Postictal Psychosis in Temporal Lobe Epilepsy
Article first published online: 10 APR 2003
Volume 44, Issue 4, pages 582–590, April 2003
How to Cite
Leutmezer, F., Podreka, I., Asenbaum, S., Pietrzyk, U., Lucht, H., Back, C., Benda, N. and Baumgartner, C. (2003), Postictal Psychosis in Temporal Lobe Epilepsy. Epilepsia, 44: 582–590. doi: 10.1046/j.1528-1157.2003.32802.x
- Issue published online: 10 APR 2003
- Article first published online: 10 APR 2003
- Accepted October 20, 2002.
- Temporal lobe epilepsy–Postictal psychosis–SPECT–Presurgical epilepsy evaluation
Summary: 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.