Prevalence and clinical characteristics of postictal psychiatric symptoms in partial epilepsy

Objectives: To identify the prevalence and clinical characteristics of postictal psychiatric ( PPS) and cognitive (PCS) symptoms in patients with refractory partial epilepsy and to investigate whether interictal psychiatric and cognitive symptoms worsened in severity during the postictal period. Methods: Using a 42-item questionnaire, the authors determined the prevalence and clinical characteristics of PPS and PCS that occurred after > 50% of seizures in 100 of 114 consecutive patients with refractory partial epilepsy during a 3-month period. The postictal period was defined as the 72 hours that followed a seizure. The prevalence of all interictal psychiatric and cognitive symptoms was identified and the frequency with which they worsened postictally determined. Results: A mean of 2.8 +/- 1.8 PCS ( median = 3) and 5.9 +/- 5.3 PPS ( median = 5) was identified, which included postictal symptoms of depression (PSD) in 43 patients, anxiety (PSA) in 45, postictal psychotic symptoms ( PIP) in 7, hypomanic symptoms in 22, neurovegetative symptoms in 52, and fatigue in 37. Most patients experienced more than one type of PPS. Independently of the occurrence of PPS, 38 patients reported a worsening of interictal psychiatric and cognitive symptoms postictally. A history of depression and anxiety significantly increased the number of PSD, PSA, and PIP. Conclusions: Postictal psychiatric symptoms are common among patients with refractory partial epilepsy, and the severity of interictal psychiatric and cognitive symptoms commonly worsens during the postictal period.