Abstract
BackgroundPartial complex epilepsy with psychosensorial and psychotic symptoms remains a relatively rare condition that can sometimes be mistaken for an axis I psychiatric disorder. There is no specific treatment for this particular type of epilepsy, anti-epileptic medication being the cornerstone of therapeutic intervention with the occasional addition of neuroleptics. Lack of response to anti-epileptic agents is often a sign of poor prognosis and requires risky and sometimes invasive interventions with high morbidity for patients.Case presentationWe report the case of a 21-year-old right-handed Caucasian man of French-Canadian descent who was living with his mother immediately before being hospitalized in a psychiatric setting for the first time. He seemed obsessed with developing new concepts to reach a more ‘perfect’ existence. He also claimed feeling odd sensations in his mind and in his body that could be linked to some sort of ‘evolutionary’ process resulting from spiritual uplift. He reported non-specific visual hallucinations and what sounded like auditory hallucinations and telepathic powers. The first diagnosis was a possible schizophreniform disorder and our patient was hospitalized. Shortly afterwards, an electroencephalogram showed an important subcortical epileptic activity, compatible with partial complex epilepsy with psychosensorial and psychotic symptoms. Despite a negative response to medication, symptoms proper to this type of epilepsy were substantially alleviated using a psychotherapeutical treatment intended for patients with psychotic disorders, namely integrated psychological therapy (IPT). Significant functional improvement in our patient has been achieved since then.ConclusionsThis case report illustrates that despite a negative response to medication, symptoms proper to this type of epilepsy could be substantially alleviated using psychotherapeutical treatment modalities. To the best of our knowledge, this is the first time such a finding has been reported in the scientific literature. This could open the way for new research themes and therapeutic interventions for such patients.
Highlights
Partial complex epilepsy with psychosensorial and psychotic symptoms remains a relatively rare condition that can sometimes be mistaken for an axis I psychiatric disorder
Inter-ictal psychoses are considered to occur in about 7 percent of all patients with epilepsy and have been described in both partial and generalized epileptic syndromes [3]
In summary, significant functional improvement was achieved for severe psychotic symptomatology in our patient experiencing partial complex epilepsy using therapeutic methods that have proven to be effective in treating schizophrenic patients
Summary
It seems possible that both partial complex epilepsy with psychotic symptoms and chronic psychotic disorders (such as schizophrenia) share more etiologic similarities than had been thought until now. Considering that anti-convulsant medication may be ineffective and that other neuroleptic drug and brain surgery can be risky, neurocognitive and social cognitive psychotherapeutic interventions may be an interesting treatment modality in the future for patients with epilepsy with psychosensorial and psychotic symptoms, as for other organic disorders with psychiatric symptoms [29]. Authors’ contributions LDB and AD were involved in the initial writing of the manuscript. Author details 1Centre de recherche de l’Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, 7401, Rue Hochelaga, Montréal, Québec H1N 3M5, Canada. Author details 1Centre de recherche de l’Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, 7401, Rue Hochelaga, Montréal, Québec H1N 3M5, Canada. 2Centre de recherche de l’Institut Universitaire en Santé Mentale de Montréal, Institut Philippe-Pinel de Montréal, Université de Montréal, Montreal, Québec, Canada. 3Department of Psychiatry, Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Montreal, Québec, Canada. 4Department of Psychology, Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Montreal, Québec, Canada. 5Centre de recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, Québec, Canada. 6Department of Psychiatry, Université de Montréal, Montreal, Québec, Canada. 7Institut Universitaire en Santé Mentale de Montréal, Montreal, Québec, Canada
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