Download psychosis in patients with epileptic focus in the eeg. case studies

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PSYCHOSIS IN PATIENTS WITH EPILEPTIC FOCUS IN THE EEG.
CASE STUDIES
Teresa Korwin-Piotrowska, Karolina Korwin-Piotrowska
Department of Neurology PAM
1 Unii Lubelskiej Str., 71-252 Szczecin
Department of Psychiatry PAM
26 Broniewskiego Str., 71-460 Szczecin
Summary
Introduction. Researchers have been discussing the associations between epileptic seizures and
psychotic disorders for many years. It is now an indisputable fact that acute or, less frequently,
chronic psychosis may emerge during the development of the epileptic focus.
Objective. The aim of this study is to discuss the diagnostic difficulties in patients with epileptic
focus progressing with psychotic features alone, without seizures. The study is based on four cases.
Discussion. Four patients with psychosis and epileptic focus without epileptic seizures are presented. All patients are men, aged: 18, 19,19 and 43. The clinical picture of two patients was dominated
by positive psychotic symptoms (delusions and hallucinations). The two remaining patients had
negative symptoms (isolation, social withdrawal, loss of life goal). Their psychic disturbances did
not show paroxysmal features and the course of their disorder was chronic. All patients were diagnosed with schizophrenia. Since they all failed to improve in response to neuroleptic treatment, they
were diagnosed as having drug-resistant schizophrenia. EEG which was performed in all these
cases within a few years of the diagnosis revealed paroxysmal abnormalities. Taking this fact into
consideration, anticonvulsant medication was introduced. After this treatment, the patients' condition improved significantly: three patients were able to continue their education. It is noteworthy that
all the patients in our study were males whereas in the other reported studies, schizophrenia-like
psychoses are more common in women. The most probable explanation of the development of such
psychosis is that this disorder is directly related to the development of the epileptic focus which is a
dynamic process. This diagnosis of schizophrenia-like psychosis in patients with epileptic focus in
the EEG can be confirmed by the efficacy of anticonvulsant treatment and normalisation of EEG.
Key words: Psychotic disorder – Epileptic focus – Kindling
Recived February 17, 2004
SUMMARY
Epileptologia 2004, 12: 267-277