Electroconvulsive therapy in psychoses of epilepsy - A forgotten alternative

This case report discusses a 35-year-old woman with refractory temporal lobe epilepsy and no prior psychiatric history who developed persecutory, erotomanic and megalomaniac ideations, auditory hallucinations, and dysphoric mood. Psychiatric symptoms, including psychosis, are well-documented in patients with epilepsy, posing unique management challenges due to potential interactions between antiepileptic and antipsychotic medications. In this case, the patient demonstrated persistent epileptiform activity on electroencephalogram despite treatment with three antiepileptic drugs. Concurrently, standard antipsychotic treatments were ineffective, suggesting drug-resistant psychosis. Notably, complete remission of psychotic symptoms was achieved with electroconvulsive therapy (ECT), a well-established intervention for various psychiatric conditions but rarely reported in the context of epilepsy-associated psychosis. This case underscores the need for novel therapeutic approaches in managing complex comorbidities like drug-resistant psychosis in epilepsy. It also highlights the potential role of ECT as a safe and effective treatment option in these challenging clinical scenarios.