Trials and Tribulations of Diagnosing and Managing Psychosis Secondary to Non-Convulsive Epilepsy

Abstract

Background: It is well known that psychotic symptoms can occur as a result of seizure activity in the brain. This can easily be diagnosed in those with recognizable seizures by taking a careful history. However, in the absence of a typical seizure presentation, it is far more challenging to differentiate between an organic and primary psychosis. Case Presentation: We present the case of a 51-year-old female who had a 28-year history of treatment-resistant schizophrenia. She did not report or display any seizure activity, and an extensive investigation was unremarkable. The unusual nature of her psychopathology, which was predominantly visual hallucinations and somatic delusions, and the difficult to treat nature of her symptoms, prompted investigation with Electroencephalograph which demonstrated bilateral temporal lobe epileptic activity. Conclusion: Treatment with divalproex sodium and discontinuation of antipsychotic medication achieved an excellent response, where her visual hallucinations and somatic delusions were both remarkably ameliorated.