A right-handed woman with independent left- and right-sided temporal lobe discharges was studied by continuous EEG and videotape monitoring for 3 weeks. Changes in affect were noted in the immediate and extended postictal periods and varied with the side of discharge. After a left-sided discharge, she became globally aphasic and depressed. Right-sided discharges evoked laughing and postictal hypomania. These manifestations were attributed to contralateral hemispheric disinhibition after ipsilateral seizure inactivation. This case provides evidence that the speech-dominant hemisphere subserves positive feelings and the nondominant hemisphere negative ones.
"Guimond et al. (2008) also carried out a literature review and suggested that ictal fear occurs more often in right-sided than left-sided epilepsy. Hurwitz et al. (1985) reported on a patient with independent left-and right-sided temporal lobe seizures. After a left-sided seizure the patient became depressed, whereas right-sided seizures evoked postictal hypomania. "
[Show abstract][Hide abstract] ABSTRACT: We systematically analyzed the video-recorded and patient-reported, as well as positive and negative ictal affective symptoms (IAS) in temporal lobe epilepsy (TLE). Our aim was to assess (1) frequency, (2) gender effect, (3) lateralizing significance, (4) localizing value, and (5) prognostic significance in epilepsy surgery of IAS in patients with video-registered seizures.
We reviewed ictal video recordings of 184 patients (99 women, aged 16-63). All patients had surgery for intractable TLE with video-recorded complex partial seizures (CPS) due to temporal lobe lesions visualized by high-resolution magnetic resonance imaging (MRI). Affective auras (AAs) were categorized into two groups: positive or negative.
We registered AAs in 18% of patients: positive in 3%, negative in 15%. We saw ictal affective behavior (IAB) in 22% of patients; 10% had positive, whereas 14% had negative IAB. Two patients had both positive and negative IAB. AAs showed an association with IAB in case of fear expression versus fear auras (p = 0.018). IAB, especially negative IAB, occurred more often in women than in men. Patients with negative IAB were younger than others. We could not demonstrate an association between IAS and the localization, lateralization, or hemispheric dominance. Surgical outcome did not associate with IAS.
Patient-reported and video-recorded negative-but not positive-affective signs are related to each other. Video-recorded negative AAs occur more often in women and young patients.
"during the postictal manic episodes (Nishida et al., 2005). Other reports (Wolf, 1982a; Hurwitz et al., 1985; Barczak et al., 1988; Byrne, 1988; Logsdail et al., 1988; Savard et al., 1991; Kanner et al., 1996; Chakrabarti et al., 1999; Kudo et al., 2001) also described cases of postictal mania (PIM) or postictal hypomania or seizure-related psychopathology equivalent to mania. Some cases of PIM or postictal hypomania were also reported after electroconvulsive therapy in patients with depression (Fink and Kahn, 1961; Andrade et al., 1988; Devanand et al., 1988). "
[Show abstract][Hide abstract] ABSTRACT: To clarify the differences between postictal mania (PIM) and postictal psychosis (PIP).
Five patients with PIM were compared to 17 patients with PIP, with respect to clinical, epileptological, electrophysiological, and neuroimaging features. PIM was distinguished from PIP by the symptoms observed in the postictal period based on the ICD-10 criteria.
Postictal manic episodes lasted for a longer period than postictal psychotic episodes. Patients with PIM had more recurrent postictal episodes than patients with PIP. The age at onset of epilepsy in patients with PIM was older than that in patients with PIP. PIM was associated with frontal lobe and temporal lobe epilepsies, whereas PIP was associated with temporal lobe epilepsy. The estimated epileptogenic zone was on the language dominant side in PIM, whereas there was no predominant hemispheric laterality in PIP. Electroencephalography (EEG) performed during the early period of postictal manic and psychotic episodes showed decreased frequency of interictal epileptiform discharges in both PIM and PIP. Single-photon emission computed tomography (SPECT) during postictal manic and psychotic episodes showed increased perfusion in the temporal and/or frontal lobes in both PIM and PIP. Three patients with PIM showed increased perfusion during postictal episodes on bilateral or the language nondominant side, which were contralateral to the estimated epileptogenic zone, whereas three patients with PIP showed increased perfusion on the areas, which were ipsilateral to the estimated epileptogenic zone.
PIM has a distinct position among the mental disorders observed in the postictal period.
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