2008 Volume 25 Issue 4 Pages 441-449
We report a patient with right temporal lobe epilepsy in whom two kinds of seizure-related psychotic episodes developed. A 36-year-old right-handed woman suffered several complex partial seizures per week that were preceded by auras consisting of fear and deja vu. Despite treatments with various antiepileptic drugs (AEDs), seizures remained intractable. At age 34 years, the AEDs discontinued for a presurgical examination, the habitual seizures increase, and the patient experienced two psychotic episodes within 1 month (Episode I and Episode II). Episode I consisted of abnormal auditory and visual perception and continuous fear with ictal discharge and was diagnosed as aggravated psychiatric aura including 'aura continua'. Episode II consisted of abnormal perception of time and fear and anxiety following a lucid interval. It was diagnosed as postictal psychosis. Although there were definite differences between the two conditions with respect to the clinical course and electroencephalographic findings, we found some common symptoms such as abnormal perception originating in the temporal-occipital region, fear and anxiety, and a dreamy state. These findings suggest that the symptoms of the psychiatric aura and postictal psychosis originated in a shared brain region.
