title: Postictal psychosis in temporal lobe epilepsy: risk factors and postsurgical outcome?
abstract: OBJECTIVE
  Postictal psychosis (PIP) occurs in ∼7% of patients with temporal lobe epilepsy (TLE). The aims of this study were to identify risk factors that may predispose patients to developing PIP and determine whether the severity of PIP predicts postsurgical outcome.
  
  
  METHODS
  We compared 20 patients with a history of TLE+PIP to 60 age-matched TLE patients without any psychiatric history (TLE-only), with respect to pre-surgical clinical and neuropsychological variables. Group differences in postsurgical psychiatric, histopathological, cognitive and seizure outcomes were also examined.
  
  
  RESULTS
  TLE+PIP patients were significantly less likely to have localised ictal epileptiform activity than the TLE controls (p=0.05) and were significantly more likely to have a positive family psychiatric history than TLE controls (p=0.04). Other pre-surgical clinical and neuropsychological variables did not distinguish between the groups. Patients with two or more PIP episodes had significantly increased odds of developing de novo psychopathology within 4 years of surgery, after controlling for comorbid pre-surgical psychiatric status and a history of SGTCS (OR: 9.11, 95% CI: 1.53-54.10, p=0.02). A history of PIP did not significantly predict other postsurgical outcomes (seizure freedom (ILAE=1) or cognitive outcome).
  
  
  CONCLUSIONS
  Our results suggest that more widespread or diffuse brain abnormalities as reflected by pre-surgical EEG findings and positive genetic determinants may contribute to the development of PIP. Furthermore, patients with recurrent PIP episodes who undergo TLE surgery are at increased risk of developing de novo psychiatric disorders, particularly mood disorders. This has implications for pre-operative counselling and highlights a need for postsurgical psychiatric monitoring for these patients.
authors: Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK. r.cleary@ucl.ac.uk
authors: Rebecca A
authors: RA
authors: Cleary
authors: Pamela J
authors: PJ
authors: Thompson
authors: Maria
authors: M
authors: Thom
authors: Jacqueline
authors: J
authors: Foong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000150:complications* / Q000523:psychology* / Q000601:surgery; D056344:Executive Function; D005260:Female; D006801:Humans; D007361:Intelligence Tests; D007858:Learning / Q000502:physiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000502:physiology; D008569:Memory Disorders / Q000209:etiology / Q000523:psychology; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D011618:Psychotic Disorders / Q000209:etiology* / Q000523:psychology*; D012307:Risk Factors; D012640:Seizures / Q000150:complications* / Q000523:psychology* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Epilepsy surgery; Neuropsychiatry; Neuropsychology; Seizures; Temporal lobe epilepsy