Abstracts

Epileptic patients have an increased risk of psychiatric comorbidity causing considerable burden and impact on quality of life. Prevalence of psychotic disorders in epilepsy is between 2-9%. Psychosis is more often classified according to the chronologic relation between the psychotic episode and the preceding seizure, i.e., ictal, postictal or interictal psychosis.
The aim of this study is to characterize the clinical features and to evaluate the prevalence of psychotic disorders in our epileptic population. Clinical records of 370 epileptic patients evaluated in our section between 2002 and 2004 were review. Patients who presented psychotic disorders were included for analysis. Patients MRI, EEG recordings, demographic and clinical data were analyzed. Patients with: psychosis antedating epilepsy, history of substance abuse, other neurological disorder or symptoms related to AEDs, were excluded. Twenty-six patients (7%) experienced psychosis. The mean age was 36 years old (SD:11.02)
- Ictal Psychosis: Three patients (11.53%). All had localization related epilepsy with complex partial seizures (CPS). Psychosis and EEG discharges stopped with AEDs.The mean time of epilepsy diagnosis was 2.3 years (SD: 00.57)
- Postictal psychosis: Seven patients (26.92%), 6 patients post status epilepticus and one post cluster of seizures. The mean interval between epilepsy and psychosis onset was 22.28 years (SD: 11.98). Five patients suffered CPS secondary to remote symptomatic epilepsy. Two patients had generalized seizures and idiophatic epilepsy. In all cases symptoms ceased within 7 days.
- Interictal psychosis: Twenty patients (76.92%). The mean interval between onset of epilepsy and psychosis was 21 years (SD: 11.02). Most patients had remote symptomatic CPS. Seventeen patients showed focal interictally epileptiform discharges on EEG. Prevalence of psychotic disorders in our study are in accordance with previous studies. Our data also support that psychosis might be associated with CPS and remote symptomatic epilepsy.
Interictal and postictal psychosis appears to be related to longstanding epilepsy.
Adequate treatment of psychotic disorders is as important as seizure control for epilepsy management.
Detecting and treating psychiatric comorbidities is required to help patients to achieve their maximal functional state and improve their quality of life.
References
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