Postictal psychosis in temporal lobe epilepsy

Epilepsia. 2003 Apr;44(4):582-90. doi: 10.1046/j.1528-1157.2003.32802.x.


Purpose: Postictal psychosis is a well-known complication, occurring especially in patients with temporal lobe epilepsy. It usually runs a benign course. The literature on this topic is sparse, and the underlying pathogenic mechanisms are not known.

Methods: We report five patients with temporal lobe epilepsy in whom postictal psychosis developed during the course of video-EEG monitoring; they were studied with hexamethyl-propyleneamine-oxime single-photon emission computed tomography (HMPAO-SPECT) during and after the psychotic event.

Results: In comparison to the interictal state, all SPECT scans obtained during postictal psychosis were remarkable for bifrontal and bitemporal hyperperfusion patterns. Some studies also demonstrated unilateral left lateral frontal hyperperfusion. These cortical blood-flow patterns appeared to be distinct from those obtained during complex partial seizures.

Conclusions: Our data suggest that postictal psychoses in patients with temporal lobe epilepsy are associated with hyperactivation of both temporal and frontal lobe structures. This hyperperfusion may reflect ongoing (subcortical) discharges, active inhibitory mechanisms that terminate the seizure, or simply a dysregulation of cerebral blood flow.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Dominance, Cerebral / physiology
  • Electroencephalography
  • Epilepsy, Complex Partial / diagnostic imaging*
  • Epilepsy, Complex Partial / physiopathology
  • Epilepsy, Temporal Lobe / diagnostic imaging*
  • Epilepsy, Temporal Lobe / physiopathology
  • Female
  • Frontal Lobe / blood supply
  • Frontal Lobe / diagnostic imaging
  • Humans
  • Hyperemia / diagnostic imaging
  • Hyperemia / physiopathology
  • Male
  • Monitoring, Physiologic
  • Neurocognitive Disorders / diagnostic imaging*
  • Neurocognitive Disorders / physiopathology
  • Risk Factors
  • Technetium Tc 99m Exametazime
  • Temporal Lobe / blood supply
  • Temporal Lobe / diagnostic imaging
  • Tomography, Emission-Computed, Single-Photon*
  • Video Recording


  • Technetium Tc 99m Exametazime