Neuropsychiatric Symptoms of Epilepsy

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A.E. Cavanna
level of consciousness is compromised (“complex partial seizures” in the traditional
classification) or not (“complex partial seizures” in the traditional classification)
[ 18 , 39 ]. At neurobiological level, the investigation of the neurophysiological and
neuroimaging correlates of ictal experiential phenomena induced by temporal lobe
seizures has started to shed light on the brain mechanism underpinning pathophysiological
states of altered contents of consciousness or “epileptic qualia” [ 12 , 40 ,
41 ]. The most common alterations of the contents of consciousness during temporal
lobe seizures encompass perceptual, dysmnesic, affective, and cognitive phenomena
[ 42 – 45 ]. Reported perceptual phenomena include illusions and distortion of
body image, as well as structured hallucinations. These later tend to present with the
characteristic features of organic hallucinations (complex visual scenes, stereotyped,
of short duration, and with preserved insight) [ 46 ]. See Case 10.1 .
Case 10.1: An Illustrative Case
A.B. was a 17-year-old male patient with a 1-year history of recurrent episodes
characterized by visual hallucinations. He was originally referred to the
Psychiatry Clinic for possible onset of schizophrenia and started on antipsychotic
medications, without substantial benefits. His past medical history was
unremarkable and there was no significant family history for psychiatric or
neurological conditions. Routine tests including toxicological screening were
unremarkable. On in-depth psychiatric assessment, it became clear that he
had good insight into the nature of his hallucinatory experiences, which he
described as vivid visual experiences of a hooded figure crossing his visual
fields from left to right in slow motion for the duration of a couple of minutes
(Fig. 10.2 ). He reported emotional distress associated with these experiences,
although there was no communication between the hooded figure and him.
These hallucinations were highly stereotyped and their frequency was weekly,
sometimes leaving A.B. in a state of mild confusion.
Fig. 10.2 Visual hallucination displayed by patient A.B. as a result of right temporal lobe
epilepsy
An organic basis for these episodic symptoms was suspected and A.B. was
referred to the Neuropsychiatry Clinic for a specialist assessment. A routine