Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
Neurologia. 2013 Mar;28(2):81-7. doi: 10.1016/j.nrl.2012.03.005. Epub 2012 Jun 14.
Epileptic psychoses are categorised as peri-ictal and interictal according to their relationship with the occurrence of seizures. There is a close temporal relationship between peri-ictal psychosis and seizures, and psychosis may present before (preictal), during (ictal) or after seizures (postictal). Epileptic psychoses usually have acute initial and final phases, with a short symptom duration and complete remission with a risk of recurrence. There is no temporal relationship between interictal or chronic psychosis and epileptic seizures. Another type of epileptic psychosis is related to the response to epilepsy treatment: epileptic psychosis caused by the phenomenon of forced normalisation (alternative psychosis), which includes epileptic psychosis secondary to epilepsy surgery. Although combination treatment with antiepileptic and neuroleptic drugs is now widely used to manage this condition, there are no standard treatment guidelines for epileptic psychosis.
We present 5 cases of peri-ictal epileptic psychosis in which we observed an excellent response to treatment with levetiracetam. Good control was achieved over both seizures and psychotic episodes. Levetiracetam was used in association with neuroleptic drugs with no adverse effects, and our patients did not require high doses of the latter.
Categorising psychotic states associated with epilepsy according to their temporal relationship with seizures is clinically and prognostically useful because it provides important information regarding disease treatment and progression. The treatment of peri-ictal or acute mental disorders is based on epileptic seizure control, while the treatment of interictal or chronic disorders has more in common with managing disorders which are purely psychiatric in origin. In addition to improving the patient's quality of life and reducing disability, achieving strict control over seizures may also prevent the development of interictal psychosis. For this reason, we believe that establishing a treatment protocol for such cases is necessary.
根据与癫痫发作的关系，癫痫性精神病可分为发作期和发作间期。发作期精神病与癫痫发作密切相关，精神症状可能在发作前（发作前）、发作时（发作期）或发作后（发作后）出现。癫痫性精神病通常具有急性初始和终末阶段，症状持续时间短，有复发风险，可完全缓解。发作间期或慢性精神病与癫痫发作之间无时间关系。另一种癫痫性精神病与癫痫治疗反应有关：由强制性正常化现象引起的癫痫性精神病（交替性精神病），包括癫痫手术后引起的癫痫性精神病。虽然目前广泛使用抗癫痫药物和神经阻滞剂联合治疗来控制这种情况，但对于癫痫性精神病尚无标准的治疗指南。
我们报告了 5 例发作期癫痫性精神病患者，观察到左乙拉西坦治疗有良好的反应。抗癫痫药物和神经阻滞剂联合治疗不仅控制了癫痫发作，也控制了精神病发作。在治疗过程中没有观察到不良反应，且患者无需使用高剂量的神经阻滞剂。
根据与癫痫发作的时间关系对与癫痫相关的精神状态进行分类在临床和预后上均具有重要意义，因为它提供了关于疾病治疗和进展的重要信息。发作期或急性精神障碍的治疗主要基于控制癫痫发作，而发作间期或慢性障碍的治疗与管理纯粹起源于精神的障碍更为相似。除了提高患者的生活质量和减少残疾外，严格控制癫痫发作还可能预防发作间期精神病的发生。因此，我们认为有必要为这种情况制定治疗方案。
