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S U MM ARY Acute interictal psychotic attacks during withdrawal of medication are described in two patients with temporal lobe epilepsy submitted to depth EEG study with a view to surgical treatment. The patients were on chronic treatment with clonazepam associated in one with phenobarbitone and in the other with phenobarbitone plus carbamazepine. Our observations suggest that the acute withdrawal of clonazepam, the plasma levels of which were monitored, may play a part in producing psychotic attacks characterised by dysphoric manifestations, irritability, aggressiveness, anxiety, and hallucinations. These symptoms could be interpreted as a withdrawal syndrome.A relatively high incidence of psychiatric disorders has been found in patients suffering from temporal lobe epilepsy (Bruens, 1975;Pond, 1975). These psychoses have been classified as psychotic states with and without disturbances of consciousness (Bruens, 1975;Helmchen, 1975).The first condition is a postparoxysmal state (ictal psychosis) characterised by confusion, disorientation, delusion, and hallucination. EEG recording may show generalised spikes, paroxysmal sharp waves, temporal theta and delta waves. Psychotic states with a normal level of consciousness (interictal psychoses) are brief episodic attacks (depressive and dysphoric states) sometimes prolonged by chronic manic-depressive syndromes and paranoid or schizophrenia-like patterns. Interictal epileptic EEG activity may disappear during these episodes ("forced normalisation") (Landolt, 1958). In some patients these attacks alternate with epileptic seizures, the socalled "alternative psychoses" of Tellenbach (1965) andJanz (1969).McDanal and Bolman (1975) and Wolf (1977) have drawn attention to the role of antiepileptic drugs in determining acute epileptic psychoses. They demonstrated that anticonvulsant plasma levels during psychotic attacks may be normal or low and that their aetiology is not necessary toxic,

Significant correlations in the concentrations of phenobarbital, phenytoin, and carbamazepine in the brain, plasma, and cerebrospinal fluid were found in 12 surgically treated epileptic patients. These findings confirm the clinical reliability of monitoring anticonvulsant drug plasma levels as part of the routine management of epilepsy. Phenobarbital, phenytoin, and carbamazepine are uniformly distributed in the gray and white matter in different brain areas (except for a higher concentration of phenobarbital in the rhinencephalic structures in comparison with the corresponding temporal neocortex) and in normal and scar tissue. In these 12 patients, all of whom were medically resistant, molar cortex concentration of phenobarbital and phenytoin was at "therapeutic" levels or even higher. These data suggest that in therapy-resistant patients, despite cerebral drug concentrations of the same therapeutic level as, or higher than, those present in medically controlled patients, anticonvulsant drugs are pharmacologically ineffective.