Left temporal rhythmic electrical activity: a correlate for psychosis? A case report.
It is well recognized that epileptic patients are at higher risk for acute or chronic psychotic states than non-epileptic subjects. Here we present intracranial depth electrode recordings during a psychotic episode in a 20-year-old woman who was referred for presurgical evaluation. Unrelated to her seizures, she presented acoustic hallucinations and delusions and became agitated for a duration of 18-24 hours. During this period, a new unusual pattern of sharp slow waves was seen semi-rhythmically every 2-3 sec from left anterior neocortical temporal areas. Her condition responded well to a treatment with Haloperidol, but not with Benzodiazepines. Ictal and interictal scalp- and depth-EEG recordings outside the psychotic episode as well as MRI-based volumetry, PET, SPECT and neuropsychological testing gave evidence of bilateral temporal and frontal dysfunction. This case report suggests that psychosis in epileptic patients may be based on a bilateral cerebral dysfunction linked together in a pathological network, but with a focal (here: left temporal) driving mechanism.
Seeck
M
M
Department of Neurology, University Hospital of Geneva, Switzerland. margitta.seeck@hcuge.ch
Alberque
C
C
Spinelli
L
L
Michel
C M
CM
Jallon
P
P
de Tribolet
N
N
Landis
T
T
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D004351:Drug Resistance; D004569:Electroencephalography; D004827:Epilepsy / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D011618:Psychotic Disorders / Q000503:physiopathology*; D013702:Temporal Lobe / Q000503:physiopathology*
D000927:Anticonvulsants