Postictal psychosis in temporal lobe epilepsy: a case–control study

Background and purpose To investigate the prevalence of postictal psychosis ( PP ) in patients with temporal lobe epilepsy ( TLE ) and to estimate the predictive value of various variables for the development of PP . Methods By retrospectively reviewing the charts of all patients evaluated with video‐electroencephalogram ( EEG )‐monitoring at our unit between J anuary 1995 and F ebruary 2012, we identified 684 patients with TLE , of which 48 patients had a history of PP . Patients with TLE and PP were compared with 200 controls (patients with TLE without a psychotic history) on demographic, clinical, EEG and magnetic resonance imaging ( MRI ) variables. Results The prevalence of PP in our TLE sample was 7.0%. Aggressive behaviour during PP was present in 22.9% of the sample. Univariate analysis revealed that PP was significantly associated with early age at epilepsy onset ( P = 0.007), longer duration of epilepsy ( P = 0.002), presence of ictal fear ( P = 0.005), impaired intellectual function ( P = 0.045), and bilateral ictal and interictal epileptiform activity (both P < 0.0001). Using logistic regression analysis, ictal fear [odds ratio ( OR ) 2.88; P = 0.015] and bilateral interictal EEG activity ( OR 6.40; P < 0.0001) were predictive of PP development. No association of PP with MRI pathology or epilepsy‐relevant aetiological factors was found. Conclusions PP is a frequent and potentially dangerous complication within the course of TLE . Bilateral or widespread functional central nervous system disturbances rather than distinct structural brain alterations or certain predisposing aetiologies of epilepsy appear to be a risk factor for the development of PP . Ictal fear may be a predictive clinical variable of PP in TLE .