Prolonged preictal psychosis in refractory seizures: a report of three cases

Seizures and psychosis coexist in a large number of patients with epilepsy, and a significant amount of research on their relationship has been published. There are several reports and reviews on postictal and interictal psychosis in patients with epilepsy. We describe three patients with refractory temporal lobe epilepsy, each of whom presented with a history of episodic psychosis that preceded almost all habitual seizures and, thus, served as a useful warning symptom. All three patients had intractable left complex partial seizures; two had right mesial temporal sclerosis, and the third had a gliotic area in the right frontotemporal region on MRI. This is the first report of psychosis preceding seizures. The literature on seizure anticipation, as well as on the complex relationship between seizures and psychosis, is also reviewed.