Postictal psychosis: A review

Although postictal psychosis (PIP) has only recently been characterized, it is an important complication of medically intractable complex partial seizures. The demographics, symptomatology, treatment, and outcome of patients with PIP will be reviewed. PIP commonly occurs in the setting of increased frequency and bitemporal epileptiform interictal activity. Features differentiating PIP from other epileptic psychoses will be discussed, as will the proposed underlying mechanisms. PIP is associated with a later age of onset and higher IQ scores than chronic interictal psychosis, suggesting less underlying brain damage. Although animal kindling studies suggest that postictal dopaminergic hyperactivity is part of a homeostatic response to increased seizure frequency, human radioligand PET studies indicate its potential role in the evolution of psychotic symptoms.