Type of Article: Case Report Psychiatric Manifestations in a Young Patient with Temporal Lobe Epilepsy: A Case Report

INTRODUCTION: Temporal lobe epilepsy (TLE) begins in temporal lobes of brain, which process emotions, short-term memory, urges such as hunger, thirst, fight-or-flight and sexual arousal. Risk factors for the development of psychopathology in TLE include poorly-controlled seizures, multiple discharges on EEG, structural lesions and psycho-social factors. Childhood onset affects the development of personality and social functioning adversely. CASE: A 17 years old female was diagnosed with TLE 3 years ago following an episode of disorganized behavior, aggression and confusion. Neurologist was consulted after encountering many bad experiences with faith-healers. EEG suggested left fronto-temporal epileptogenic focus. She showed improvement with Phenytoin(300mg) but eventually became noncompliant. She developed repetitive and intrusive obscene thoughts and started to count numbers to relieve the associated anxiety. She was started on Sertraline(50mg) and resumed Phenytoin. Seizures decreased but patient developed aggression, suicidal gestures and had one impulsive suicidal attempt which required hospitalization. In her recent admission with us for aggression, obsessions and suicidal ideation, she showed moderate improvement with Sodium Valproate(600mg) and Fluoxetine(20mg). DISCUSSION: Patients with TLE showed higher incidence of psychiatric disorders including mood disorders, Obsessive compulsive disorder, Generalized anxiety disorder, self-injurious behaviors and personality changes. Complex behavioral patterns seen with epilepsy may arise from the epilepsy itself, as a postictal phenomenon or from a comorbid psychiatric condition. CONCLUSION: Further studies are needed to understand biological underpinnings of these psychiatric symptoms.