Abstracts

Rationale: The neuropsychiatric syndrome of post-ictal psychosis (PIP) requires prompt diagnosis and management. However, this condition remains little studied with mostly case reports and small sample series comprising the state of knowledge. This study describes the phenomenology of PIP and then compares epilepsy-related factors in patients who experienced an episode of PIP with those that have no such history (EPI). Methods: This was a retrospective chart review project with data collected from patients seen on the inpatient service at the Minnesota Epilepsy Group, P.A. Two groups (PIP: n = 8; EPI: n = 8) were identified and matched for age, gender, and education. They were then compared on a number of epilepsy-related variables including duration of epilepsy, full scale IQ, AEDs, history of epilepsy surgery, and past psychiatric history. Also reported are psychiatric, imaging, seizure type, and EEG characteristics for the PIP group. Results: The most prominent symptoms of psychosis were hallucinations (88%), delusions (75%), agitation (63%), and paranoia (50%). 75% developed the PIP following a cluster of seizures. The interval from seizure onset to first symptoms of PIP was on average 43 hours. 86% of the PIP group had a structural abnormality on MRI with 57% exhibiting mesial temporal sclerosis (1 R, 1 L, 2 Bilat). On video-EEG, left temporal (43%) and bi-temporal (43%) lobe seizure onset was most frequently observed in the PIP group. Complex-partial seizures with and without secondary generalization was seen in 100% of the PIP group. Between group analyses revealed statistically significant differences for duration of epilepsy (27.25 vs. 13.75 years, p = .009), number of AEDs (2.88 vs. 1.50, p = .004), and prior surgery (50% vs. 0%, p = .021). Prior surgeries for the PIP group included 2 LTL, 1 RTL, and 1 LF topectomy. The two groups were comparable with respect to general intelligence (FSIQ = 90 vs. 98), prior psychiatric history (38% each) and use of specific AEDs.Conclusions: These findings characterize a sample of persons with epilepsy who developed an episode of PIP. Risk factors appear to be longer duration of epilepsy, greater number of AEDs, and prior epilepsy surgery. Specific AED use, general cognitive ability, and past psychiatric history did not appear to be associated with the development of PIP. This project will provide the impetus for a longitudinal study on PIP with the aim of empirically identifying predictors and management strategies for this unique condition.