Royal College of Surgeons in Ireland
Postictal Psychosis in Epilepsy.....pdf (769.16 kB)

Postictal psychosis in epilepsy: a clinicogenetic study

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posted on 2023-11-17, 16:47 authored by Vera Braatz, Helena Martins Custodio, Costin Leu, Luigi Agrò, Baihan Wang, Stella Calafato, Genevieve Rayner, Michael DoyleMichael Doyle, Christian Hengsbach, Francesca Bisulli, Yvonne G Weber, Antonio Gambardella, Norman DelantyNorman Delanty, Gianpiero CavalleriGianpiero Cavalleri, Jacqueline Foong, Ingrid E Scheffer, Samuel F Berkovic, Elvira Bramon, Simona Balestrini, Sanjay M Sisodiya

Objective: Psychoses affecting people with epilepsy increase disease burden and diminish quality of life. We characterized postictal psychosis, which comprises about one quarter of epilepsy-related psychoses, and has unknown causation.

Methods: We conducted a case-control cohort study including patients diagnosed with postictal psychosis, confirmed by psychiatric assessment, with available data regarding epilepsy, treatment, psychiatric history, psychosis profile, and outcomes. After screening 3,288 epilepsy patients, we identified 83 with psychosis; 49 had postictal psychosis. Controls were 98 adults, matched by age and epilepsy type, with no history of psychosis. Logistic regression was used to investigate clinical factors associated with postictal psychosis; univariate associations with a p value < 0.20 were used to build a multivariate model. Polygenic risk scores for schizophrenia were calculated.

Results: Cases were more likely to have seizure clustering (odds ratio [OR] = 7.59, p < 0.001), seizures with a recollected aura (OR = 2.49, p = 0.013), and a family history of psychiatric disease (OR = 5.17, p = 0.022). Cases showed predominance of right temporal epileptiform discharges (OR = 4.87, p = 0.007). There was no difference in epilepsy duration, neuroimaging findings, or antiseizure treatment between cases and controls. Polygenic risk scores for schizophrenia in an extended cohort of postictal psychosis cases (n = 58) were significantly higher than in 1,366 epilepsy controls (R2 = 3%, p = 6 × 10-3 ), but not significantly different from 945 independent patients with schizophrenia (R2 = 0.1%, p = 0.775).

Interpretation: Postictal psychosis occurs under particular circumstances in people with epilepsy with a heightened genetic predisposition to schizophrenia, illustrating how disease biology (seizures) and trait susceptibility (schizophrenia) may interact to produce particular outcomes (postictal psychosis) in a common disease.


Epilepsy Society

UK Department of Health's NIHR Biomedical Research Centres funding scheme

Muir Maxwell Trust and the Epilepsy Society

Union Chimique Belge (UCB)

Science Foundation Ireland (16/RC/3948)

European Regional Development Fund

European Commission grant 279062, EpiPGX

NIHR Academic Clinical Fellowship

Chinese Scholarships Council

Mental Health Research UK John Grace QC award 2018

BMA Margaret Temple Fellowship

NIHR (NIHR200756)

Medical Research Council (G0901310, G1100583, G1100583)

Wellcome Trust (085475/B/08/Z, 085475/Z/08/Z)

National Human Genome Research Institute (NHGRI)

National Heart, Lung, and Blood Institute

NHGRI grant UM1 HG008895

NHGRI grant 5U01HG009088-02

FutureNeuro industry partners

Open Access Funding provided by Universita degli Studi di Firenze within the CRUI-CARE Agreement



The original article is available at

Published Citation

Braatz V. et al. Postictal psychosis in epilepsy: a clinicogenetic study. Ann Neurol. 2021;90(3):464-476.

Publication Date

20 July 2021

PubMed ID



  • Beaumont Hospital
  • FutureNeuro Centre
  • School of Pharmacy and Biomolecular Sciences

Research Area

  • Neurological and Psychiatric Disorders




  • Published Version (Version of Record)