Acute Postictal Psychosis: A Stereo EEG Study

Abstract

An acute psychosis characterized by auditory hallucinations and paranoid delusions developed in a 19-year-old man with temporal lobe epilepsy after he had a cluster of seizures when antiepileptic drugs (AEDs) had been gradually discontinued. Continuous sterotactic depth and epidural EEG recordings confirmed that this was a postictal rather than an ictal event. Acute postictal psychosis is a self-limited condition phenomenologically distinct from ictal or postictal confusion.

Post-ictal psychosis after right temporal lobectomy.

“…Although there were common features in some of these patients, no generalisations can be made regarding symptoms. Three patients had depressive delusions and hallucinations (1, 2 and 4) and non-specific psychosis (2,3,4). Two patients had nuclear syndromes, paranoid delusions and delusional moods (2 and 3).…”

Aggression and Violence in Patients with Epilepsy

“…Episodes of postictal psychosis can evolve from a period of postictal confusion or they may emerge from lucid states (20). In either case, they tend to follow a psychosis-free interval of several hours up to a few days after a seizure or, usually, a cluster of complex partial seizures with or without secondary generalization (21)(22)(23)(24).…”

Postictal Psychosis in a 3-Year-Old Child

“…Rare depth electrode studies have shown increased temporal lobe spiking, which has not been confirmed by subsequent studies. 8 An interesting correlation has been noted between postictal psychosis and bilateral independent interictal and ictal foci, validating the need for a repeat study in cases of patients with postictal psychosis and only unilateral focus on long-term monitoring. 9 Forty percent of patients showed new-onset intermittent frontal delta activity during postictal psychosis in a study by Kanner et al 9 DC exhibited EEG findings of insomnia with loss of sleep architecture and gradual resolution of diffuse background slowing.…”