Postictal psychosis related regional cerebral hyperperfusion

Postictal behavioural impairments are due to a severe prolonged hypoperfusion/hypoxia event that is COX-2 dependent

“…Prior to this report the direction of postictal hemodynamic changes was unclear since conflicting reports indicated either postictal hypoperfusion (Rowe et al, 1991; Newton et al, 1992; Leonhardt et al, 2005) or hyperperfusion (Fong et al, 2000; Tatlidil, 2000; Hassan et al, 2012). This discordance is most likely explained by the variable timing of the single postictal scans.…”

“…It is well established that there is a dramatic, transient increase in blood flow during seizures (Gibbs et al, 1934; Penfield et al, 1939) with a corresponding decrease in oxygenation that quickly recovers (Bahar et al, 2006; Suh et al, 2006). The few studies that investigated changes in blood flow during the postictal period have not yielded consistent observations with reports of local hypoperfusion (Rowe et al, 1991; Newton et al, 1992; Leonhardt et al, 2005) and hyperperfusion (Fong et al, 2000; Tatlidil, 2000; Hassan et al, 2012). These inconsistencies were likely due to the variable time-points after the seizure when blood flow was measured.…”

Post‐ictal psychosis in a patient with a history of nocturnal epilepsy

“…However, in a study carried out by Fong et al, lateral temporal hyperperfusion was observed upon SPECT imaging, which is inconsistent with Todd's paralysis phenomenon, which would predict the presence of hypoperfusion. 20 Another possible Table 1. Recommended pharmacotherapy for post-ictal psychosis explanation for post-ictal psychosis is high extracellular potassium levels post-seizure with a subsequent depression in neuronal activity.…”

“…This demonstration of increased cerebral blood flow is consistent with the findings of Fong et al who showed a marked increase in cerebral blood flow over the right temporal and left basal ganglia in two patients with post-ictal psychosis. 20 The presence of hyperperfusion may be related to the psychosis. However, the difficulty in incorporating this finding into an established underlying neurobiological mechanism is the fact that seizures may separate cerebral perfusion from metabolic activity by altering cerebrovascular auto regulation.…”

Postictal psychosis related regional cerebral hyperfusion

“…I wish to comment on the postictal psychosis related regional cerebral hyperperfusion reported by Fong et al 1. Based on the their findings of hyperperfusion on SPECT within the time frame of postictal psychosis, the authors argue against the hypothesis that postictal psychosis is a psychic manifestation of a Todd's phenomenon.…”