title: Schizophrenia Associated with Epileptiform Discharges without Seizures Successfully Treated with Levetiracetam.
abstract: BACKGROUND
  Schizophrenia-like disorders can be divided into endogenic or primary, idiopathic, polygenetic forms, and different secondary, organic subgroups [e.g., (para)epileptic, immunological, degenerative]. Epileptic and paraepileptic explanatory approaches have a long tradition due to the high rate of electroencephalography (EEG) alterations in patients with schizophrenia.
  
  
  METHODS
  We present the case of a 23-year-old female patient suffering, since the age of 14 years, from a fluctuating paranoid-hallucinatory syndrome with formal thought disorder, fear, delusions of persecution, auditory, visual, and tactile hallucinations, as well as negative and cognitive symptoms. Laboratory measurements showed increased titers of antinuclear antibodies (ANAs) in the context of ulcerative colitis. While there was no clear history or evidence of epileptic seizures, the EEG showed generalized 3 Hz polyspike wave complexes. Under treatment with levetiracetam, the symptoms disappeared and the patient was able to complete vocational training.
  
  
  CONCLUSIONS
  The schizophrenia-like symptoms associated with epileptiform discharges but not overt seizures and the good response to antiepileptic treatment could be interpreted in the context of a (para)epileptic pathomechanism. The EEG alterations might be due to a polygenetic effect due to different genes. Mild immunological mechanisms in the framework of ulcerative colitis and increased ANA titers might have supported the network instability. This case report illustrates (1) the importance of EEG screenings in schizophrenia, (2) a potential pathogenetic role of epileptiform discharges in a subgroup of patients with schizophrenia-like symptoms, and (3) that antiepileptic medication with levetiracetam could be a successful treatment alternative in schizophrenia-like disorders with EEG alterations.
authors.affiliation: Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg , Freiburg , Germany.
authors.forename: Dominique
authors.initials: D
authors.lastname: Endres
authors.affiliation: Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg , Freiburg , Germany.
authors.forename: Evgeniy
authors.initials: E
authors.lastname: Perlov
authors.affiliation: Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg , Freiburg , Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Feige
authors.affiliation: Freiburg Epilepsy Center, Department of Neurosurgery, Faculty of Medicine, University of Freiburg , Freiburg , Germany.
authors.forename: Dirk-Matthias
authors.initials: DM
authors.lastname: Altenmüller
authors.affiliation: Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg , Freiburg , Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Venhoff
authors.affiliation: Section for Experimental Neuropsychiatry, Department of Psychiatry, Faculty of Medicine, University of Freiburg , Freiburg , Germany.
authors.forename: Ludger
authors.initials: L
authors.lastname: Tebartz van Elst
keywords: LANI hypothesis; epilepsy; epileptiform discharges; levetiracetam; paraepileptic; schizophrenia