Secondary Schizophrenia (38 page)

epilepsy and SLP. Seizures, either by the presence of
Chronic interictal psychoses studied longitudinally

continuous subictal activity or by their modulation of
will help determine how seizures modulate the
Organic Syndromes of Schizophrenia – Section 3

expression of psychotic symptoms. The boundary
erotopias, abnormal gyral patterns, or cortical dys-between postictal and brief interictal psychoses is
genesis? Are large ventricles and low volume of the
poorly defined, and a comparison of the clinical fea-cortex, thalamus, cerebellum, and so on, commonly
tures of these subgroups, as currently distinguished, as
reported in schizophrenia, also present in the chronic
well as their ictal, EEG, and neuroimaging correlates,
SLP of epilepsy? Functional imaging studies, using
will be instructive. Methodologically superior family-PET, SPECT, or functional MRI, should examine the
genetic studies of SLP will help answer the question of
hypothesis of hypofrontality in SLP if a final com-whether the epilepsy patients who become psychotic
mon pathway for the psychoses is hypothesized. PET

are so predisposed genetically. Some work of this kind
and SPECT should be applied to the study of neu-has begun to appear
[92].

rotransmitter function in SLP, in particular to exam-Newer neurophysiological and neuroimaging tech-ine pre-and postsynaptic dopamine, serotonin, and
niques have not yet been sufficiently applied to the
glutamate functions. Patients who received tempo-psychoses of epilepsy. Magnetoencephalography, with
ral lobe surgery and had a previous history of psy-its potential to detect deep limbic discharges nonin-chosis, or developed psychosis subsequently, remain
vasively, may help answer the question of whether
an excellent resource for neuropathological studies.

prolonged psychosis can be produced by continuous
Nonpsychotic patients should be used for comparison,
subictal activity without abnormalities on scalp EEG.

and surgically excised tissue, should be examined for
Because both anticonvulsants and antipsychotics may
cell disarray, low numbers of certain cells (e.g. neu-confound such studies, drug-free and preferably drug
rons containing dinucleotide phosphate diaphorase),
naive subjects should be studied. Magnetic source
small neuronal size, and abnormal cell migration.

imaging is also an excellent technique with which to
Newer techniques, such as immunocytochemistry and
examine SLP for anomalous cerebral lateralization in
in situ hybridization for gene expression of messenger
view of the intriguing but uncertain literature on lat-RNA, when applied to surgically excised tissue, may
erality of epilepsy and SLP. The application of MRI,
help examine the dopamine hyperfunction, glutamate
with its ability to image mesial sclerosis, heterotopias,
hypofunction, and other neurotransmitter hypotheses
and other developmental abnormalities and to per-of schizophrenia in subjects with SLP. Several tech-form volumetric assessments, can address a number
niques are now available to identify candidate genes
of questions: Does mesial temporal sclerosis under-for cortical development that could be applied to tissue
lie schizophrenia-like psychosis in epilepsy, or is it
from patients with SLP. Finally, because animal models
related to neurodysplastic lesions? Do the patients
of epilepsy are well established, they provide a useful
who develop SLP also have abnormalities of the tem-entry point to the development of suitable models for
poral and/or frontal neocortices? Do they have het-schizophrenia or psychotic disturbance.

Chapter 6 – Schizophrenia-like psychosis and epilepsy

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