Psychosis associated with epilepsy: significance of the laterality of the epileptogenic lesion.

Sherwin, Ira

doi:10.1136/jnnp.44.1.83

Cited by 86 publications

(33 citation statements)

References 10 publications

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“…This result is in accordance with earlier studies [5,6,15,21,22,25]. While in some of them, left-sided pathology was the most frequent finding, others found bilateral alterations [9,10,20,23].…”

Section: Discussionsupporting

confidence: 93%

EEG: a helpful tool in the prediction of psychosis

Gschwandtner

Pflueger

Semenin

et al. 2009

Eur Arch Psychiatry Clin Neurosci

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j Abstract Objective EEG investigation in patients with an at risk mental state (ARMS) for psychosis and patients with a first episode of psychosis (FE) in comparison to healthy controls (HC) in a clinical follow up study of Early Detection of Psychosis. Method Seventy-three patients (42 ARMS, 31 FE) and 35 HC were investigated. ARMS patients were followed up in order to monitor transition to psychosis. Psychopathology was assessed with respect to positive and negative symptoms. At study baseline EEG was recorded using the 10/20 system. Two blinded neurologists analyzed the EEGs visually for presence of generalized or focal slowing and epileptiform discharges. EEG data were controlled for medication and substance abuse. For statistical analyses we used v 2 -tests, logistic regression, ANOVA, and receiver operating characteristics. Results Patients showed significantly more pathological EEG abnormalities than HC (P < 0.05), located more frequently in temporal or fronto-temporal regions (P < 0.01) of the brain, with twice as many pathologies in ARMS than in FE patients. The specificity of the prediction of psychosis could be increased from 59 to 73% by considering EEG pathology in addition to psychopathology alone. In contrast, sensitivity of prediction remained unchanged. Conclusions These results show that EEG investigation in patients at risk for psychosis can add to the identification of those patients who will not develop psychosis later on.

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Section: Discussionsupporting

confidence: 93%

EEG: a helpful tool in the prediction of psychosis

Gschwandtner

Pflueger

Semenin

et al. 2009

Eur Arch Psychiatry Clin Neurosci

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“…In this regard, although high rates of bitemporal foci were noted in some studies (45,56,67), other authors reported more lateralized foci (63,68). However in most of the studies that reported a preponderance of left temporal foci among psychotic patients, these patients were being considered for temporal lobectomy.…”

Section: Temporal Lobe Epilepsy and Psychosesmentioning

confidence: 99%

Behavioral, Psychotic, and Anxiety Disorders in Epilepsy: Etiology, Clinical Features, and Therapeutic Implications

1999

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Summary: This chapter deals with some aspects of psychiatric disturbances in people with epilepsy. Because depression and its treatment are extensively described later in this issue, they are not discussed here. The same pertains to forced normalization. Key Words: Epilepsy-Anxiety-PsychosisDepress ion-Qua1 i ty of 1 i fe-Ps e u do s ei zure s-A n t idepressants-Antipsychotics-Antiepileptic drugs.Although most people with epilepsy lead a normal emotional and cognitive life, neurobehavioral problems can be found in a large number of patients. Higher rates of psychopathology are observed in people with epilepsy relative to the general population (1,2), to other neurologic control groups (3), and to people with chronic nonneurologic disorders (1,4). In particular, increased psychopathology is more common in temporal lobe epilepsy (TLE) than in generalized epilepsy (5). Nevertheless, many issues remain highly controversial, owing in part to several methodologic problems, such as the nosographic approach, the sample examined, the type of control groups, the comparison among nonhomogeneous forms of epilepsy, and the different antiepileptic drugs (AEDs).Psychiatric disturbances can be related either to involvement of brain structures (biologic pathogenesis) or to the chronic characteristics of epilepsy (psychosocial pathogenesis). These psychiatric symptoms may develop in relationship to the seizures (in prodromal, ictal, or postictal periods) but more commonly are present in a chronic interictal condition.The wide range of clinical diversity is related to the anatomic foci, to patterns of spread, and to biologic or psychological differences among patients. Interictal behavioral changes in epilepsy remain controversial and difficult to define, mainly because pathogenesis may be attributable to several factors, such as epilepsy itself, possible brain lesions, the AEDs prescribed, and psychosocial problems (6). On the other hand, the existence of cognitive changes in epilepsy is well established, and Addrress correspondence and reprint requests to Dr. Riccardo Tom at Dipartimento di Neuroscienze, via Cherasco 11, 10126 Torino, Italy.sometimes the presence of cognitive disorders can facilitate the appearance of psychiatric disturbances (7).One of the most widely discussed problems is the incidence of psychiatric pathology in epilepsy, with a wide range of values in the literature related to the type of study. Epilepsy is characterized by a broad spectrum of severity. Ideally, patients for study trials should be selected consecutively from a general epilepsy population, but most epidemiologic studies are carried out in centers for epilepsy and include many refractory subjects who demonstrate a range of pathologic disturbances more severe than those observed in the general population of patients with epilepsy. In community studies, the prevalence of associated psychiatric disorders is low, whereas in specialty referral centers, particularly those serving indigent populations, the prevalence can rise to 25-50%: Among patient...

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“…Prevalence in general population studies varies from 2-7,1% [8][9][10] , in general clinics from 0,8-9,2% [13][14][15][16][17][18][19][20] and in neurological or epilepsy clinics from 8,8-27% [21][22][23][24][25][26] . The purpose of this paper is to report the case of a patient with refractory epilepsy and epileptic psychosis and the value of therapeutic surgery such as temporal lobectomy in her treatment.…”

mentioning

confidence: 99%

Complete remission of epileptic psychosis after temporal lobectomy: case report

Marchetti

Tavares

Gronich

et al. 2001

Arq. Neuro-Psiquiatr.

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-We report a case of a female patient with refractory complex partial seizures since 15 years of age, recurrent postictal psychotic episodes since 35 which evolved to a chronic refractory interictal psychosis and MRI with right mesial temporal sclerosis (MTS). After a comprehensive investigation (video-EEG intensive monitoring, interictal and ictal SPECT, and a neuropsychological evaluation including WADA test) she was submitted to a right temporal lobectomy. Since then, she has been seizure-free with remission of psychosis, although with some persistence of personality traits (hiperreligiosity, viscosity) which had been present before surgery. This case supports the idea that temporal lobectomy can be a safe and effective therapeutic measure for patients with MTS, refractory epilepsy and recurrent postictal epileptic psychosis or interictal epileptic psychosis with postictal exacerbation.KEY WORDS: epilepsy, mental disorders, psychosis, temporal lobe.Remissão completa de psicose epiléptica de paciente submetida a lobectomia temporal: relato de caso RESUMO -Relatamos o caso de uma paciente que apresentava crises parciais complexas desde a idade de 15 anos, episódios psicóticos recorrentes desde os 35, evoluindo para psicose crônica interictal refratária, em quem investigação pela ressonância magnética (RM) revelou a presença de esclerose temporal mesial (ETM) direita. Após investigação abrangente (monitorização intensiva pelo vídeo-EEG, SPECT interictal e ictal e avaliação neuropsicológica incluindo teste de WADA), a paciente foi submetida a lobectomia temporal direita. Desde então, ela está sem crises e a sua psicose remitiu, persistindo apenas alguns traços de personalidade (religiosidade, viscosidade) que ela já apresentava anteriormente. Este caso dá suporte à idéia de que a lobectomia temporal pode ser uma medida terapêutica segura e eficaz para pacientes com ETM, epilepsia refratária e psicose epiléptica pós-ictal recorrente ou psicose epiléptica interictal com agravamento pós-ictal. PALAVRAS-CHAVE: epilepsia, transtornos mentais, psicose, lobo temporal. Several mental disorders may occur in patients with epilepsy. Psychoses associated with epilepsy are among those of major concern to neurologists and psychiatrists. These psychoses are classified into periictal (of which most significant are the postictal psychoses) and interictal. Postictal psychoses have onset in the late postictal period (hours or days after) of an isolated seizure or of a cluster of complex partial seizures (CPS) with or without secondary generalization. Its presentation is typically pleomorphic, with delusions and hallucinations, loose associations, mannerisms and mood swings 1,2 . Prevalence is of 4% in cases of apparently non-refractory epilepsy 3 and of 7-18% in cases of refractory epilepsy 2,4,5 . Interictal psychoses are chronic and/or recurrent, with delusions, hallucinations, thought disorders, disorganized behavior, relative absence of catatonic symptoms, mood swings, apragmatism and emotional blunting (less intense t...

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Psychosis associated with epilepsy: significance of the laterality of the epileptogenic lesion.

Cited by 86 publications

References 10 publications

EEG: a helpful tool in the prediction of psychosis

EEG: a helpful tool in the prediction of psychosis

Behavioral, Psychotic, and Anxiety Disorders in Epilepsy: Etiology, Clinical Features, and Therapeutic Implications

Complete remission of epileptic psychosis after temporal lobectomy: case report

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