Ictal (and Postictal) Psychiatric Disorders
Both ictal and postictal disorders are characterised by symptoms that are temporally related to the epileptic seizure. The acute disruption of cerebral activity that occurs with the seizure discharge can result in transient alterations of consciousness, as well as specific behavioural syndromes. There is a possible link between ictal behavioural symptoms and temporal lobe epilepsy, as seizure-induced alterations of the contents of consciousness are the classic expression of ‘epileptic auras’ of temporal lobe seizures. The epileptic aura is a subjective ictal phenomenon caused by focal epileptic discharges that may precede the observable clinical features of a seizure. Ictal behavioural symptoms are a common presentation of experiential auras, encompassing perceptual, cognitive, dysmnesic, and affective phenomena. Ictal psychotic symptoms often take the form of perceptual abnormalities, with structured hallucinations and illusions involving all sensory systems. Postictal behavioural symptoms characteristically present after a symptom-free period (‘lucid interval’) ranging from several hours to up to 7 days after an epileptic seizure. Both ictal and postictal behavioural symptoms should initially be treated by optimising antiepileptic therapy. Complete remission of seizure-related behavioural symptoms can only be achieved with full remission of the underlying epilepsy.
KeywordsConsciousness Epilepsy Epileptic aura Psychosis Temporal lobe
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