Postictal psychiatric phenomena are relatively frequent in patients with treatment-resistant epilepsy. This chapter reviews the most relevant clinical aspects of peri-ictal symptomatology. Ictal panic is one of the most frequently misdiagnosed symptoms in medical practice, as it is often diagnosed as a panic attack. Postictal psychiatric phenomena may be the expression of isolated psychiatric symptoms; clusters of postictal psychiatric symptoms (PPS) mimicking a depressive, anxiety or psychotic episode; postictal exacerbation in severity of interictal psychiatric symptoms and persistence of interictal symptoms into the postictal period. In contrast to postictal symptoms of depression (PSD) or PDE, postictal psychotic episodes (PIPE) can be readily prevented and treated. Prevention of PIPE is possible in patients who are found to have bilateral ictal foci in the course of a video-EEG or who are known to develop PIPE after a cluster of seizures.

Wolf-Hirschhorn syndrome (WHS) is a multiple congenital anomalies/intellectual disability disorder due to deletion, or loss of material, of the distal portion of the short arm of chromosome 4. Seizures/epilepsy represents one of the main clinical challenges in 4p WHS. Epilepsy is well controlled in most WHS individuals (80%). Phenobarbital has been reported as the most effective drug against tonic-clonic seizures. About 30-40% of the deletions will not be detected by karyotype. Therefore, fluorescence in situ hybridization (FISH) with cosmid probes from the WHS critical region (WHSCR), or comparative genomic hybridization microarray (aCGH) are necessary to confirm the diagnosis. Brain magnetic resonance imaging (MRI) should be performed in all individuals with seizures, since malformation of the cerebral cortex may modify prognosis and management. A waking/sleeping video-EEG-polygraphic study, electrocardiogram [ECG], surface electromyogram [EMG]) is recommended in infancy and childhood, in order to achieve the best characterization of seizures.