123I-IMP SPECT brain imaging in epileptic psychosis: a study of two cases of temporal lobe epilepsy with schizophrenia-like syndrome

Abstract

To examine the relationship between functional abnormality of the brain and the development of epileptic psychosis, regional cerebral blood flow (rCBF) patterns with single photon emission computed tomography (SPECT) using N-isopropyl-(iodine-123)-p-iodoamphetamine (123I-IMP) were serially examined in interictal stages with and without the psychotic state in 2 medicated patients with temporal lobe epilepsy with schizophrenia-like syndrome. Both patients had epileptic EEG foci in the left temporal lobe and schizophrenia-like syndrome in Bruens' classification of epileptic psychosis, mainly consisting of auditory hallucinations and delusions of persecution and reference accompanying the enhancement of interictal epileptic discharges. In both patients, the SPECT scans obtained in the stages without the psychotic state revealed focal hypoperfusion images in the left temporal lobe regionally consistent with the EEG foci. On the other hand, the SPECT scans in the stages with the psychotic states revealed focal hyperperfusion images in the left temporal lobe or amygdala in case 1, and a normal perfusion pattern without asymmetric images of the right and left temporal lobes in case 2. These results suggest that temporo-limbic dysfunction, in particular hyperfunction in the temporo-limbic system in the left dominant hemisphere, arises at the time of the psychotic state in epileptic psychosis.