Association with temporal lobe epilepsy

Table 9.5. Epilepsy classification

Postictal

Interictal

No psychotic

psychosis

psychosis

episode

(n = 45a)

(n = 126°)

(n = 2728)

Idiopathic localization-related epilepsy

42

Symptomatic localization-related epilepsy

Temporal lobe epilepsyb

39

74

422

Extra-temporal lobe epilepsy

10

35

857

Idiopathic generalized epilepsy

5

308

Symptomatic/cryptogenic generalized epilepsy

7

369

Others

2

11

a Six patients with both postictal and interictal psychoses were excluded. b Chi-square = 5.14, statistically significant difference (p<0.05).

Table 9.6. Laterality and localization of the laboratory findings

Postictal psychosis (n = 45)

Interictal psychosis (n = 126)

EEG findings

Temporal foci

33

78

Extra-temporal foci

8

15

Sidedness (L/R)

11/18

43/41

Diffuse SWC

1

21b

MRI localization

Temporala

16

25b

Extra-temporal"

4

14

Sidedness (L/R)

12/9

" Patients with both temporal and extra-temporal pathology were excluded. b Statistically significant difference (P<0.05). SWC, spike and wave complex.

Table 9.7. Seizures in patients with postictal or interictal psychoses

Postictal psychosis (n = 45)

Interictal psychosis ( n = 126)

SPS

25

79

CPS

37

84a

GTC

36

97

Minor GS

0

a Statistically significant difference (P<0.05).

SPS, simple partial seizures; CPS, complex partial seizures; GTC, generalized tonic-clonic seizures; minor GS, minor generalized seizures including absence, generalized myoclonic seizure and generalized tonic seizure.

Notes:

a Statistically significant difference (P<0.05).

SPS, simple partial seizures; CPS, complex partial seizures; GTC, generalized tonic-clonic seizures; minor GS, minor generalized seizures including absence, generalized myoclonic seizure and generalized tonic seizure.

Table 9.8. Simple partial seizures in localization-related epilepsy

Postictal psychosis ( n = 43)

Interictal psychosis ( n = 103)

Autonomic

16

40

Déjà vu

10

10a

Motor

4

15

Elementary visual

0

a Statistically significant difference (P<0.05).

Note:

a Statistically significant difference (P<0.05).

In a previous study based on MRI results (Kanemoto et al., 1996 b), we suggested that medial temporal lesions with additional neocortical involvement were especially closely linked with postictal psychosis. We have also stressed the close association of postictal psychosis with psychic auras, such as déjà vu and ictal fear (Kanemoto et al., 1996). In the present study as well, we confirmed a statistically significant predominance of déjà vu (Table 9.8). Considering the results of a cortical stimulation study conducted by Gloor et al. (1982), which demonstrated involvement of the lateral as well as medial temporal structure in the genesis of déjà vu, this predominance of déjà vu aura agrees with the finding obtained from our MRI study. Although Savard et al. (1991) suggested that the high incidence of ictal fear in patients with postictal psychic aura was proof of the similarity between postictal and interictal psychoses, the current study contradicts this, demonstrating that such psychic auras were a salient feature of patients with postictal but not interictal psychosis. Furthermore, several authors have pointed out that bilateral interictal epileptiform discharges predisposed patients to develop postictal psychosis (Savard et al., 1991; Umbricht et al., 1995).

Table 9.9. Psychopathologie! findings (Modified SAPS)a

Postictal psychosis (n = 45)

Interictal psychosis ( n = 126)

Delusion of perception

0

37

Delusions of reference

3

113

Persecutory delusions

5

111

Verbal hallucinations

3

82

Visual hallucination

9

2

Grandiose delusions

12

1

Religious delusions

10

3

Pressure of speech

22

1

Illusion of familiarity

13

1

Mental diplopia

8

a Only features that demonstrated significant difference (P<0.005) are listed. SAPS, Scale for the Assessment of Positive Symptoms (Andreason, 1984).

Notes:

a Only features that demonstrated significant difference (P<0.005) are listed. SAPS, Scale for the Assessment of Positive Symptoms (Andreason, 1984).

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