Postictal mania versus postictal psychosis: differences in clinical features, epileptogenic zone, and brain functional changes during postictal period.
OBJECTIVE
To clarify the differences between postictal mania (PIM) and postictal psychosis (PIP).


METHODS
Five patients with PIM were compared to 17 patients with PIP, with respect to clinical, epileptological, electrophysiological, and neuroimaging features. PIM was distinguished from PIP by the symptoms observed in the postictal period based on the ICD-10 criteria.


RESULTS
Postictal manic episodes lasted for a longer period than postictal psychotic episodes. Patients with PIM had more recurrent postictal episodes than patients with PIP. The age at onset of epilepsy in patients with PIM was older than that in patients with PIP. PIM was associated with frontal lobe and temporal lobe epilepsies, whereas PIP was associated with temporal lobe epilepsy. The estimated epileptogenic zone was on the language dominant side in PIM, whereas there was no predominant hemispheric laterality in PIP. Electroencephalography (EEG) performed during the early period of postictal manic and psychotic episodes showed decreased frequency of interictal epileptiform discharges in both PIM and PIP. Single-photon emission computed tomography (SPECT) during postictal manic and psychotic episodes showed increased perfusion in the temporal and/or frontal lobes in both PIM and PIP. Three patients with PIM showed increased perfusion during postictal episodes on bilateral or the language nondominant side, which were contralateral to the estimated epileptogenic zone, whereas three patients with PIP showed increased perfusion on the areas, which were ipsilateral to the estimated epileptogenic zone.


CONCLUSIONS
PIM has a distinct position among the mental disorders observed in the postictal period.
Nishida
Takuji
T
National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan. tnishida-jes@umin.ac.jp
Kudo
Tatsuya
T
Inoue
Yushi
Y
Nakamura
Fumihiro
F
Yoshimura
Masaki
M
Matsuda
Kazumi
K
Yagi
Kazuichi
K
Fujiwara
Tateki
T
D017668:Age of Onset; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology*; D015897:Comorbidity; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000706:statistics & numerical data; D004827:Epilepsy / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D038801:International Classification of Diseases / Q000706:statistics & numerical data; D007802:Language; D008279:Magnetic Resonance Imaging; D015225:Magnetoencephalography; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D012008:Recurrence; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data; D014888:Wechsler Scales