Affective disorder associated with post-traumatic epilepsy, misdiagnosis and under treatment: A case report
Introduction A history of traumatic brain injury (TBI) is often associated with acquired epilepsy, which is associated with psychiatric co-morbidity, that when undetected might lead to misdiagnosis and mistreatment. Objectives The objective is to present the case of a 47-years-old male with a hist...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2022-06-01
|
| Series: | European Psychiatry |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933822011476/type/journal_article |
| _version_ | 1827753534746001408 |
|---|---|
| author | E. Giourou A. Theodoropoulou S. Yfantis O. Prodromaki E. Georgila P. Gourzis |
| author_facet | E. Giourou A. Theodoropoulou S. Yfantis O. Prodromaki E. Georgila P. Gourzis |
| author_sort | E. Giourou |
| collection | DOAJ |
| description |
Introduction
A history of traumatic brain injury (TBI) is often associated with acquired epilepsy, which is associated with psychiatric co-morbidity, that when undetected might lead to misdiagnosis and mistreatment.
Objectives
The objective is to present the case of a 47-years-old male with a history of TBI and undetected acquired epilepsy, with a subsequent treatment resident mood disorder that was lead to a full clinical remission once epileptic activity was controlled using anti-seizure monotherapy.
Methods
After compulsory admittion to our inpatient psychiatric unit because of suicidal ideation and persistent aggressive behavior with volatile mood swings, the patient was fully evaluated and his psychiatric and medical histories were recorded. A brain CT scan and EEG were performed. Laboratory tests excluded other medical co-morbidity.
Results
The patient had a previous history of TBI and subsequent multiple episodes of mood disorders that failed to reach full remission even if treated with antidepressives and antipsychotics for adequate time and dosage according to current quidelines. EEG was positive for epileptiform activity with sporadic slow theta waves and right frontotemporal epileptic-like features while the patient was free of clinical seizures. Carbamazepine was initiated and titrated up to 1200mg daily leading to the full remission of the initial clinical symptoms along with the EEG findings’ improvement. The patient remained stable with his functionality at its utmost recovery during the two-years follow-up evaluations.
Conclusions
TBI induced epilepsy might be under-diagnosed in the absence of clinical seizures leading to the mistreatment of the associated psychiatric disorders that could be the only clinical presentation of the underlying pathology.
Disclosure
No significant relationships.
|
| first_indexed | 2024-03-11T07:36:35Z |
| format | Article |
| id | doaj.art-1b590ff108944112857dda8359821b12 |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-03-11T07:36:35Z |
| publishDate | 2022-06-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-1b590ff108944112857dda8359821b122023-11-17T05:09:19ZengCambridge University PressEuropean Psychiatry0924-93381778-35852022-06-0165S452S45310.1192/j.eurpsy.2022.1147Affective disorder associated with post-traumatic epilepsy, misdiagnosis and under treatment: A case reportE. Giourou0A. Theodoropoulou1S. Yfantis2O. Prodromaki3E. Georgila4P. Gourzis5General University Hospital of Patras, Greece, Department Of Psychiatry, Patras, GreeceGeneral University Hospital of Patras, Greece, Department Of Psychiatry, Patras, GreeceGeneral University Hospital of Patras, Greece, Department Of Psychiatry, Patras, GreeceGeneral University Hospital of Patras, Greece, Department Of Psychiatry, Patras, GreeceGeneral University Hospital of Patras, Greece, Department Of Psychiatry, Patras, GreeceGeneral University Hospital of Patras, Greece, Department Of Psychiatry, Patras, Greece Introduction A history of traumatic brain injury (TBI) is often associated with acquired epilepsy, which is associated with psychiatric co-morbidity, that when undetected might lead to misdiagnosis and mistreatment. Objectives The objective is to present the case of a 47-years-old male with a history of TBI and undetected acquired epilepsy, with a subsequent treatment resident mood disorder that was lead to a full clinical remission once epileptic activity was controlled using anti-seizure monotherapy. Methods After compulsory admittion to our inpatient psychiatric unit because of suicidal ideation and persistent aggressive behavior with volatile mood swings, the patient was fully evaluated and his psychiatric and medical histories were recorded. A brain CT scan and EEG were performed. Laboratory tests excluded other medical co-morbidity. Results The patient had a previous history of TBI and subsequent multiple episodes of mood disorders that failed to reach full remission even if treated with antidepressives and antipsychotics for adequate time and dosage according to current quidelines. EEG was positive for epileptiform activity with sporadic slow theta waves and right frontotemporal epileptic-like features while the patient was free of clinical seizures. Carbamazepine was initiated and titrated up to 1200mg daily leading to the full remission of the initial clinical symptoms along with the EEG findings’ improvement. The patient remained stable with his functionality at its utmost recovery during the two-years follow-up evaluations. Conclusions TBI induced epilepsy might be under-diagnosed in the absence of clinical seizures leading to the mistreatment of the associated psychiatric disorders that could be the only clinical presentation of the underlying pathology. Disclosure No significant relationships. https://www.cambridge.org/core/product/identifier/S0924933822011476/type/journal_articleepilepsyTBIcarbamazepineaffective disorders |
| spellingShingle | E. Giourou A. Theodoropoulou S. Yfantis O. Prodromaki E. Georgila P. Gourzis Affective disorder associated with post-traumatic epilepsy, misdiagnosis and under treatment: A case report European Psychiatry epilepsy TBI carbamazepine affective disorders |
| title | Affective disorder associated with post-traumatic epilepsy, misdiagnosis and under treatment: A case report |
| title_full | Affective disorder associated with post-traumatic epilepsy, misdiagnosis and under treatment: A case report |
| title_fullStr | Affective disorder associated with post-traumatic epilepsy, misdiagnosis and under treatment: A case report |
| title_full_unstemmed | Affective disorder associated with post-traumatic epilepsy, misdiagnosis and under treatment: A case report |
| title_short | Affective disorder associated with post-traumatic epilepsy, misdiagnosis and under treatment: A case report |
| title_sort | affective disorder associated with post traumatic epilepsy misdiagnosis and under treatment a case report |
| topic | epilepsy TBI carbamazepine affective disorders |
| url | https://www.cambridge.org/core/product/identifier/S0924933822011476/type/journal_article |
| work_keys_str_mv | AT egiourou affectivedisorderassociatedwithposttraumaticepilepsymisdiagnosisandundertreatmentacasereport AT atheodoropoulou affectivedisorderassociatedwithposttraumaticepilepsymisdiagnosisandundertreatmentacasereport AT syfantis affectivedisorderassociatedwithposttraumaticepilepsymisdiagnosisandundertreatmentacasereport AT oprodromaki affectivedisorderassociatedwithposttraumaticepilepsymisdiagnosisandundertreatmentacasereport AT egeorgila affectivedisorderassociatedwithposttraumaticepilepsymisdiagnosisandundertreatmentacasereport AT pgourzis affectivedisorderassociatedwithposttraumaticepilepsymisdiagnosisandundertreatmentacasereport |