EPP114
ON THE EDGE OF AWARENESS: ICTAL CONSCIOUSNESS AND PSYCHOSIS IN FOCAL EPILEPSY
A. Tarrada 1,*, S. Baltassis 2
1Unit of neuropsychiatry, Psychotherapeutic Center of Nancy, Nancy, 2Neurology, Hospital of Pitie-Salpêtrière, Paris, France
Introduction: Psychoses of epilepsy (POE) are psychotic disorders arising after epilepsy onset, affecting up to 13% of patients with focal epilepsy. Based on their temporal relationship with seizures, POE is classified as peri-ictal psychosis —with postictal psychosis (PIP) being most common—or interictal psychosis. These subtypes often overlap within the same patients, suggesting shared mechanisms.
Objectives: While interictal risk factors are well documented, ictal correlates remain poorly characterized. This study assessed the association between objective ictal features, ictal consciousness and POE.
Methods: We included 112 patients with drug-resistant focal epilepsy who underwent epilepsy-specific psychiatric assessment and long-term video-EEG or stereo-EEG (S-EEG) monitoring. Seizure semiology and epilepsy features were compared between patients with (n = 15) and without POE (n = 97). Ictal consciousness was assessed using the Consciousness Seizure Scale(CSS). For analysis, CSS scores were categorized into three levels: 0–1 (preserved consciousness), 2–6 (altered), and 7–9 (abolished). Seizure onset zones were examined in S-EEG patients (n = 37).
Results: POE was associated with altered ictal consciousness (p = .04), following a non-linear pattern peaking at intermediate CSS scores (p = .015). POE patients were older (p = .005), had longer epilepsy duration (p= .005), and higher depression (p= .002) and anxiety scores (p =.001). Non-significant trends were found for lateral epilepsy (p = .07) and learning disabilities (p= .06).
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Conclusions: POE was associated with intermediate ictal impairement of consciousness, possibly reflecting partial disconnection from reality. These patients also had longer disease duration, possibly reflecting a cumulative seizure burden. Lateral temporal involvement—implicated in impaired awareness and psychiatric vulnerability—raises whether psychosis risk stems from seizure focus or ictal consciousness quality.
Disclosure of Interest: None Declared