• DOI:10.1097/MIB.0000000000001032
• Corpus ID: 50145928

Letters to the Editor.

@article{CohenMekelburg2017LettersTT,
  title={Letters to the Editor.},
  author={Shirley Cohen-Mekelburg and Yecheskel Schneider and Ellen J Scherl and Adam F. Steinlauf},
  journal={Inflammatory bowel diseases},
  year={2017}
}

• S. Cohen-Mekelburg, Yecheskel Schneider, +1 author A. Steinlauf
• Published 2017
• Medicine, Psychology
• Inflammatory bowel diseases

Postictal psychosis related regional cerebral hyperperfusion Postictal psychosis is a known complication of complex partial seizure in particular temporal lobe epilepsy. It usually runs a benign and self limiting course. A postictal phenomenon with focal cerebral hypofunc-tion (similar to Todd's palsy), rather than ongoing seizure activity, has been postulated. 1 2 Surface EEG is either normal or showing non-specific slow waves. 3 Hence, antipsychotic medications are prescribed instead of antiepileptic drugs. Until recently, the pathogenic mechanisms have remained unknown. In this communication, we report on two patients with postictal psychosis, during which a cerebral SPECT study showed a hyperperfusion signal over the right temporal lobe and contralateral basal ganglion. As hyperperfusion in ictal cerebral SPECT is closely linked to epileptic activities, 4 our findings support a contrary explanation for postictal psychosis. Prolonged video-EEG telemetry study was performed in patients who underwent presur-gical evaluation for epilepsy surgery. Antiepi-leptic drugs were withdrawn to facilitate seizure recording. A diagnosis of temporal lobe epilepsy was based on analysis of the electroclinical events and, if applicable, post-operative outcome after anterior temporal lobectomy. Psychosis was diagnosed according to the fourth edition of the diagnostics and statistical manual of mental disorders (DSM-IV) criteria of brief psychotic disorders without marked stressor. HMPAO-SPECT was performed during the psychotic period, which ranged from 2–4 days after the last seizure. Interictal cerebral SPECT, brain MRI, and a Wada test were performed as part of presurgical evaluation. Patient 1 was a 34 year old Chinese woman with complex partial seizures since the age of 18. Her seizure control was suboptimal on a combination of antiepileptic drugs. Brain MRI showed a small hippocampus on the right. Interictal EEG showed bilateral temporal sharp waves and ictal recordings confirmed a right temporal epileptogenic focus. A Wada test confirmed right hippocampal memory dysfunction. Six hours after her last secondary generalised tonic-clonic seizure after video-EEG telemetry, she began to develop emotional lability, talking nonsense, motor restlessness, and auditory hallucination. A cerebral SPECT study was performed at day 4 after her last seizure. Her psychotic features persisted although she was taking antipsychotic medication (pimozide). Cer-ebral SPECT showed a clear hyperperfusion signal over the right lateral temporal neocor-tex and contralateral basal ganglion. An interictal cerebral SPECT study was repeated at 4 weeks after postictal psychosis which showed a complete resolution of hyperper-fusion signal in the right temporal lobe and basal ganglia. Anterior temporal lobectomy was performed and she became …