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Systematic review of structural and functional brain alterations in psychosis of epilepsy
  1. James Allebone1,
  2. Richard Kanaan2,3,
  3. Sarah J Wilson1,3,4
  1. 1Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
  2. 2Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
  3. 3Florey Institute of Neuroscience and Mental Health, Brain Research Institute (Austin Campus), Melbourne, Victoria, Australia
  4. 4Comprehensive Epilepsy Programme, Austin Health, Melbourne Brain Centre, Melbourne, Victoria, Australia
  1. Correspondence to James Allebone, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC 3010, Australia; james.allebone{at}unimelb.edu.au

Abstract

This systematic review critically assesses structural and functional neuroimaging studies of psychosis of epilepsy (POE). We integrate findings from 18 studies of adults with POE to examine the prevailing view that there is a specific relationship between temporal lobe epilepsy (TLE) and POE, and that mesial temporal lobe pathology is a biomarker for POE. Our results show: (1) conflicting evidence of volumetric change in the hippocampus and amygdala; (2) distributed structural pathology beyond the mesial temporal lobe; and (3) changes in frontotemporal functional network activation. These results provide strong evidence for a revised conceptualisation of POE as disorder of brain networks, and highlight that abnormalities in mesial temporal structures alone are unlikely to account for its neuropathogenesis. Understanding POE as a disease of brain networks has important implications for neuroimaging research and clinical practice. Specifically, we suggest that future neuroimaging studies of POE target structural and functional networks, and that practitioners are vigilant for psychotic symptoms in all epilepsies, not just TLE.

  • Epilepsy
  • Functional Imaging
  • Neuropsychiatry
  • PET

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Footnotes

  • Contributors JA: study concept and design, acquisition of data, analysis and interpretation of data, drafting and critical revision of the manuscript for intellectual content. RK and SJW: study concept and design, critical revision of the manuscript for intellectual content.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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