...Ictal psychotic episodes can be the clinical expression of nonconvulsive recurrent seizure activity known as
status epilepticus of simple partial, complex partial, or absence seizures. In the case of simple partial status, the diagnosis may often be difficult because scalp recordings may not detect any changes in ictal EEG patterns.
Postictal psychotic symptoms were reported by 7 out of 100 consecutive patients with intractable partial epilepsy in one study. These symptoms were also associated with symptoms of depression, anxiety, and disturbances in sleep and appetite. The duration of these symptoms ranged from 2 to 24 hours.
Psychotic symptoms may cluster and form postictal psychotic episodes, which may occur in 6% to 10% of patients with intractable epilepsy. More often than not, the presence of postictal psychotic episodes is suggestive of more than one seizure focus. Postictal psychotic episodes may last from several hours to several weeks. They usually remit with low doses of antipsychotic medication.
Typically, episodes of postictal psychosis occur in patients who have had epilepsy for at least 10 to 15 years. The episodes tend to follow the occurrence of clusters of generalized tonic-clonic seizures and may appear after a symptom-free lag-time of 12 to 120 hours. Usually, the first symptom is insomnia. If these episodes tend to recur after a cluster of seizures in a particular patient, family members are taught to identify the insomnia and administer antipsychotic medication at low doses, which may abort the psychotic episode. Given the episodic nature of these symptoms and rapid remission after low doses of antipsychotic medication, patients with postictal psychosis should not be prescribed continuous antipsychotic medication.
Recent studies have shown that some patients who experience recurrent postictal psychotic episodes can go on to develop interictal psychotic disorders. In those patients, long-term therapy with antipsychotic drugs may be necessary.
Among the most frequent symptoms of postictal psychosis are:
- thought blocking (a sudden interruption in thought) and overt thought disorder, manifested by an inability to express thoughts in a coherent manner
- illusions and formed and unformed hallucinations in different modalities (visual, auditory, olfactory, etc.)
- paranoid, religious, and grandiose delusions
- acute confusion
