Postictal psychosis in temporal lobe epilepsy.
OBJECTIVE
Postictal psychosis is a well-known complication, occurring especially in patients with temporal lobe epilepsy. It usually runs a benign course. The literature on this topic is sparse, and the underlying pathogenic mechanisms are not known.


METHODS
We report five patients with temporal lobe epilepsy in whom postictal psychosis developed during the course of video-EEG monitoring; they were studied with hexamethyl-propyleneamine-oxime single-photon emission computed tomography (HMPAO-SPECT) during and after the psychotic event.


RESULTS
In comparison to the interictal state, all SPECT scans obtained during postictal psychosis were remarkable for bifrontal and bitemporal hyperperfusion patterns. Some studies also demonstrated unilateral left lateral frontal hyperperfusion. These cortical blood-flow patterns appeared to be distinct from those obtained during complex partial seizures.


CONCLUSIONS
Our data suggest that postictal psychoses in patients with temporal lobe epilepsy are associated with hyperactivation of both temporal and frontal lobe structures. This hyperperfusion may reflect ongoing (subcortical) discharges, active inhibitory mechanisms that terminate the seizure, or simply a dysregulation of cerebral blood flow.
Leutmezer
Fritz
F
Universitätskliniken für Neurologie, Vienna, Austria.
Podreka
Ivo
I
Asenbaum
Susanne
S
Pietrzyk
Uwe
U
Lucht
Helmut
H
Back
Claude
C
Benda
Norbert
N
Baumgartner
Christoph
C
D000328:Adult; D004292:Dominance, Cerebral / Q000502:physiology; D004569:Electroencephalography; D017029:Epilepsy, Complex Partial / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply / Q000000981:diagnostic imaging; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008991:Monitoring, Physiologic; D019965:Neurocognitive Disorders / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012307:Risk Factors; D019690:Technetium Tc 99m Exametazime; D013702:Temporal Lobe / Q000098:blood supply / Q000000981:diagnostic imaging; D015899:Tomography, Emission-Computed, Single-Photon; D014741:Video Recording
D019690:Technetium Tc 99m Exametazime