Acute Psychosis During Intracranial EEG Monitoring: Close Relationship Between Psychotic Symptoms and Discharges in Amygdala

Abstract

Summary:Purpose: This report examined the underlying mechanism of psychosis associated with epilepsy.Methods: An adult patient with epilepsy manifesting acute psychosis during long-term EEG monitoring is presented, together with a literature review on this subject.Results: A 25-year-old woman with intractable temporal lobe epilepsy developed acute psychosis while she underwent long-term intracranial EEG monitoring. After a clustering of seizures, she manifested psychotic symptoms including hallucination, stupor, and repeated fear. The transition of psychotic symptoms corresponded to the changes in frequency and morphology of seizure discharges restricted to the left amygdala. Improvement of psychosis coincided with disappearance of seizure discharges.Conclusions: This case confirmed a close relationship between psychotic symptoms and seizure discharges in the left amygdala. It is suggested that paroxysmal bombardment of the medial temporal lobe structure may be a pathogenetic factor of acute psychosis associated with epilepsy.

Neuroimaging of frontal–limbic dysfunction in schizophrenia and epilepsy-related psychosis: Toward a convergent neurobiology

“…Another case of ictal psychosis detectable only via intracranial EEG occurred in a young woman with intractable epilepsy and left mesial temporal sclerosis [46]. The patient, who had no prior psychiatric history, suffered a cluster of seizures, recovered to her baseline mental status, then became psychotic, and later stuporous while undergoing intracranial EEG monitoring with electrodes implanted in amygdala and hippocampus.…”

“…Although this dysregulation/hyperactivity is not traditionally considered to be epileptic, intracranial recordings from a small number of psychotic patients indicate that this may be the case for some patients with epilepsy [46, 78], as well as perhaps for patients even without known epilepsy [44], and it should be noted that here may be a gradient between epileptic and nonepileptic activity; this may explain in part the utility of antiepileptic medications in treating both epilepsy and psychosis [79]. SPECT studies performed during periods of psychosis showing focal hyperperfusion – a finding typically associated with active seizing – also support the idea that psychosis might be associated with deep limbic epileptic activity [21–24].…”

Interictal Spikes in Psychiatric Patients: A Controversy in Need for Resurrection

“…Furthermore, the work by Heath (1996) has also demonstrated spiking activity during psychotic episodes when depth electrodes were inserted in such patients. A more recent work by Takeda (2001) further asserted the observations by Heath. All are evidence supporting the notion that IEDs (it may also be important to differentiate IEDs from interictal epileptic discharges) are not benign and insignificant findings and that research in this area must take full advantage of advancing technology and increasing knowledge about the neurobiological bases of behavioral disorders.…”

Amygdala pathology in schizophrenia and psychosis of epilepsy

“…In another case, the transition of psychotic symptoms corresponded to the changes in frequency and morphology of seizure discharges restricted to the left amygdala. Improvement of psychosis coincided with the disappearance of seizure discharges [54]. In a study of six patients with postictal psychoses, Briellmann et al [55] did not find any evidence of volume loss in the hippocampus.…”