Postictal psychosis and its electrophysiological correlates in invasive EEG: A case report study and literature review

We identified two patients with medically refractory temporal lobe epilepsy, from whom intracranial EEG recordings were obtained at the time of postictal psychosis. Both patients had mesial temporal epilepsy associated with hippocampal sclerosis. In both patients, the postictal psychosis was associated with a continual “epileptiform” EEG pattern that differed from their interictal and ictal EEG findings (rhythmical slow wave and “abortive” spike-slow wave complex activity in the right hippocampus and lateral temporal cortex in case 1 and a periodic pattern of triphasic waves in the contacts recording activity from the left anterior cingulate gyrus). Some cases of postictal psychosis might be caused by the transient impairment of several limbic system structures due to the “continual epileptiform discharge” in some brain regions. Case 2 is the first report of a patient with TLE in whom psychotic symptoms were associated with the epileptiform impairment of the anterior cingulate gyrus.

► We present two patients with postictal psychosis during invasive EEG.
► Both patients had mesial temporal lobe epilepsy.
► Psychotic symptoms were associated with a continual epileptiform EEG pattern.
► In one case, the epileptiform impairment of the anterior cingulate was present.