In summary, significant functional improvement was achieved for severe psychotic symptomatology (delusions, social withdrawal and hallucinations) in our patient experiencing partial complex epilepsy using therapeutic methods that have proven to be effective in treating schizophrenic patients. To the best of our knowledge, this is the first case of a psychotherapeutic treatment used effectively in treating refractory epilepsy of this type [
16].
When considering treatment options, one must keep in mind the forced normalization phenomenon in epilepsy, whereby improved seizure control is associated with a normalization of the EEG and the emergence of psychotic features [
17] and dysphoria [
12]. It is thought that abnormal synaptic activity may induce plastic changes through kindling mechanisms, and impair the naturally occurring homeostatic seizure-suppressing mechanisms (inhibitory factors) that maintain the inter-ictal state, with adverse consequence that these factors become dysfunctional, causing these symptoms when the epileptic activity is gone [
7]. Therefore, it is not surprising to find contradictory results when outcomes of temporal lobe surgery in treating patients with epilepsy and concomitant psychotic and dysphoric symptoms are compared [
18‐
20]. With regard to non-anti-convulsant medication, patients with epilepsy with inter-ictal psychosis seem to achieve higher remission rate with lower doses of anti-psychotic drugs compared to patients with schizophrenia [
21]. With regard to dysphoric symptoms, they usually respond well to anti-depressant medication [
12]. However, given the pro-convulsant properties of neuroleptic drugs in general, they should be prescribed with a great deal of parsimony when EEGs remain abnormal [
22]. Reports of successful treatment of psychosis associated to complex partial seizures have shown good response to anti-convulsant medication such as carbamazepine and valproic acid [
23], but this was not the case for our patient, which further underscores the possibility that the psychotherapeutic component of the treatment plan explains, at least to some extent, the progress noted for our patient. Finally, anti-epileptic drugs have been shown to decrease cognitive functioning [
24], which was not the case with our patient; he remained stable and even improved on some fronts (for example, speed of information processing).