Abstract Details

Title Postictal Psychosis and Postictal Delirium: A Report of Five Cases

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) Epilepsy/Clinical Neurophysiology (EEG) Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 047

Objective

Our study aims to increase the knowledge about clinical features in postictal psychosis.

Background Psychiatric comorbidities are commonly seen in patients with epilepsy. Around 6% of the epilepsy population may suffer postictal psychosis (PP) or postictal delirium (PD). Differences between those terms remain unclear. Therefore, appropriate identification, medical assessment and treatment are not standardized.

Design/Methods We identified epilepsy patients who developed PP and PD, during their admissions in our Epilepsy Monitoring Unit, from 2015 to 2020. PP was defined as: i) event within 7 days since their last seizure; ii) duration >15 hours and <2 months; iii) identified by delusions, hallucinations without loss of consciousness and/or disorganized behavior; iv) lucid interval of 2.5-72 hours. PD was defined by dramatic behavior or affective changes within minutes after a seizure. We then proceed to identify clinical differences between these two groups.

Results Five males with temporal epilepsy met the inclusion criteria. The median age was 26.6 years (IQR=24.5-31.3). Mean epilepsy onset was 3.5 years of age (IQR=1.4-14) before either episode started. Three patients (60%) had bitemporal epilepsy; one (20%) had right temporal epilepsy and one (20%) had left temporal epilepsy. Three (60%) patients developed PP, as they had a lucid interval with a median of 720 minutes (IQR=5-2340). Two patients (40%) developed PD, one of them after a prolonged seizure (12 minutes). The median time duration for PP was 24 hours (IQR=13-37). Status epilepticus preceded psychosis in two patients (40%) and three (60%) had epileptic activity in cluster. Persecutory delusions were presented in the three cases of PP. Three patients (60%) underwent surgical resection and psychosis persisted in relation to recurrent seizures.

Conclusions Post ictal psychosis and delirium seems to be related with frequent (clusters and status) or long term ictal activity. Temporal lobe epilepsy appears to be related with psychosis, compared to other focal epilepsies.

Authors/Disclosures
PRESENTER	No disclosure on file
Richard McLachlan, MD	No disclosure on file
Jorge G. Burneo, MD, MSPH, F�鶹��ýӳ�� (University of Western Ontario)	Dr. Burneo has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier, Clinical Neurology and Neurosurgery Journal. Dr. Burneo has received research support from The Jack Cowin Endowed Chair in Epilepsy Research. Dr. Burneo has received publishing royalties from a publication relating to health care. Dr. Burneo has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Jazz Pharmaceuticals.
Ana Suller Marti, MD (University Hospital London Ontario)	Dr. Suller Marti has nothing to disclose.

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