Abstracts

Psychosis in epilepsy is more commonly postictal and less often ictal or related to treatment. However de novo psychosis upon administration of antiepileptic medications is not uncommon. De novo psychosis on rapid withdrawal of antiepileptic medications in patients with epilepsy in the seizure monitoring unit (SMU) has not been reported. The purpose of this article is to investigate a possible link between withdrawal of carbamazepine and the onset of psychotic symptoms., We describe the clinical course of two patients in whom rapid or abrupt withdrawal of carbamazepine was followed by new onset of psychotic symptoms. We analysed patient specific factors such as history, age, gender, date/time since last seizure and length of use of carbamazepine as well as the rate of withdrawal and related these to the onset of symptoms. The symptoms displayed included aggression, disorientation, delusions/hallucinations and violent behaviour. Neither patient had a previous psychiatric history. One patient has frontal lobe epilepsy with nocturnal complex partial seizures. This patient was admitted to the SMU unit for further localization of seizure foci using invasive subdural and depth electrode monitoring. During the admission carbamazepine was withdrawn rapidly over 4 days from 1200mg/day to zero. The second patient has temporal lobe epilepsy with complex partial seizures and has had previous left temporal lobectomy. This patient abruptly stopped taking carbamazepine on her own and was admitted to the SMU immediately following onset of psychosis. There were also 2 previous admissions for psychosis on abrupt withdrawal of carbamazepine., Carbamazepine was withdrawn rapidly in 1 patient and abruptly in the 2^nd patient. Both patients became aggressive, disoriented and delusional and did not return to baseline behaviour for several days. At onset of psychosis neither of the patients was on any other anti epileptic medications. No clinical or subclinical seizures were recorded before, during or after the psychosis on video EEG telemetry. MRI scans were normal., We believe that these cases indicate a possible link between withdrawal of carbamazepine and new onset of psychotic symptoms. Carbamazepine withdrawal followed by de novo psychosis in epilepsy patients has not been reported. These cases indicate a need for extra caution when withdrawing carbamazepine rapidly in the seizure monitoring unit or for other reasons.,