Running down phenomenon and acute interictal psychosis in medial temporal lobe epilepsy

Purpose: To examine the relationship between presurgical acute interictal psychosis and postsurgical running down phenomenon in a strictly homogeneous group with medial temporal lobe epilepsy. Methods: Forty patients with mesial temporal sclerosis and an ultimate excellent surgical outcome, were divided into running down positive and negative groups. Various clinical and laboratory data, including presurgical psychotic episodes, were analyzed in the two groups. Results: Patients in the running down positive group exhibited a significantly high incidence of presurgical history of acute interictal psychosis. Conclusion: We hypothesize that areas of secondary epileptogenesis beyond the scope of the primary epileptogenic zone, suggested by postsurgical running down phenomenon, may play an important role in the blockage and shift of the habitual propagation of seizure activity from the primary epileptogenic zone, to which Wolf attributed acute interictal psychosis. (C) 2000 Elsevier Science B.V. All rights reserved.