Itsuo Kawai

Postictal Psychosis: A Comparison with Acute Interictal and Chronic Psychoses

Summary: We studied 30 patients with postictal psychosis and compared them with 33 patients with acute interictal psychosis and 25 patients with chronic psychosis. All patients had either complex partial seizures (CPS) or EEG temporal epileptogenic foci. Patients with postictal psychosis had a high incidence of psychic auras and nocturnal secondarily generalized seizures. The most striking feature that distinguished postictal psychosis from both acute interictal and chronic psychoses was phenomenological: the relatively frequent occurrence of grandiose delusions as well as religious delusions in the setting of markedly elevated moods and feeling of mystic fusion of the body with the universe. In addition, postictal psychosis exhibited few schizophreniform psychotic traits such as perceptual delusions or voices commenting. Reminiscence, mental diplopia, and a feeling of impending death were also fairly frequent complaints of patients with postictal psychosis. Interictal acute psychosis and chronic epileptic psychosis were psychopathologically similar. Although acute interictal and chronic epileptic psychoses could simulate schizophrenia, postictal psychosis results in a mental state quite different from that of schizophrenic psychosis.

Characteristics of temporal lobe epilepsy with mesial temporal sclerosis, with special reference to psychotic episodes

This study investigates the histories and the clinical course of 111 patients who had nonlesional temporal lobe epilepsy.We compared 61 patients with unilateral hippocampal sclerosis (UHS group) and 50 patients with minimal change (MRI negative group) assessed on the basis of MRI. In agreement with previous reports, we confirmed statistically that patients in the UHS group strongly tended to have had febrile convulsive status during early childhood or infancy and that habitual seizures tended to begin at a younger age than the other subset of nonlesional temporal lobe epilepsy. Strikingly, episodes of psychoses, especially postictal psychoses, occurred significantly more often in the UHS group than in the MRI negative group. Additional involvement of temporal neocortex further augmented this association. We stress the role of mesial temporal pathology, and its linkage to the temporal neocortex, in the genesis of postictal psychoses. NEUROLOGY 1996;47: 1199-1203

Characteristics and treatment of temporal lobe epilepsy with a history of complicated febrile convulsion

This study aimed to examine the close correlation between complicated febrile convulsions (CFC) and medial temporal lobe epilepsy and to delineate characteristics of temporal lobe epilepsy with CFC. Patients with temporal lobe epilepsy were divided into those with a prior episode of CFC (n=52), those with febrile convulsions other than CFC, and those witout either (n=345). Clinical constellations, neuroimaging, drug resistance, and effects of temporal lobectomy of the three groups were compared. A close association between CFC and temporal lobe epilepsy was confirmed. The salient features of temporal lobe epilepsy with CFC were early age at onset of habitual seizures (about 10 years), the predominance of autonomic auras, and a high incidence of MRI evidence of unilateral medial temporal sclerosis. Patients with temporal lobe epilepsy with prior CFC had an excellent outcome after surgery, by contrast with an unfavourable response to drug therapy. The surgical results were discouraging in patients with temporal lobe epilepsy without history of any febrile convulsions and without solid brain tumours. These results indicate surgical intervention as the choice of therapy in a substantial number of patients with temporal lobe epilepsy with a history of CFC.

Visual Cognitive Disturbance During Spike-Wave Discharges

Summary: Cognitive functions of patients showing slow spike‐wave discharge in EEG without obvious absence seizures were investigated using tachistoscopic stimuli triggered by spike‐waves. Response times obtained during spike‐waves and during non‐spike‐waves were compared for three tests (tapping, simple reaction, and morphological discrimination). We present one case of Len‐nox‐Gastaut syndrome in which the test results could be statistically confirmed. The tapping test was interrupted by the occurrence of spike‐waves. Response times during spike‐waves were more delayed than during non‐spike‐waves in both the simple reaction tests and morphological discrimination tests. The differences in response times measured during spike‐waves and during non‐spike‐waves were significantly greater in the morphological discrimination test than in the simple reaction test. The positive correlation between the length of spike‐waves and response time in the discrimination test was significantly more pronounced than in the reaction test. These results were also confirmed in two other patients with Lennox‐Gastaut syndrome. We conclude that spike‐wave discharges may impair cognitive processing more intrinsically than motor functions.

Oculoclonic Status Epilepticus

Summary: Continuous oculoclonic status epilepticus occurred for 90 min in a 4‐year‐old girl. The seizure consisted of continuous contralateral horizontal nystagmus concurrent with left occipital spike discharges, occasional vomiting and no loss of consciousness. Oculoclonic status epilepticus may be a variant form of versive status epilepticus.

Postictal Psychoses: In Comparison with Acute Interictal Psychoses

The association between epilepsy and psychosis has attracted considerable attention since the 19th century. While modern research has made great efforts to elucidate the nature of the chronic and acute interictal psycho, observations on postictal psychotic states have been largely ignored. Such authors as Levin et Logsdail et a1.6 and Savard et al.7 are exceptions. They pointed out that postictal psychoses occurred after a lucid interval; postictal psychoses could not be explained simply as a sequel to the impaired consciousness precipitated by the preceding seizures. The present study aims to clarify the salient features of postictal psychoses by comparing postictal and interictal (or alternative) psychoses. sis2 4 8 9

Treatment of childhood epilepsy with rectal valproate: Case reports and pharmacokinetic study

Two children with status epilepticus were treated successfully by the rectal administration of valproate (VPA), and complete seizure control was obtained in one patient without severe side effects. In addition, there was no essential difference in pharmacokinetics between rectal and oral administration of VPA as determined by computerized simulation of plasma concentration data of VPA after rectal administration in two healthy adults or an epileptic child. Although these findings suggest that the early absorption of VPA within 30 minutes of rectal administration is slightly more rapid than that of oral administration, rectal VPA seems to be unsuitable for the first choice in the treatment of status epilepticus, since it has not so immediate effects as intravenous administration of DZP.

Ictal body scheme disturbance induced by looking through a small opening.

Summary: The case of a patient is reported in which seizures consisting of a feeling that the left arm was absent were induced by looking through a small opening (e.g. camera view finder). The EEG showed right parietal sharp wave discharges between and during such seizures. This observation is interpreted as an example of a reflex epilepsy triggered by the specific stimulus of looking through a small opening, and involving the right parietal lobe.

The lateralizing value of scalp ictal eeg patterns in temporal lobe epilepsy with unilateral hippocampal atrophy with special attention to the initial slow waves

We investigated the ictal scalp electroencephalogram (EEG) in 81 seizures of 25 patients with magnetic resonance imaging (MRI) evidence of unilateral hippocampal atrophy. All patients had proven temporal lobe epilepsy because they became seizure free or had only auras after temporal lobectomy with a minimum follow-up of 1 year. We studied the initial 10 seconds of the ictal discharge as an epoch. In addition to the commonly encountered recruiting theta rhythm (i.e., increase pattern), we found another dominant ictal pattern at onset (PAO), a decrease pattern. Decrease pattern, characterized by gradually diminishing high voltage slow waves, was the most frequently encountered PAO (44%) and, when lateralized, was as accurate as rhythmic theta waves in correlating with the side of surgery (97% decrease pattern and 98% rhythmic theta waves). Lateralized postictal EEG abnormalities were very unreliable in lateralization. Invasive EEG monitoring is not necessary for some patients with temporal lobe epilepsy (TLE) and unilateral hippocampal atrophy even if they show initial slow waves in the ictal EEG pattern.

Effects of Playtherapy on Hyperkinetic Children with Psychomotor Epilepsy

The hyperkinetic or restless behavior disorders improved remarkably in five of 11 cases. These five cases, involving the subjects who are now over 15 years of age, did not have any symptom for five years after psychotherapy. The other four cases became less hyperkinetic and their school adjustments were moderately above average. But they are slightly asthenic or occasionally violent to their families. The symptoms of the two cases were unchanged and the psychotherapy was stopped.