Psychosis
Ictal Psychoses - include non-convulsive status:
- Prolonged automatisms
- Confusion
- Episodic hallucinations
- Mood changes
- Paroxysmal EEG changes
- Clearly episodic, rarely >1 hour
Post-ictal Psychoses- Fugues:
- Wandering
- Altered behaviour
- Amnesia
- ?“dissociative”
- EEG usually “normal”
Twilight states:
- Abnormal subjective experience (cognitive and affective)
- Perseveration
- Subtle cognitive impairments
- Paranoid hallucinatory experiences
- May be associated with deep EEG changes or with “forced normalization”
Chronic Inter-ictal Psychoses:
- 3% risk - especially if left temporal lobe
Chronic paranoid hallucinatory:
- “Schizophreniform”
- Onset 10-15 years after epilepsy
- Less Family history
- Pre-morbid personality
- Warmer affect
- Less personality deterioration
Affective disorder and Epilepsy
Ictal emotion:
- Fear, also depression,
- Rarely elation
- Can be prodromal, partial status, post ictal
- Lack precipitant
- Sudden onset and ending
- Have a primitive, unvarying quality
Inter-ictal depression and anxiety:
- 15-45% prevalence
- Major Affective Disorder 11% (cf 4.9% gen pop)
- 62% lifetime prevalence (cf 17% gen pop)
- High anxiety and hostility scores
- Risk after surgery: 2yrs=10%(successful or not)
- Multi-factorial causation (biological, personal, family and societal factors)
- Treatment: attend to these factors:
SSRIs, can use ECT
A range of interactions, mostly “academic”
Personality and Epilepsy
A long and misleading history of prejudice
- Possibly a "Temporal lobe personality syndrome”
- Bear and Fedio 1977 :
- Humourless sobriety
- Circumstantiality
- Viscosity
- Religiosity
- Emotionality (Rt)
- Hypergraphia (Rt)
- Ruminative intellectual (Lt)
- However, “current data do not support or refute any consistent clustering of behavioural traits in epilepsy” Devinsky 1996
- But may show extremes and diversity.
Aggression and Epilepsy
- Aggression - ictal, possibly ictal, not ictal
- Ictal: usually part of confusion, poor handling etc
- Very rare as part of an automatism
- Poorly directed, fragmentary, simple, brief,
- Repetitive, lack of concealment, remorse after
- Possibly ictal: ? “Episodic Dyscontrol”
- Not ictal: statistical relationship between epilepsy and
- Violence for various epidemiological reasons.