Postictal psychosis in a child
A Nissenkorn1, M Moldavsky, M Lorberboym
1Pediatrics Department, Wolfson Medical Center, Holon Sackler Medical School, Tel-Aviv University, Israel.
Insights
Postictal psychosis, a brief psychotic episode after seizures, is described for the first time in a child. This case highlights a potential link between childhood epilepsy and psychosis.
Area of Science:
- Neurology
- Child Psychiatry
Background:
- Postictal psychosis is a known complication of epilepsy in adults, typically occurring after poorly controlled partial complex seizures.
- It often follows a lucid interval and is associated with underlying structural brain abnormalities, frequently involving the temporal lobe.
Observation:
- This report details a 9-year-old boy with a history of neonatal stroke and right hemiparesis who experienced status epilepticus.
- Following the seizure cluster, he developed a schizophrenia-like psychosis with a lucid interval.
Findings:
- Electroencephalography indicated left-sided slowing, and neuroimaging revealed left hemisphere hypoplasia and reduced perfusion in the left medial temporal lobe.
- The child's psychosis resolved spontaneously within 7 days without antipsychotic medication.
Implications:
- This case represents the first documented instance of postictal psychosis in a pediatric patient.
- It suggests that postictal psychosis may occur in children with epilepsy and underlying brain abnormalities, warranting further investigation.
Abstract:
Postictal psychoses are brief psychotic episodes that usually occur after poorly controlled partial complex seizure clusters. The psychosis commonly appears following a lucid interval, ranging from a few hours to days after seizure termination. An underlying structural brain abnormality is common and usually involves the temporal lobe. Postictal psychosis, while well known in adults, has not been described previously in children. We describe a 9-year-old boy with right hemiparesis due to a neonatal stroke, who developed a postictal schizophrenia-like psychosis following status epilepticus. Electroencephalography showed left-sided slowing. A brain computed tomographic scan and magnetic resonance imaging revealed left hemisphere hypoplasia. A 99mTc-ECD single photon emission computed tomographic scan of the brain revealed decreased left-hemisphere perfusion, most pronounced to the medial temporal lobe. The psychosis resolved gradually over 7 days without antipsychotic therapy. To the best of our knowledge, this is the first description of postictal psychosis in a child.
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