A Rare Case of Non Convulsive Status Epileptic with Psychotic Presentation

Abstract

Background Psychosis associated with epilepsy is one of the temporal and frontal lobe epilepsy (TFLE) forms of presentation. Non-convulsive epileptic status (NCSE) clinical features are subtle and non-specific and, consequently, they are generally not diagnosed and confused with behavioral or psychiatric disorders. It remains a challenge to characterize neurobiological changes that contribute to the genesis or maintenance of both conditions, with a clear need for further investigation. Case report A 56-year-old male patient was hospitalized due to a one month period with persecutory delusions, auditory hallucinations, thought diffusion, passivity phenomena and total insomnia. There were no relevant changes in the general and neurological physical examinations, analytical study, urine’s substance abuse drugs and cerebral CT. His psychotic symptoms diminished with paliperidone, but one month after his admission he began to present periods of confusion, consciousness floating, temporal and spatial disorientation, disperse attention, behavioral disorganization at night and ataxia. He realized an electroencephalogram (EEG) and had practically continued epileptic activity in the temporal and frontal lobes, which ceased with the addition of valproic acid (VPA). Four months later the patient was discharged, medicated with paliperidone and VPA, with no psychotic symptomatology. Conclusions Today the most accepted theory is that both Psychosis and Epilepsy are the consequence of underlying neuropath physiological dysfunction, going towards the specter of a Psychosis’s “continuum”. The NCES can have a variety of clinical presentations and the EEG is necessary to make a definitive diagnosis, but this can be difficult especially due to its low availability and because there is currently no consensus on the EEG diagnostic criteria. This clinical case was particularly challenging and the diagnostic delay could represent a liability to the patient’s recovery. In both pathologies, the treatment remains a challenge for psychiatrists and neurologists, and further studies are needed to clarify the best diagnostic and therapeutic approach.