Nonconvulsive status epilepticus and psychotic symptoms: case report

Nonconvulsive status epilepticus (NCSE) is an epileptic condition, lasting more than 30 min, characterized by continuous or recurrent epileptic activity on EEG, which is responsible for various clinical symptoms (especially in mental status or behavior) in the absence of manifest seizure activity. It includes different clinical forms, from minor confusion to complex behavioral disorders, psychosis, or coma. These psychotic symptoms can be very complex and their differential diagnosis canbe difficult. We report the case of a 31-year-old male patient without previous personal or family recorded history of epilepsy and/or schizophrenic disorder, without identifiable stressors, showing a subacute episode of anxiety with aggression. Initially,he was discharged without treatment. Seven days later he went to the emergency services accompanied by his family members reporting delusions of injury. He presented a disorganized behavior with self-harm, anxiety, dysesthesia, cenestopathy and internal field hallucinations (auditory and visual). The initial EEG study revealed a nonconvulsive status with an active temporal focus. In this patient, the psychotic symptoms and EEG abnormalities consistent with NCSE appeared simultaneously. Once the EEG returned to normal, the symptoms only persisted residually and were compatible with intraictal psychosis.