Is it in your differential diagnosis? Two Case Reports

Temporal Lobe Epilepsy (TLE), also referred as Complex Partial Seizures, is a medical diagnosis that must be considered in the pediatric, adolescent, and adult population presenting for psychiatric care. Mood disorders are common in people with epilepsy, with a prevalence rate of 20 to 50%. Scant literature exists that seeks specifically to enhance our knowledge of the similarities and subtle differences between TLE, Bipolar Disorder (BD) and Post Traumatic Stress Disorder (PTSD). Our objective is to describe an adolescent and adult case; one initially diagnosed as BD, the other PTSD, when in fact, it was TLE. We aim to illustrate that misdiagnosis and failure to diagnose are common. The provider must engage in a thorough review of systems and consider TLE in the differential diagnosis. A delay in the appropriate diagnosis and treatment can lead to a substantial amount of adverse effects and worsening of symptoms and negatively impact one’s quality of life.

Two case studies; an adolescent and one adult, diagnosed with BD and the other PTSD. Both endorsed a history of symptoms indicative of TLE. Key assessment findings and screening diagnostics alerted us to the differential diagnosis of TLE. The overlap of the symptom presentation is described.

TLE and many psychiatric conditions often present with overlapping symptoms. Patients have the potential to present with absence seizures, unprovoked irritability, oppositionality, aggression, anger, paroxysmal anxiety, somatic symptoms such as headaches, nausea, burning in the abdomen, stereotyped movements or behaviors, hypergraphia bizarre or incongruous affect, symptoms of fear, disturbed sleep, tearfulness, memory problems, déjà vu, fugue states, changes in cognition, inability to concentrate, fatigue, auditory and visual hallucination and bad temper.

Our differential diagnosis of TLE was confirmed with electroencephalogram (EEG). By prescribing the appropriate medications to these two individuals, they were able to experience improved moods, become more productive in society, working, attending church, family outings, etc. They were weaned off their antipsychotic medications, of which an abundance of troubling side effects is now a non-issue.

A delay in the proper diagnosis of TLE can have a significant negative impact on the adolescent and adult population. A need exists to educate mental health professionals on the overlap of symptoms of TLE and psychiatric disorders. The significant issue at hand is that they may not be receiving adequate or appropriate medications. Considering TLE in the differential diagnosis of presenting mood instability ensures our patients they are getting the basics of psychiatric care; which always emphasizes ruling out medical conditions first.