A case series on disorder on psychiatric symptoms in epileptic patients with emphasis on the disorder of awareness of body

Abstract

Background: Paroxysmal psychiatric symptoms are commonly associated with pre-ictal, ictal, or post-ictal phases of seizure. Most of the studies regarding psychiatric symptoms are semiological in nature emphasising anatomical correlates of seizure in patients in pre-neurosurgical evaluation. Phenomenological studies of psychiatric symptoms in epilepsy are limited by various factors. Objective: To describe and evaluate phenomenological understanding of ictal fear and reflex epilepsy in two patients while emphasising their experiences with respect to disorder of awareness of body while also presenting electroencephalogram (EEG), imaging results, and clinical examination of the patients. Methods and results: Two case reports of patients attending Department of Psychiatry, Tezpur Medical College and Hospital (TMCH) revealed ictal fear in generalised myoclonic epilepsy in one case and reflex epilepsy in generalised epilepsy syndrome in another case. Conclusion: It was concluded that in undiagnosed cases of epilepsy as with the first case, diagnosis of ictal fear is very difficult. Ictal fear in generalised myoclonic seizure as compared to partial seizure such as temporal lobe seizures is not common. Diagnosis of reflex epilepsy in generalised epilepsy syndrome is confused with dissociative phenomenon/conversion syndromes. Phenomenological evaluation of these psychiatric symptoms revealed disorder in awareness of body.

Keywords

• ictal fear
• partial seizures
• temporal lobe epilepsy
• body schema
• reflex epilepsy