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Postictal psychiatric phenomena are relatively frequent in patients with treatment-resistant epilepsy. This chapter reviews the most relevant clinical aspects of peri-ictal symptomatology. Ictal panic is one of the most frequently misdiagnosed symptoms in medical practice, as it is often diagnosed as a panic attack. Postictal psychiatric phenomena may be the expression of isolated psychiatric symptoms; clusters of postictal psychiatric symptoms (PPS) mimicking a depressive, anxiety or psychotic episode; postictal exacerbation in severity of interictal psychiatric symptoms and persistence of interictal symptoms into the postictal period. In contrast to postictal symptoms of depression (PSD) or PDE, postictal psychotic episodes (PIPE) can be readily prevented and treated. Prevention of PIPE is possible in patients who are found to have bilateral ictal foci in the course of a video-EEG or who are known to develop PIPE after a cluster of seizures.
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