ADVANCED NEWS: Psychosis as a manifestation of frontal lobe epilepsy

[brain]

Psychosis as a manifestation of frontal lobe epilepsy

1: Epilepsy Behav. 2007 Nov 1; (Epub ahead of print)

ABSTRACT

Luat AF, Asano E, Rothermel R, Sood S, Chugani HT.
Children’s Hospital of Michigan–Detroit Medical Center/Wayne State University, Detroit, MI, USA.

A 7-year-old girl presented with a cluster of seizures occurring in one day and followed by the development of paranoid delusions. Her electroencephalogram (EEG) revealed a psychomotor variant. Cranial MRI was normal, but the 2-deoxy-2-[(18 )F]fluoro-D-glucose (FDG) positron emission tomography (PET) scan showed hypometabolism in the left inferior frontal cortex. Her psychotic symptoms occurred episodically. Three years later, she developed hypermotor seizures associated with a fearful look. Video/EEG monitoring captured seizures of left frontotemporal onset. Her seizures became drug resistant and she underwent epilepsy surgery. Intracranial electrocorticography captured spontaneous and electrically induced seizures with onset in the left inferior frontal region, which was resected. She became seizure-free and her psychosis resolved. This case illustrates that frontal lobe epilepsy can present solely with psychotic symptoms, which may delay the diagnosis of epilepsy. We suggest that these cases may be underdiagnosed. When epilepsy is suspected and if MRI fails to demonstrate an abnormality, FDG PET scanning and video/EEG monitoring should be considered.

PMID: 17981091 [PubMed - as supplied by publisher]

[RobinN]

and yet there is this information...
Posted by Zoe here:
Psych symp. in Adults and Metabolism disorders

Inborn errors of metabolism (IEMs) may present in adolescence or adulthood as a psychiatric disorder. In some instances, an IEM is suspected because of informative family history or because psychiatric symptoms form part of a more diffuse clinical picture with systemic, cognitive or motor neurological signs. However, in some cases, psychiatric signs may be apparently isolated. We propose a schematic classification of IEMs into three groups according to the type of psychiatric signs at onset. Group 1 represents emergencies, in which disorders can present with acute and recurrent attacks of confusion, sometimes misdiagnosed as acute psychosis. Diseases in this group include urea cycle defects, homocysteine remethylation defects and porphyrias. Group 2 includes diseases with chronic psychiatric symptoms arising in adolescence or adulthood. Catatonia, visual hallucinations, and aggravation with treatments are often observed. This group includes homocystinurias, Wilson disease, adrenoleukodystrophy and some lysosomal disorders. Group 3 is characterized by mild mental retardation and late-onset behavioural or personality changes. This includes homocystinurias, cerebrotendinous xanthomatosis, nonketotic hyperglycinaemia, monoamine oxidase A deficiency, succinic semialdehyde dehydrogenase deficiency, creatine transporter deficiency, and α and β mannosidosis. Because specific treatments should be more effective at the ‘psychiatric stage’ before the occurrence of irreversible neurological lesions, clinicians should be aware of atypical psychiatric symptoms or subtle organic signs that are suggestive of an IEM. Here we present an overview of IEMs potentially revealed by psychiatric problems in adolescence or adulthood and provide a diagnostic strategy to guide metabolic investigations.

http://www.springerlink.com/content/y357258681167734/

[brain]

Yes Robin, Zoe posted it, but
read the DATE of the publication.
Big difference.

This is the newer and latest findings!

[RobinN]

I am sorry I really don't see your point.
There are so few studies on how imbalances of metabolism can cause behavioural changes, and yet many that just want to point the finger at psychological not being related to just that. I see it differently.
The date here really doesn't matter IMO

[Bernard]

Looks like it's a bit of a chicken and egg question...

[RobinN]

I agree Bernard, but where do the funds come for doing all of the surgeries and the advanced technology procedures. The funds are just not there for the nutritional side of the coin. So that flip never comes up very often.

[speber]

What gets me is "can't it be both have something to do with psychosis given the right circumstances?"...I'm seeing good arguments on both sides here. Very complex that squishy matter up there. I think nutrition can be the solution...but you have to know specifically what the physical defect is too, right? Otherwise it's a shotgun approach to treatment...even if it is something other than pharmaceuticals.

[RobinN]

I guess I just see it differently than others

A 7-year-old girl presented with a cluster of seizures occurring in one day and followed by the development of paranoid delusions

So what... she was fine for seven years and then wham?

I can't ask them questions as to what was tested and tried during the interim. It just seems to me they are far too excited to cut, implant, and drug before other functions that were designed to work in a miraculous way are even considered.

[brain]

Here's other Articles in relation in varying years
with conclusive findings:

Epilepsia Postictal Psychosis in Temporal Lobe Epilepsy

Purpose: Postictal psychosis is a well-known complication, occurring especially in patients with temporal lobe epilepsy. It usually runs a benign course. The literature on this topic is sparse, and the underlying pathogenic mechanisms are not known.

Methods: We report five patients with temporal lobe epilepsy in whom postictal psychosis developed during the course of video-EEG monitoring; they were studied with hexamethyl-propyleneamine-oxime single-photon emission computed tomography (HMPAO-SPECT) during and after the psychotic event.

Results: In comparison to the interictal state, all SPECT scans obtained during postictal psychosis were remarkable for bifrontal and bitemporal hyperperfusion patterns. Some studies also demonstrated unilateral left lateral frontal hyperperfusion. These cortical blood-flow patterns appeared to be distinct from those obtained during complex partial seizures.

Conclusions: Our data suggest that postictal psychoses in patients with temporal lobe epilepsy are associated with hyperactivation of both temporal and frontal lobe structures. This hyperperfusion may reflect ongoing (subcortical) discharges, active inhibitory mechanisms that terminate the seizure, or simply a dysregulation of cerebral blood flow.

[brain]

From Neurology INDIA:

A study of epilepsy-related psychosis

ABSTRACT

The association of epilepsy and psychosis is studied. Among the 500 patients of epilepsy evaluated, there were 12 patients, 8 males and 4 females with epilepsy-related psychosis. Their average age was 38 years. The interval between the age of onset of epilepsy and psychotic features was 9 years. Complex partial seizures were present in 7 patients and primary generalized tonic-clonic seizure was present in 1 patient. Four patients had post-ictal psychosis, 7 had acute interictal psychosis and 1 patient had chronic psychosis. The inter-ictal and chronic psychoses were schizophreniform whereas the post-ictal psychoses were not. EEG showed a temporal focus in 7 patients with complex partial seizures and an extra-temporal focus was identified in 4 out of the other 5 patients. Imaging (CT scan/MRI) revealed abnormalities in 10 patients. This study attempts to define the characteristics of psychoses occurring in epileptics.

[brain]

Temporal Lobe Epilepsy

Frontal lobe epilepsy: Frontal lobe complex partial seizures have certain distinctive .....

depression and psychosis (1-2%), and depersonalization ...

This page is fully loaded with information and is
constantly updated and revised. So it would not
be surprising if a month or two from now it's
been updated or revised with more new findings.

[brain]

Psychiatric Consequences of Epilepsy



NOTE: This website contains the ENTIRE
breakdown of the whole episode, you are
encouraged to visit it as it is extremely
detailed to the maximum core.

Epilepsy is a common neurological disorder having a prevalence of around 1%. It is estimated that between 30-50% of epileptics have significant psychiatric difficulties. The incidence of psychosis and mood disorders is high in this population and personality disturbance is also more common than in the general population. Epileptics are at greater risk of developing schizophrenia particularly those with temporal lobe epilepsy. Personality disturbance is also more common in the group with focal temporal lobe seizures. Aggressiveness of an explosive nature is characteristic and libido is often reduced. Impulsiveness, moodiness and suspiciousness have been described but these findings are open to criticism.

Psychiatric complications of epilepsy (you may wish to review the classification of epilepsy at this point) will be divided into :


1. Peri-ictal
1. Precipitation of seizures
2. Prodrome
3. Auras
4. Ictal
5. Post-ictal
2. Inter-ictal
1. Schizophreniform psychosis
2. Affective psychosis
3. Non Epileptic Attack Disorder (previously pseudoseizures)
4. Cognitive impairment
5. Personality

[Bernard]

Looks like the research brain is sharing is related to post-ictal psychosis. This isn't really related to the study Robin posted unless it can be shown that the underlying FLE/temporal lobe epilepsy is caused by IEM (which may be the case in for some and not for others).

[Zoe]

Yes Robin, Zoe posted it, but
read the DATE of the publication.
Big difference.

This is the newer and latest findings!

If new is better consider this:
At one time frontal lobotomies were the vogue. Would "new" ice picks make them better and more effective?

The date is not relevant here, the information is what matters. In kindling, the conventional model of seizure development, an irritation to the brain, repeated often and enough times will cause an area of the brain to become hypersensitive. Eventually, it can be damaged, becoming the focus of a seizure disorder, the site of the brain where seizures originate. If a person has developed seizures as a result of celiac disease, surgery might initially give some temporary relief of the seizures. However, surgery will not cure celiac disease or prevent formation of new seizure foci from the disorder.

What about humane treatment, which might even include identifying the underlying cause of the seiizure disorder prior to doing surgery? I don't see you posting on this. What of the parent who decides to buck the system and not have a child lobotomized when advised to do so? Would you reccomend a parent lose the right to refuse having a child forcefully lobotomized "for the good of humanity"?
Like capital punishment, lobotomies are banned in much of the world because the practice is viewed as barbaric, a crime against humanity. Before you got on the band wagon, did you read the article through, think about it, put it in context? Are you really enthusiastic about encouraging someone to undergo a surgery and risk impairment to very critical brain functions, like decision making, when that person might benefit from a non-surgical treatment? Pyschiatric diagnoses have historically been used to promote racism, silence polictical activists, and define others as "defectives" like those of us who have seizure disorders to justify labeling them and subjecting them to forced "treatment."
In the United States people with seizure disorders could be forcefully sterilized up until about 1986. One of the fathers of modern neurology, Lennox, went to his grave sincerely believing that forced sterilizing of people with epilepsy and migraines would be for "the good of humanity." Advocating frontal lobotomies for seizures is like welcoming the not yet distant dark ages for epilepsy treatment.