Central European Journal of Medicine

, Volume 7, Issue 3, pp 329–334 | Cite as

Diagnostic challenge in neuropsychiatry: two case reports

  • Rytis Leonavičius
  • Virginija Adomaitienė
Case report



Temporal lobe epilepsy straddles the borderland between psychiatry and neurology. Since this condition may involve gross disorders of thought, emotion, and sensory disturbances in the absence of tonic clonic seizures, psychiatrists may often fail to recognize the epileptic origin of the disorder. Our objective was to portray two case reports to increase recognition of common psychiatric symptoms and syndromes manifested in epilepsy.


Descriptive analysis of two females, suffering from derealization — depersonalization syndrome, hallucinations, and delusions.


Both patients were being treated for decades for depression and schizophrenia; however no positive treatment results resulted. A cooperative team of psychiatrists and neurologists of the Kaunas Medical Academy revealed epileptic roots of these cases, which resulted in treatment changes from antipsychotics to mood stabilizers. This new treatment showed long-acting positive outpatient outcomes.


Contemporary medical science could show improved outcomes not only by fragmenting into smaller specialized pieces, but also associating into bigger units, especially in the case of psychiatry. However, more exhaustive research should be provided to confirm such necessity.


Epilepsy Hallucinations Delusions Psychosis Antipsychotics 


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  1. [1]
    Kasper B.S., Kasper E.M., Pauli E., Stefan H., Phenomenology of hallucinations, illusions, and delusions as part of seizure semiology, Epilepsy Behav., 2010, 18(1–2), 13–23PubMedCrossRefGoogle Scholar
  2. [2]
    So E.L., Value and limitations of seizure semiology in localizing seizure onset, J. Clin. Neurophysiol., 2006, 23(4), 353–357PubMedCrossRefGoogle Scholar
  3. [3]
    Adachi N., Onuma T., Kato M., Ito M., Akanuma N., Hara T., et al., Analogy between psychosis antedating epilepsy and epilepsy antedating psychosis, Epilepsia, 2011, 52(7), 1239–1244PubMedCrossRefGoogle Scholar
  4. [4]
    de Araújo Filho G.M., da Silva J.M., Mazetto L., Marchetti R.L., Yacubian E.M., Psychoses of epilepsy: a study comparing the clinical features of patients with focal versus generalized epilepsies, Epilepsy Behav., 2011, 20(4), 355–358Google Scholar
  5. [5]
    Mirsattari S.M., Gofton T.E., Chong D.J., Misdiagnosis of epileptic seizures as manifestations of psychiatric illnesses, Can. J. Neurol. Sci., 2011, 38(3), 487–493PubMedGoogle Scholar
  6. [6]
    Elliott B., Joyce E., Shorvon S., Delusions, illusions and hallucinations in epilepsy: 2. Complex phenomena and psychosis, Epilepsy Res., 2009, 85(2–3), 172–186PubMedCrossRefGoogle Scholar
  7. [7]
    Usiukina M.V., Kornilova S.V., Shamanaev A.S., Shakhbazi T.A., Chronic schizophrenia-like psychoses in epilepsy, Zh. Nevrol. Psikhiatr. Im. S. S. Korsakova, 2009, 109(8), 16–20, (in Russian)PubMedGoogle Scholar
  8. [8]
    Meador K.J., Emergence of temporal lobe surgery for epilepsy, Arch. Neurol., 2001, 58, 1011–1012PubMedCrossRefGoogle Scholar
  9. [9]
    Hudry J., Perrin F., Ryvlin P., Mauguiere F., Royet J.P., Olfactory short-term memory and related amygdale recordings in patients with temporal lobe epilepsy, Brain, 2003, 126, 1851–1863PubMedCrossRefGoogle Scholar
  10. [10]
    Khalsa S., Moore S.A., Van Hoesen G.W., Hughlings Jackson and the role of the entorhinal cortex in temporal lobe epilepsy: From Patient A to Doctor Z, 2006, 9(3), 524–531Google Scholar
  11. [11]
    Jan M.M.S., Girvin J.P., Seizure semiology: Value in identifying seizure origin, Can. J. Neurol. Sci., 2008, 35, 22–30PubMedGoogle Scholar
  12. [12]
    Schillace B.L., ’Temporary failure of mind’: Déjà vu and epilepsy in Radcliffe’s The Mysteries of Udolpho, Eighteenth-Century Stud., 2009, 42(2), 273–287CrossRefGoogle Scholar
  13. [13]
    Bladin P.F., ’The Epilepsies’: Kinnier Wilson’s landmark epileptology, J. Clin. Neurosci., 2005, 12(8), 863–872PubMedCrossRefGoogle Scholar
  14. [14]
    Lardreau E., An approach to nineteenth-century medical lexicon: the term ‘dreamy state’, J. Hist. Neurosci., 2011, 20(1), 34–41PubMedCrossRefGoogle Scholar
  15. [15]
    Selimbeyoglu A., Parvizi J., Electrical stimulation of the human brain: perceptual and behavioral phenomena reported in the old and new literature, Front. Hum. Neurosci., 2010, 4(46), 1–11Google Scholar
  16. [16]
    Restak R., Complex partial seizures present diagnostic challenge, Psych. Times, 1995, 12(9), 1–6Google Scholar
  17. [17]
    Antonaci F., Nappi G., Galli F., Manzoni G.C., Calabresi P., Costa A., Migraine and psychiatric comorbidity: a review of clinical findings, J. Headache Pain, 2011, 12(2), 115–125PubMedCrossRefGoogle Scholar
  18. [18]
    Filho G.M., Mazetto L., da Silva J.M., Caboclo L.O., Yacubian E.M., Psychiatric comorbidity in patients with two prototypes of focal versus generalized epilepsy syndromes, Seizure, 2011, 20(5), 383–386PubMedCrossRefGoogle Scholar
  19. [19]
    Bragatti J.A., Torres C.M., Londero R.G., Assmann J.B., Fontana V, Martin K.C., et al., Prevalence of psychiatric comorbidities in temporal lobe epilepsy: the value of structured psychiatric interviews, Epi. Disord., 2010, 12(4), 283–291Google Scholar
  20. [20]
    Mauguiere F., Scope and presumed mechanisms of hallucinations in partial epileptic seizures, Epileptic Disord., 1999; 1(2), 81–91PubMedGoogle Scholar
  21. [21]
    Taylor D.C., Whatever happened to the ‘epileptic prodrome’?, Epilepsy Behav., 2007, 11(3), 251–252PubMedCrossRefGoogle Scholar
  22. [22]
    Otmakhova N.A., Lewey J., Asrican B., Lisman J.E., Inhibition of perforant path input to the CA1 region by serotonin and noradrenaline, J. Neurophysiol., 2005, 94(2), 1413–1422PubMedCrossRefGoogle Scholar
  23. [23]
    Cameron O.G., Minoshima S., Regional brain activation due to pharmacologically induced adrenergic interoceptive stimulation in humans, Psychosom. Med., 2002, 64, 851–861PubMedCrossRefGoogle Scholar
  24. [24]
    Gastaut H. New comments on the epilepsy of Fyodor Dostoevsky, Epilepsia, 1984, 25, 408–411PubMedCrossRefGoogle Scholar
  25. [25]
    Trummer M., Eustacchio S., Unger F., Tillich M., Flaschka G., Right hemispheric frontal lesions as a cause for anorexia nervosa report of three cases, Acta Neurochir. (Wien), 2002, 144(8), 797–781CrossRefGoogle Scholar
  26. [26]
    Testa S.M., Schefft B.K., Szaflarski J.P., Yeh H.S., Privitera M.D., Mood, personality, and health-related quality of life in epileptic and psychogenic seizure disorders, Epilepsia, 2007, 48(5), 973–982PubMedCrossRefGoogle Scholar
  27. [27]
    Santos-Soares P.C., Bacellar A., Povoas H.P., Oliveira-Filho J., Filgueiras N.M., Brito A.F., Excessive water ingestion and repeated seizures: the domino effect, Arq. Neuropsiquiatr., 2008, 66(3A), 552–553, (in Portuguese)PubMedCrossRefGoogle Scholar
  28. [28]
    Devinsky O., Hafler D.A., Victor J., Embarrassment as the aura of a complex partial seizure, Neurol., 1982, 32(11), 1284–1285Google Scholar
  29. [29]
    Park S.M., Lee S.A., Kim J.H., Kang J.K., Ictal spitting in a patient with dominant temporal lobe epilepsy: Supporting evidence of ictal spitting from the nondominant hemisphere, Eur. Neurol., 2007, 57(1), 47–49PubMedCrossRefGoogle Scholar
  30. [30]
    Haut S., Differentiating migraine from epilepsy, Adv. Stud. Med., 2005, 5(6A), 658–665Google Scholar
  31. [31]
    Mascia A., Di Gennaro G., Esposito V., Grammaldo L.G., Meldolesi G.N., Giampà T., et al., Genital and sexual manifestations in drug-resistant partial epilepsy, Seizure, 2005, 14(2), 133–138PubMedCrossRefGoogle Scholar
  32. [32]
    Canuet L., Ishii R., Iwase M., Ikezawa K., Kurimoto R., Takahashi H., et al., Psychopathology and working memory-induced activation of the prefrontal cortex in schizophrenia-like psychosis of epilepsy: Evidence from magnetoencephalography, Psychiatry. Clin. Neurosci., 2001, 65(2), 183–190CrossRefGoogle Scholar
  33. [33]
    Lax Pericall M.T., Taylor E., Psychosis and epilepsy in young people, Epi. Behav., 2010, 18(4), 450–454CrossRefGoogle Scholar
  34. [34]
    Verhoeven W.M., Egger J.I., Gunning W.B., Bevers M., de Pont B.J., Recurrent schizophrenia-like psychosis as first manifestation of epilepsy: a diagnostic challenge in neuropsychiatry, Neuropsychiatr. Dis. Treat., 2010, 25(6), 227–231CrossRefGoogle Scholar
  35. [35]
    Kim S., Mountz J.M., SPECT Imaging of Epilepsy: An Overview and Comparison with F-18 FDG PET, Int. J. Mol. Imaging, 2011, 2011:813028. Epub 2011 Jul 14PubMedGoogle Scholar
  36. [36]
    Schmidt M.H., Pohlmann-Eden B., Neuroimaging in epilepsy: The state of the art, Epilepsia, 2011, 52(4), 49–51PubMedCrossRefGoogle Scholar
  37. [37]
    Gotman J., Pittau F., Combining EEG and fMRI in the study of epileptic discharges, Epilepsia, 2011, 52(4), 38–42PubMedCrossRefGoogle Scholar

Copyright information

© © Versita Warsaw and Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Psychiatry of Medical Academy of Lithuanian University of Health SciencesKaunasRepublic of Lithuania

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