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Cheval M, Hingray C, Kanemoto K, de Toffol B, Tarrada A. Insights into Postictal Psychosis, from functional imaging and EEG: A systematic review. Seizure 2024; 121:45-55. [PMID: 39074414 DOI: 10.1016/j.seizure.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/27/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
Multiple hypotheses exist about the pathophysiology of Postictal Psychosis (PIP). As the clinical manifestations of PIP are roughly stereotyped, we assumed the existence of a common neurological pathway. This study aimed to determine if a specific brain network sustained the psychotic episode, regardless of the localization of the epileptogenic zone. We conducted a systematic review following the PRISMA guidelines. We included a total of 24 studies providing electrophysiological results(n=22) and metabolic imaging performed during the PIP(n=5). Temporal and frontal lobes seemed frequently involved, without clear evidence for lateralization. The EEG patterns were heterogenous, varying from unchanged to diffuse slowing. Metabolic pattern showed an increased perfusion within temporal and frontal lobes during PIP. These results correspond to the patterns described during postictal state, but they persisted throughout PIP, within regions larger than the epileptogenic zone and resolved with the recovery. PIP symptoms are associated with an excessive persistence of postictal changes within extended frontotemporal networks. A hypothesis could be that PIP results from an abnormally prolonged and diffuse post-ictal dysregulation.
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Affiliation(s)
- Margaux Cheval
- EEG-monitoring Unit, Neurology Department, Hôpital Central, CHU de Nancy, 54000 Nancy, France; Epileptology Unit, Reference Center for Rare Epilepsies, Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.; Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Coraline Hingray
- EEG-monitoring Unit, Neurology Department, Hôpital Central, CHU de Nancy, 54000 Nancy, France; Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, 54000 Laxou, France
| | - Kousuke Kanemoto
- Department of Neuropsychiatry, Aichi Medical University, Nagoya, Japan
| | - Bertrand de Toffol
- UMR 1253, iBrain, Université de Tours, Inserm, France; Neurology and Neurophysiology Unit, Centre Hospitalier de Cayenne, France & CIC INSERM 1424
| | - Alexis Tarrada
- EEG-monitoring Unit, Neurology Department, Hôpital Central, CHU de Nancy, 54000 Nancy, France; Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, 54000 Laxou, France..
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Tarrada A, Hingray C, Aron O, Dupont S, Maillard L, de Toffol B. Postictal psychosis, a cause of secondary affective psychosis: A clinical description study of 77 patients. Epilepsy Behav 2022; 127:108553. [PMID: 35074723 DOI: 10.1016/j.yebeh.2022.108553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/28/2021] [Accepted: 01/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Postictal psychosis (PIP) is a severe complication occurring at least in 2% of patients with epilepsy. Since the 19th century, psychiatrists have reported the specificity of PIP presentation, but descriptions did not clearly distinguish PIP from after-seizure delirium. This study aimed to provide a precise description of psychiatric signs occurring during PIP, and improve recognition of PIP. METHODS We performed a review of clinical descriptions available in literature (48 patients), that we gathered with a retrospective multicentric case series of patients from three French epilepsy units (29 patients). For each patient, we collected retrospectively the psychiatric signs, and epilepsy features. RESULTS We found a high prevalence of persecutory (67.5%) and religious (55.8%) delusions, with almost systematic hallucinations (83.1%) and frequent mood disturbances (76.6%), especially euphoria. Severe consequences were not negligible (other-directed assault in 20.8%, self-directed in 13.0%). The type of delusion was associated with mood symptoms (p = 0.017). Episode onset was mainly sudden/rapid (90.9%), its duration was mostly between one and 14 days (64.9%) and the response to antipsychotic medication was good. Disorder was recurrent in more than a half of the sample (57.1% of patients with at least 2 episodes). CONCLUSION Considering our findings, PIP resembles more an affective psychosis, than a purely psychotic disorder. The presence of affective signs differentiates PIP from other psychotic comorbidities in epilepsy. Additionally, resemblance between PIP and psychotic manic episode might help to discuss links between epilepsy and bipolar disorder.
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Affiliation(s)
- Alexis Tarrada
- Unité de monitoring video-EEG, service de neurologie, explorations fonctionnelles, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Université Paris Descartes, Faculté de Médecine, 75006 Paris, France.
| | - Coraline Hingray
- Unité de monitoring video-EEG, service de neurologie, explorations fonctionnelles, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, 54000 Laxou, France.
| | - Olivier Aron
- Unité de monitoring video-EEG, service de neurologie, explorations fonctionnelles, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
| | - Sophie Dupont
- Unité d'Epileptologieet Unité de réadaptation, Hôpital de la Pitié-Salpêtrière, AP-HP, Centre de recherche de l'Institut du cerveau et de la moelle épinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France; Université Paris Sorbonne, Paris, France; CRHU de Nancy, Département de Neurologie, Nancy, France.
| | - Louis Maillard
- Unité de monitoring video-EEG, service de neurologie, explorations fonctionnelles, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France.
| | - Bertrand de Toffol
- UMR 1253, iBrain, Université de Tours, Inserm, France; Service de Neurologie & Neurophysiologie Clinique, CHU Bretonneau, Tours, France; Service de Neurologie, Centre Hospitalier de Cayenne, France; CIC INSERM, 1424 CH Cayenne, France.
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Pottkämper JCM, Hofmeijer J, van Waarde JA, van Putten MJAM. The postictal state - What do we know? Epilepsia 2020; 61:1045-1061. [PMID: 32396219 PMCID: PMC7317965 DOI: 10.1111/epi.16519] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
This narrative review provides a broad and comprehensive overview of the most important discoveries on the postictal state over the past decades as well as recent developments. After a description and definition of the postictal state, we discuss postictal sypmtoms, their clinical manifestations, and related findings. Moreover, pathophysiological advances are reviewed, followed by current treatment options.
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Affiliation(s)
- Julia C M Pottkämper
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jeannette Hofmeijer
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Michel J A M van Putten
- Clinical Neurophysiology, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
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