Ictal and Peri-Ictal Psychopathology

Abstract

Patients with epilepsy may experience psychiatric symptoms preceding the seizure (pre-ictal), following the seizure (post-ictal), independently of seizure occurrence (interictal), or as an expression of the seizure (ictal). Compared to interictal, peri-ictal psychiatric symptoms are less investigated and recognized. However, they contribute substantially to disability and distress among people with epilepsy.The relationship between interictal and periictal symptoms is still largely unknown but it seems that they are intimately related in epilepsy. Greater appreciation and understanding of the periictal period is clinically important, providing a model for understanding basic mechanisms underlying mood and thought disorders and the substrates of cognition, volition, emotion, and consciousness.The present paper is aimed at reviewing major psychiatric symptoms that may occur around the ictus with special attention to clinical descriptions and relationships with interictal psychopathology.

Rapamycin attenuates aggressive behavior in a rat model of pilocarpine-induced epilepsy

“…Psychiatric disturbances can occur around the same time as seizures. They are recognized as peri-ictal symptoms, by which the psychiatric behaviors can be initiated or exacerbated immediately before, during or following the seizures (Kanner and Balabanov, 2002, Mula and Monaco, 2011). Psychiatric disorders sometimes also independently precede the onset of spontaneous recurrent seizures, which suggests that the underlying mechanism(s) of psychiatric disorders may trigger seizures (Hesdorffer et al, 2000).…”

The interictal dysphoric disorder of epilepsy: Legend or reality?

“…It seems now established that epileptic seizures are not just characterized by the ictal phase but a number of behavioral manifestations can occur around the ictus, either preceding or following [31,32]. Such symptoms may be subtle and difficult to identify if not specifically sought.…”

Peri-ictal behavioural change in people with an intellectual disability

“…Postictal manic symptoms arise in approximately 22% of PWE, some authors have made close associations between post ictal mania and PIP Mula and Monaco, 2011;Mula et al, 2010). Typically post ictal mania presents with racing thoughts and excessive energy lasting on average 2 h .…”

“…Peri-ictal behavioural and cognitive changes cause disability and distress in PWE; despite this they are poorly investigated and recognised (Boylan, 2002;Mula and Monaco, 2011). Epilepsy is common and severe in people with intellectual disabilities (PWID) (Espie et al, 2012).…”