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Postictal Mania versus Postictal Psychosis: Differences in Clinical Features, Epileptogenic Zone, and Brain Functional Changes during Postictal Period
Author(s) -
Nishida Takuji,
Kudo Tatsuya,
Inoue Yushi,
Nakamura Fumihiro,
Yoshimura Masaki,
Matsuda Kazumi,
Yagi Kazuichi,
Fujiwara Tateki
Publication year - 2006
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1167.2006.00893.x
Subject(s) - mania , psychosis , psychology , epilepsy , psychiatry , neuroscience , bipolar disorder , mood
Summary: Purpose: To clarify the differences between postictal mania (PIM) and postictal psychosis (PIP). Methods: Five patients with PIM were compared to 17 patients with PIP, with respect to clinical, epileptological, electrophysiological, and neuroimaging features. PIM was distinguished from PIP by the symptoms observed in the postictal period based on the ICD‐10 criteria. Results: Postictal manic episodes lasted for a longer period than postictal psychotic episodes. Patients with PIM had more recurrent postictal episodes than patients with PIP. The age at onset of epilepsy in patients with PIM was older than that in patients with PIP. PIM was associated with frontal lobe and temporal lobe epilepsies, whereas PIP was associated with temporal lobe epilepsy. The estimated epileptogenic zone was on the language dominant side in PIM, whereas there was no predominant hemispheric laterality in PIP. Electroencephalography (EEG) performed during the early period of postictal manic and psychotic episodes showed decreased frequency of interictal epileptiform discharges in both PIM and PIP. Single‐photon emission computed tomography (SPECT) during postictal manic and psychotic episodes showed increased perfusion in the temporal and/or frontal lobes in both PIM and PIP. Three patients with PIM showed increased perfusion during postictal episodes on bilateral or the language nondominant side, which were contralateral to the estimated epileptogenic zone, whereas three patients with PIP showed increased perfusion on the areas, which were ipsilateral to the estimated epileptogenic zone. Conclusions: PIM has a distinct position among the mental disorders observed in the postictal period.