Las psicosis de la epilepsia: presentación de un caso clínico y revisión de la literatura

Abstract

Recibido: 13/08/2012; aceptado con modificaciones: 17/12/2012 RESUMEN: Presentamos el caso de un varón de 72 años con un diagnóstico previo de epilepsia del lóbu-lo temporal y esquizofrenia paranoide, que mostraba episodios de psicosis con sintomatología pleomórfica y atípica que no respondía bien al tratamiento antipsicótico. El paciente no presentaba un deterioro en su personalidad y había demostrado un buen ajuste y funcionamiento social. Tras revisar el caso se llega a cuestionar el diagnóstico previo de esquizofrenia paranoide proponiendo el diagnóstico alternativo de epilepsia del lóbulo temporal: crisis comiciales con sintomatología psicótica. Se instaura el tratamiento adecuado con éxito lo que permite el alta del paciente a su domicilio. Revisamos la literatura en la materia, concluyendo que las psicosis de la epilepsia han de tenerse en cuenta en casos de psicosis atípicas, resistentes a tratamiento en personas con buen funcionamiento psico-social sin deterioro en su personalidad. PALABRAS CLAVE: epilepsia del lóbulo temporal; psicosis comiciales; psicosis de la epilepsia; psicosis de la epilepsia tipo esquizofrenia. CONFLICTO DE INTERESES: Ninguno.ABSTRACT: We describe the case of a 72 year old man with a diagnosis of temporal lobe epilepsy and paranoid schizophrenia, who presented atypical psychotic episodes which did not respond to anti-psychotic medication. His personality had not deteriorated and he showed good social adjustment and functioning. After reviewing the case, we challenged the diagnosis of paranoid schizophrenia, proposing an alternative diagnosis of temporal lobe epilepsy with ictal psychosis. He was successfully treated and discharged home. We review the literature on the subject. The psychosis of epilepsy are a diagnostic option which must be seriously considered in cases of treatment resistant atypical psychosis in subjects with good pre-morbid functioning and social adjustment free from personality decline. KEY WORDS: temporal lobe epilepsy; ictal psychosis; psychosis of epilepsy; schizophrenia like psychosis of epilepsy. DECLARATION OF INTEREST: None.

Peri‐ictal psychiatric manifestations in people with epilepsy: An umbrella review

“…In the same line, in up to 13% of PWE, dysphoric disorders, with irritability and depressed mood, which manifested in interictal or pre‐ictal periods, generated difficulties for diagnosis and delayed treatment 42 . Or the psychoses that occur in 4% of PWE in their postictal periods in focal epilepsy or with idiopathic generalized epilepsy 43 . Therefore, it is important to perform a careful clinical assessment of patients to distinguish between peri‐ictal PM from “primary psychiatric manifestations” in people without epilepsy to optimize the treatment and prognosis.…”

“… 42 Or the psychoses that occur in 4% of PWE in their postictal periods in focal epilepsy or with idiopathic generalized epilepsy. 43 Therefore, it is important to perform a careful clinical assessment of patients to distinguish between peri‐ictal PM from “primary psychiatric manifestations” in people without epilepsy to optimize the treatment and prognosis.…”