Abstracts

Rationale: Psychosis of epilepsy (POE) is a term applied to a group of psychotic disorders which are believed to be closely associated with patients with refractory epilepsy. Studies have suggested that the emergence or recurrence of some forms of POE may be closely linked to seizure exacerbation. However, many epilepsy centers tend to avoid submitting patients with refractory epilepsy and POE to prolonged video-electroencephalographic (VEEG) monitoring, excluding these patients of the chance of a complete evaluation of their epilepsy. The purpose of this study was to analyze safety and adverse events (AEs) during VEEG monitoring and the surgical outcome of patients with refractory epilepsy and a previous history of POE.Methods: We retrospectively reviewed the medical records of 19 patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) and previous psychiatric diagnosis of POE who were admitted for diagnostic scalp VEEG monitoring (14 women, mean age 39 years, range 28-65, 8 postictal and 11 interictal psychosis) within a 9-year period. AEs were examined and their risk factors were analyzed. Seizure number and types as well as timing and presence of seizure-related adverse outcomes were noted. The Engel scale and the Epilepsy Surgery Inventory (ESI-55) of patients who underwent epilepsy surgery were analyzed.Results: Three patients (15.8%) experienced AEs: two had postictal psychosis (PIP) and one had psychogenic nonepileptic seizures. All patients with AEs had more than 100 seizures during life. The two patients with PIP had a previous history of postictal psychosis. Age of epilepsy onset, duration of epilepsy, lateralized EEG or MRI asymmetries were not related with AEs. The mean length of stay was five days and was not affected by occurrence of AEs. In the first two years of follow-up in the eight patients (42.1%) who underwent epilepsy surgery, seven (87.5%) became free of disabling seizures (Engel Class I) and one (12.5%) had rare disabling seizures (Engel Class II). All patients with PIP had a complete remission of psychotic symptoms. Quality of life (QOL) improved in all but one patient. Conclusions: Prolonged VEEG monitoring is a safe procedure in patients with POE. AEs occurred but did not result in substantial morbidity or increased length of hospitalization, and such evaluation allowed the possibility of surgical intervention. Surgical outcome revealed improvement in psychotic symptoms and QOL.