Postictal psychiatric symptoms (PPS) are a relatively common but understudied phenomenon in epilepsy. The mechanisms by which seizures contribute to worsening in psychiatric symptoms are unclear. We aimed to identify PPS prospectively during and after admission to the epilepsy monitoring unit (EMU) in order to characterize the postictal physiologic changes leading to PPS. We prospectively enrolled patients admitted to the EMU and administered repeat psychometric questionnaires during and after their hospital stay in order to assess for postictal exacerbations in four symptom complexes: anger/hostility, anxiety, depression, and paranoia. Electroclinical and electrographic seizures were identified from the EEG recordings, and seizure durations were measured. The severity of postictal slowing was calculated as the proportion of postictal theta/delta activity in the postictal EEG relative to the preictal EEG using the Hilbert transform. Among 33 participants, 8 demonstrated significant increases in at least one of the four symptoms (the PPS+ group) within three days following the first seizure. The most common PPS was anger/hostility, experienced by 7/8 participants with PPS. Among the 8 PPS+ participants, four experienced more than one PPS. As compared to those without PPS (the PPS− group), the PPS+ group demonstrated a greater degree of postictal EEG slowing at 10 min (p = 0.022) and 20 min (p = 0.05) following seizure termination. They also experienced significantly more seizures during the study period (p = 0.005). There was no difference in seizure duration between groups. Postictal psychiatric symptoms including anger/hostility, anxiety, depression, and paranoia may be more common than recognized. In particular, postictal increases in anger and irritability may be particularly common. We provide physiological evidence of a biological mechanism as well as a demonstration of the use of quantitative electroencephalography toward a better understanding of postictal neurophysiology.

中文翻译：

---

发作后精神症状：神经生理学研究

发作后精神症状（PPS）是癫痫中相对常见但尚未得到充分研究的现象。癫痫发作导致精神症状恶化的机制尚不清楚。我们的目的是在进入癫痫监测单元 (EMU) 期间和之后前瞻性地识别 PPS，以表征导致 PPS 的发作后生理变化。我们前瞻性地招募了入住 EMU 的患者，并在他们住院期间和住院后进行了重复的心理测量问卷调查，以评估四种复合症状的发作后加重：愤怒/敌意、焦虑、抑郁和偏执。从脑电图记录中识别出电临床和电图癫痫发作，并测量癫痫发作持续时间。使用希尔伯特变换将发作后减慢的严重程度计算为发作后脑电图中相对于发作前脑电图的发作后θ/δ活动的比例。在 33 名参与者中，有 8 名参与者在第一次癫痫发作后三天内，四种症状中的至少一种（PPS+ 组）表现出显着增加。最常见的 PPS 是愤怒/敌意，7/8 的 PPS 参与者经历过这种情况。在 8 名 PPS+ 参与者中，有 4 名经历了不止一种 PPS。与没有 PPS 的患者（PPS− 组）相比，PPS+ 组在癫痫发作终止后 10 分钟（p = 0.022）和 20 分钟（p = 0.05）时表现出更大程度的发作后脑电图减慢。在研究期间，他们的癫痫发作次数也显着增加 (p = 0.005)。各组之间的癫痫发作持续时间没有差异。包括愤怒/敌意、焦虑、抑郁和偏执在内的发作后精神症状可能比人们认识到的更为常见。特别是，发作后愤怒和烦躁的增加可能特别常见。我们提供生物机制的生理学证据，并演示定量脑电图的使用，以更好地理解发作后神经生理学。