Recognition of the Various Expressions of Anxiety, Psychosis, and Aggression in Epilepsy


  • Andres M. Kanner

    1. Department of Neurological Sciences, Rush Medical College, Rush Epilepsy Center at Rush University Medical Center, Chicago, Illinois, U.S.A.
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Address correspondence and reprint requests to Dr. A. M. Kanner at Rush Epilepsy Center, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, U.S.A. E-mail:


Summary:  Anxiety, psychosis, and aggressive behavior are among the frequent comorbid psychiatric disorders identified in patients with epilepsy. Often the clinical manifestations of these disorders vary according to their temporal relation relative to seizure occurrence. Thus, postictal symptoms of anxiety or psychosis differ in severity, duration, and response to treatment with interictal symptomatology. Psychiatric symptomatology in epilepsy can appear concurrently with the seizure disorder and improve or remit on the abolition of epileptic activity. We refer to these as paraictal psychiatric phenomena. Such is the case of aggressive disturbances associated with gelastic seizures caused by hypothalamic hamartomas. In this article, three case studies are presented to illustrate the importance of distinguishing psychiatric symptoms of anxiety, psychosis, and aggression, with respect to their temporal relation with seizure occurrence.