Intensive monitoring of interictal psychosis in epilepsy

Abstract

Ten epileptic patients developed interictal psychosis while being treated in hospital for seizure control. They were subjected to intensive behavioral, video-electroencephalographic, and serum anticonvulsant monitoring for an average of 7.1 weeks in a specialized epilepsy unit. In 9 patients, the interictal psychosis was indistinguishable from acute schizophrenia. Only 5 of these patients had complex partial seizures; the other 4 showed evidence of generalized epilepsies. Thus a "unique" association between schizophreniform psychosis and complex partial seizures, noted by previous authors, could not be confirmed. Only 1 patient showed normalization of the electroencephalogram during psychosis and an inverse relationship between psychosis and seizure frequency. In most cases the emergence of psychosis could not be explained. Interictal psychosis in epilepsy appears to be a spectrum of disorders that may be multifactorially determined.

Psychiatric Comorbidity in Patients Evaluated for Chronic Epilepsy: A Differential Role of the Right Hemisphere?

“…Interictal psychosis is reported in 7–11% of epileptic patients [1, 35, 36] in the literature and most often 10–20 years after the epilepsy onset [37, 38], rarely as a ‘complication’ of good or excellent seizure control (i.e. ‘forced normalization’ [39]).…”

Psychiatric comorbidity in epilepsy

“…The episodes are brief (last from several days to weeks), may end in a convulsion, the consciousness is usually clear, and often an association with TLE is found (78)(79)(80)(81)(82). The phenomenology is further characterised by paranoid delusions and auditory hallucinations, and aff ective symptoms may also occur (77,(83)(84)(85). The evidence is, however, limited, so more research on this topic is needed.…”

Acute Postictal Psychosis: A Stereo EEG Study

“…It has often been misinterpreted as being the result of drug withdrawal (Demers-Desrosiers et al , 1978;Sironi et al, 1979). Electrographic documentation to separate psychotic disturbance from ictal confusion hitherto has relied mainly on extracranial EEG recording (Ramani and Gumnit, 1982; Logsdail and Toone, 1988). Persistent seizure activity in deep brain structures such as the limbic system has not been clearly excluded in postictal psychosis.…”