[Epilepsy-related psychoses]

Abstract

Background: Epilepsy-related psychoses lie in the border zone between neurology and psychiatry. The aim of this article is to give a brief overview of current knowledge of these psychoses, and to offer recommendations for their treatment.

Method: The article is based on a discretionary selection of articles found through a search in PubMed, as well as the authors' own experience with this patient group.

Results: Epilepsy-related psychoses may occur during, after or between seizures. In addition, psychoses may occur as a side-effect of antiepileptic drugs, and as so-called alternative psychosis. The latter may arise in patients who, with the aid of treatment (medication or surgery), have become completely seizure-free. Ictal psychoses and the majority of postictal psychoses are often of such short duration that treatment with antipsychotics is not appropriate. In these cases, optimizing antiepileptic treatment is the best prophylaxis. Treatment with antipsychotics may, however, be indicated for interictal psychoses and for some patients with especially long-lasting or recurrent postictal psychoses.

Interpretation: Different types of epilepsy-related psychosis require different types of treatment, and some are treated with antipychotics. In those circumstances, we recommend the use of medication that is less likely to lower the seizure threshold, for example risperidone.