Postictal Psychosis After Partial Complex Seizures: A Multiple Case Study

Savard, Ghislaine; Andermann, Frédérick; Olivier, André; Rémillard, Guy M.

doi:10.1111/j.1528-1157.1991.tb05249.x

Cited by 155 publications

(123 citation statements)

References 15 publications

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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: 78%

“…Several authors reported the appearance of psychosis when AEDs were reduced during intensive EEG monitoring in preparation for a surgical approach to intractable seizures (56,76). However, postictal psychosis does not constitute a contraindication to surgical treatment of epilepsy (56).…”

Section: Risk Factors For Interictal Psychosismentioning

confidence: 99%

“…Nevertheless the interictal psychoses can be differentiated from functional schizophrenia in terms of phenomenology, course, and outcome. They comprise a heterogeneous group of psychoses (45,55,56) that differ clinically from schizophrenia by the preponderance of purely delusional states, preservation of warm affect and personality, and predominance of visual rather than auditory hallucinations. Less common features include formal thought disorders and negative symptoms, a relatively rare familial schizophrenia or schizoid premorbid personality, and a generally more favourable outcome (31,5237).…”

Section: Clinical Aspectsmentioning

confidence: 99%

“…Possible risk factors for interictal psychosis in epilepsy include onset of epilepsy before age 20 (47), usually around puberty, a duration of epilepsy greater than 10 years, with a latent period between onset of seizures and onset of psychosis of around 14 years, female gender (71,72), left-handedness (7 1,73), relative absence of febrile convulsions (459, history of complex partial seizures (56,63,74), history of clustering of seizures (45,56), temporal lobe seizure focus, especially left-sided (63,65,75) or bilateral (49, histopathologic findings of abnormal tissue (56), such as gangliogliomas occurring at an early developmental stage and focal neuropathologic lesions (74,75), social deterioration, and AED polytherapy, particularly with high doses of AEDs (52,66). Several authors reported the appearance of psychosis when AEDs were reduced during intensive EEG monitoring in preparation for a surgical approach to intractable seizures (56,76).…”

Section: Risk Factors For Interictal Psychosismentioning

confidence: 99%

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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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Section: Temporal Lobe Epilepsy and Psychosesmentioning

confidence: 78%

Section: Risk Factors For Interictal Psychosismentioning

confidence: 99%

Section: Clinical Aspectsmentioning

confidence: 99%

Section: Risk Factors For Interictal Psychosismentioning

confidence: 99%

See 2 more Smart Citations

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

1999

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“…Moreover, it is problematic to identify one particular phenomenon as the reason for psychosis in the presence of a clinical situation involving complex drug interactions, the occurrence of seizures, and the presence of postictal confusional states. It is not uncommon for patients with epilepsy to experience clouded or stuporous states as manifestations of seizures (22)(23)(24)(25) or short-lived psychotic episodes after seizure activity (22,26). Because psychotic disturbances are relatively frequent in this patient population (12), many clinicians are concerned that these individuals may not tolerate AEDs well.…”

Section: Discussionmentioning

confidence: 99%

Occurrence of Psychosis in Patients with Epilepsy Randomized to Tiagabine or Placebo Treatment

et al. 2002

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Summary:Purpose: Patients with drug-resistant epilepsy have a higher incidence of psychiatric problems and possibly greater intolerance to antiepileptic drugs (AEDs) than do other patients with epilepsy. Concern has been raised that ␥-aminobutyric acid (GABA)ergic drugs may be associated with treatment-emergent psychosis. Tiagabine (TGB; Gabitril), a new AED that blocks synaptic GABA uptake, was developed in trials of drug-resistant patients with epilepsy. We conducted ad hoc analyses of adverse events, drug intolerance, and treatment response to evaluate the association between TGB treatment and psychosis and whether psychiatric history might be predictive of tolerance or effectiveness of this GABAergic drug.Methods: Data were analyzed from two multicenter, randomized, double-blind, placebo-controlled trials of add-on TGB therapy (32 or 56 mg daily) in 554 adolescents and adults with complex partial seizures (CPSs). After an 8-or 12-week baseline phase, double-blind treatment consisted of a 4-week titration period (with TGB dose gradually increased to 32 or 56 mg daily) and an 8-or 12-week fixed-dose period. Adverse events commonly associated with psychosis were evaluated. Treatment intolerance and effectiveness (Ն50% reduction in CPS rate) were compared among patients with and without psychiatric histories.Results: Psychotic symptoms (hallucinations) were observed in three (0.8%) of 356 TGB-treated patients and none of 198 placebo-treated patients (p ‫ס‬ 0.556, NS). Statistical analysis showed no interaction between psychiatric history and drug intolerance or treatment outcome.Conclusions: TGB administration appears to carry no significant increased risk of treatment-emergent psychosis. Psychiatric history was not predictive of the tolerance or effectiveness of the drug.

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Postictal Psychiatric Events During Prolonged Video-Electroencephalographic Monitoring Studies

Kanner

Stagno

Kotagal

et al. 1996

Archives of Neurology

201

139

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Postictal Psychosis After Partial Complex Seizures: A Multiple Case Study

Cited by 155 publications

References 15 publications

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

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

Occurrence of Psychosis in Patients with Epilepsy Randomized to Tiagabine or Placebo Treatment

Postictal Psychiatric Events During Prolonged Video-Electroencephalographic Monitoring Studies

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