Ictal and peri-ictal psychopathology

Patients with epilepsy may experience psychiatric symptoms preceding the seizure (pre-ictal), following the seizure (post-ictal), independently of seizure occurrence (interictal), or as an expression of the seizure (ictal). Compared to interictal, peri-ictal psychiatric symptoms are less investigated and recognized. However, they contribute substantially to disability and distress among people with epilepsy. The relationship between interictal and peri-ictal symptoms is still largely unknown but it seems that they are intimately related in epilepsy. Greater appreciation and understanding of the peri-ictal period is clinically important, providing a model for understanding basic mechanisms underlying mood and thought disorders and the substrates of cognition, volition, emotion, and consciousness. The present paper is aimed at reviewing major psychiatric symptoms that may occur around the ictus with special attention to clinical descriptions and relationships with interictal psychopathology.