, it feels completely different.
At first, the parent thinks it’s just stress or medication side effects. It’s only
after a support group meetingwhere another caregiver mentions postictal psychosis
that they realize psychosis can be part of the epilepsy picture. With that
knowledge, they bring detailed notes to the next neurology appointment. The care
team adds a low-dose antipsychotic, adjusts anti-seizure meds, and builds a crisis
plan. The parent later says that learning the “language” of psychosishow to talk
calmly, avoid arguments about delusions, and focus on safetychanged everything for
their family.
These examples are simplified, but they highlight a common theme: early
recognition, open communication, and coordinated care can dramatically improve
outcomes. The link between epilepsy and schizophrenia is not destiny or
doomit’s a signal that the brain is complex, and that people deserve holistic,
integrated treatment when symptoms overlap.
The bottom line: Is there a link?
So, is there a link between epilepsy and schizophrenia? Yesthere’s clear evidence
of a bidirectional, biological relationship, especially in certain
types of epilepsy and in people with specific vulnerabilities. Psychosis and even
schizophrenia are more common in individuals with epilepsy than in the general
population, and epilepsy occurs more often in people with schizophrenia than you’d
expect by chance.
But that link does not mean that everyone with seizures will develop schizophrenia,
or vice versa. Instead, it’s a reminder that brain conditions rarely stay neatly in
their own lane. Seizures, mood, thinking, and perception all share the same three
pounds of tissue inside the skull.
If you or someone you care about lives with epilepsy, schizophrenia, or both, the
most important steps are straightforward: stay informed, stay connected to
care, and speak up early about any changes in symptoms. With the right
team and treatment plan, many people find stability, pursue their goals, and write
their own storyfar beyond any diagnosis.
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