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Prevalence and clinical characteristics of postictal psychiatric symptoms in partial epilepsy

From the Division of Epilepsy and Clinical Neurophysiology and Rush Epilepsy Center, Department of Neurological Sciences, Rush Medical College, Rush University Medical Center, Chicago, IL.

Address correspondence and reprint requests to Dr. A.M. Kanner, Department of Neurological Sciences, Rush University Medical Center, 1653 W. Congress Pkwy., Chicago, IL 60612; e-mail: Andres_M_Kanner{at}rush.edu

Objectives: To identify the prevalence and clinical characteristics of postictal psychiatric (PPS) and cognitive (PCS) symptoms in patients with refractory partial epilepsy and to investigate whether interictal psychiatric and cognitive symptoms worsened in severity during the postictal period.

Methods: Using a 42-item questionnaire, the authors determined the prevalence and clinical characteristics of PPS and PCS that occurred after >50% of seizures in 100 of 114 consecutive patients with refractory partial epilepsy during a 3-month period. The postictal period was defined as the 72 hours that followed a seizure. The prevalence of all interictal psychiatric and cognitive symptoms was identified and the frequency with which they worsened postictally determined.

Results: A mean of 2.8 ± 1.8 PCS (median = 3) and 5.9 ± 5.3 PPS (median = 5) was identified, which included postictal symptoms of depression (PSD) in 43 patients, anxiety (PSA) in 45, postictal psychotic symptoms (PIP) in 7, hypomanic symptoms in 22, neurovegetative symptoms in 52, and fatigue in 37. Most patients experienced more than one type of PPS. Independently of the occurrence of PPS, 38 patients reported a worsening of interictal psychiatric and cognitive symptoms postictally. A history of depression and anxiety significantly increased the number of PSD, PSA, and PIP.

Conclusions: Postictal psychiatric symptoms are common among patients with refractory partial epilepsy, and the severity of interictal psychiatric and cognitive symptoms commonly worsens during the postictal period.

Received May 30, 2003. Accepted in final form October 28, 2003.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the March 9 issue to find the title link for this article.

See also page 683

Presented at the 52nd annual meeting of the American Academy of Neurology, May 2000, San Diego, CA, and the 55th annual meeting of the American Academy of Neurology, April 2003, Honolulu, Hawaii.

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