During the event, diagnosis cannot be made without observation of ongoing, usually lateralized, epileptiform activity on the EEG with waxing and waning patterns, and discharge frequency usually exceeding one per second. After isolated complex partial seizures, there may be a rise in prolactin level between 20 and 50 min after a single seizure in up to three-quarters of cases following temporal lobe seizures, and in slightly fewer after seizures with a frontal lobe origin.88 In

the postictal or interictal periods, there may occasionally be acute psychosis in subjects without a prior psychiatric history Such released automatisms may also engender bizarre movements Inhibitors,research,lifescience,medical or behavior. Left-sided foci have been associated with dysphoria, while right-sided discharges have been seen with laughter and hypomanla.89 Occasionally, Inhibitors,research,lifescience,medical with a relatively normal EEG, a postictal delirium can be seen after a flurry of seizures.78 However, in most patients, psychosis is a postictal phenomenon (Table II). 90 Table II. Criteria for postictal Inhibitors,research,lifescience,medical psychiatric disturbances. Adapted from reference 91: Logsdail SJ, Toone BK. Postictal psychoses: a clinical and phenomenological description. Br J Psychiatry. 1988;152:246-252. Copyright © 1988, The Royal College of Psychiatrists. … Interictal and preictal delirium As noted, components of delirium can be seen in the period between seizures, and also before

seizures.78,>80,91,92 Some patients with a delirious encephalopathy have EEGs showing profuse, bilateral, synchronous spike, and slow-wave discharges.35 Such discharges may at times resemble triphasic waves, particularly in the Inhibitors,research,lifescience,medical setting of a metabolic or toxic encephalopathy Causes include raised ammonia, lithium, tricyclic antidepressant toxicity, tlagabine treatment, baclofen, metrlzamide, Ifosfamide, and other medications.93 These patterns may be indistinguishable Inhibitors,research,lifescience,medical from the

EEG perspective, from NCSE. In such cases, the EEG may normalize or at least show marked reduction in epileptiform morphologies, but the patient may remain clinically encephalopathies93 in other cases, both an epileptic and a triphasic encephalopathlc state may coexist. One such case with raised ammonia and flurries of epileptiform triphasic waves showed resolution of this EEG activity following benzodiazepines, with a gradual normalization and Improvement in state of consciousness over 12 too h, but a further rise in serum ammonia.94 Ictal delirium The transient encephalopathies or cortical impairment seen after seizures usually resolves over minutes to hours, although on some occasions, this may take days. Biton et al, however, have identified a more prolonged postictal encephalopathy lasting for 4 to 10 days after a cluster of seizures.84 In this case, the EEG pattern was irregular in patients with borderline or mild mental CX4945 retardation.