Epilepsy-Related Psychosis in Drug-Resistant Epilepsy With Nonconvulsive Status Epilepticus and Difficult Antipsychotic Titration: A Case Report.
Wataru Omori, Ryo Hirabayashi, Kenichi Oga et al.
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Case in brief
A man in his late 50s with drug-resistant epilepsy and recurrent psychosis presented with reduced responsiveness and fluctuating alertness during medication adjustment. EEG revealed generalized rhythmic epileptiform activity, indicating nonconvulsive status epilepticus (NCSE). Treatment with fosphenytoin improved his condition, but psychosis recurred after antipsychotic withdrawal, suggesting interictal psychosis. Aripiprazole initially helped but caused side effects, leading to a switch to brexpiprazole.
What made this case unusual
The case highlights the complex interplay between nonconvulsive status epilepticus and psychosis, complicating diagnosis and management.
Diagnostic / clinical pearl
Clinicians should maintain a low threshold for EEG evaluation in patients with epilepsy presenting with altered mental status and psychosis.
Why it matters
This case underscores the importance of careful monitoring of pharmacokinetic interactions when managing psychosis in patients with drug-resistant epilepsy.