10/03/00 12:21PM "I. S. Margolis" wrote:

<<<<Please help me understand.  Am I "correct" inferring from your statement
that temporal lobe epilepsy may not always manifest grand or petite seizures
yet still be present or active enough to mimic psychotic-like symptoms?>>>>

Although there is usually a history of observable seizures these may be quite different than standard grand or petit mal seizures. The seizure may manifest itself as a complex-partial seizure and be characterized as repepitive, meaningless actions (walking in a circle, opening and closing a drawer repeatedly, facial grimacing, etc.). Or lots of variations of this. Sometimes the seizure activity is not apparent to the naked eye - only seen in specialized tests like EEGs (picks up electrical activity in the brain much like an EKG/ECG picks up electrical activity in the heart). The seizure activity can happen during sleep. Because it is not always what people typically think of as seizures, temporal lobe epilepsy is a bit trickier to diagnose sometimes. 

<<<<<Would you illuminate" your phrase "post-ictal" phase? >>>> 

Sorry for the jargon slip. :-)  Post-ictal is the name for the post seizure period. Each person and each seizure type varies in the specifics of this. Petit mal or absence seizures usually have a very short phase - some people just come out of the seizure and resume whatever they were doing. After a grand mal seizure, for example, a person may be very confused or extremely tired and have to "sleep it off" for a few minutes or several hours. Often a person with temporal lobe seizures may have an extended period of just not being themselves. Feelings of paranoia and delusions can occur. If these are the symptoms that present in the patient it is not uncommon for the assumption to be that this is a psychiatric problem rather than neurological.
Especially if the patient didn't have any obvious seizure activity in the first place. This is rare, but I've seen enough patients in my 15 years with atypical presentations of seizure disorders misdiagnosed initially as schizophrenia or psychotic depression that I always keep it in the back of my mind. Especially with a sudden onset of symptoms.

 <<<<<And what is the likelihood of remission/recurrence?>>>>

Again this varies a lot from person to person. I haven't worked directly in Neuropsych for a few years so I'm not up on all the latest meds and treatments. Usually people are put on meds for a while, monitored and after a period of being free of seizures are gradually weaned off the drugs. Then you see if they remain free of seizure activity. A lot of time it is trial and error to find what works for the individual. Some people have multiple seizures(could be in the 100s) per day - some have 1 or 2 over their lifetimes. Seizure control can vary a lot too.

<<<<Thank you for making me aware of the more likely gradualness of psychosis.  ;-)   >>>>>

Were you worried? Hehehe There's an old joke that if you're worried that you're going crazy, you're not! :-)

It's not that psychosis never has an "overnight" onset, it's just not the norm. Usually if it is very sudden, I tend to think of acute stress reaction, post-traumatic stress disorder, or an organic problem (something neurological, like seizures, or physical, like a thyroid problem).

Hope this helps!

Yvonne