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A Case of Treatment-Resistant Schizophrenia With Mesial Temporal Sclerosis: A Case Report
Shokry Alemam1, Syed Ali Bokhari1, Safa F Hasan1
1Psychiatry, Al Amal Psychiatric Hospital, Dubai, ARE.
Abstract:
Mesial temporal sclerosis (MTS) is one of the most common causes of treatment-resistant epilepsy, especially temporal lobe epilepsy (TLE). Various psychiatric symptoms are common with temporal lobe epilepsy. However, the least established symptoms were psychotic symptoms. Furthermore, treatment-resistant schizophrenia is a significant proportion of schizophrenia patients who have failed treatment with at least two different antipsychotics, resulting in poor outcomes and a significant negative impact on the patient's life. In our case report, psychotic symptoms and abnormal behaviors were explained by schizophrenia for more than 17 years in a 32-year-old female, while the diagnosis of temporal lobe epilepsy with mesial temporal sclerosis was missed, resulting in incomplete treatment, which led to a deterioration of her quality of life for years. This case aims to shed light on TLE rare manifestations and to discuss the proper investigations and treatment that might increase the quality of life of these patients. Underlining the necessity for more research in treatment-resistant schizophrenia, this unusual case underscores the importance of exploring the underlying biological, psychological, and social risk factors. It also emphasizes the need to focus additional attention on formulating proper investigation strategies for the susceptible patient population.
Insights
Mesial temporal sclerosis (MTS) can cause treatment-resistant epilepsy and psychiatric symptoms. Misdiagnosing psychotic symptoms as schizophrenia delayed TLE diagnosis, impacting quality of life.
Area of Science:
- Neurology
- Psychiatry
Background:
- Mesial temporal sclerosis (MTS) is a common cause of treatment-resistant epilepsy, often associated with psychiatric symptoms.
- Psychotic symptoms are less commonly recognized manifestations of temporal lobe epilepsy (TLE).
- Treatment-resistant schizophrenia presents significant challenges, with many patients failing multiple antipsychotic treatments.
Observation:
- A 32-year-old female presented with over 17 years of psychotic symptoms and abnormal behaviors, initially diagnosed as schizophrenia.
- The underlying diagnosis of temporal lobe epilepsy with mesial temporal sclerosis was missed for years.
- This diagnostic delay led to incomplete treatment and a significant decline in the patient's quality of life.
Findings:
- This case highlights rare manifestations of TLE, specifically psychotic symptoms.
- The study emphasizes the importance of considering TLE in patients with long-standing, unexplained psychiatric conditions.
- Delayed diagnosis of MTS/TLE can exacerbate patient suffering and hinder effective treatment.
Implications:
- The case underscores the need for comprehensive investigations in patients with treatment-resistant schizophrenia to rule out underlying neurological conditions like TLE.
- Proper diagnostic strategies are crucial for improving the quality of life for patients with complex neurological and psychiatric comorbidities.
- Further research into the biological, psychological, and social factors contributing to treatment-resistant schizophrenia and TLE is warranted.
