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epileptic psychoses are classified either based on the relationship between psychoses and seizures in terms of time or based on the duration of psychotic symptoms .
they are specifically separated into chronic psychoses or multiple types of acute episodic psychoses , which are further divided into postictal and interictal psychoses .
the prevalence of epileptic psychoses varies among reports ; however , some studies have reported similar findings at a frequency of approximately 5% , , .
symptoms widely vary and may involve not only psychotic symptoms but also anxiety or mood disorders . in this study , we report a patient with rare acute episodic symptoms including a distortion in the sense of time and a symptom wherein the patient feels that  what should be there disappears . 
the patient was a right - handed woman who was 38  years old when she visited our hospital for the first time .
although she experienced febrile convulsion once at the age of 2  years , she had no family history of mental disorders or epilepsy .
regarding her life history , she was born as the second of two children , and she did not show retardation during the fetal , infancy , or school period . after graduating from high school ,
, she lives with her mother . at the age of 16  years , she developed epilepsy with generalized tonic 
clonic seizures ( gtcs ) , and therefore , she began visiting a nearby psychiatrist . during the first several years while taking carbamazepine ( cbz ) or valproic acid ( vpa ) , she experienced no seizures .
however , she subsequently suffered from complex partial seizures ( cpss ) and simple partial seizures ( spss ) several times a week .
as in the case of habitual seizures , spss were only epigastric sensations , and they continued for a few minutes and sometimes developed into cpss . at onset , cpss involved impaired consciousness with automatisms , including ambulatory and groping actions .
complex partial seizures were sometimes followed by falling and unconsciousness , which usually continued for 12  min .
moreover , cpss often occurred independently but sometimes developed into gtcs , thus implying temporal lobe epilepsy ( tle ) .
after the first medical examination , we adjusted the dose of cbz and added phenytoin ( pht ) as the main antiepileptic agent .
however , these treatments did not result in any specific improvement in seizures , which continued for several times a week . in december 2007
furthermore , in june 2008 , she was seizure - free with the intake of 150  mg tpm , 550  mg cbz , and 150  mg pht .
after being seizure - free for 3  months , she experienced the first mental symptoms as described below .
we assessed the possibility of pht and tpm causing the symptoms , and therefore , we discontinued their use . however , the symptoms did not disappear , thus leading to the presumption that they were unrelated to antiepileptic agents , at least pht and tpm .
thereafter , we attempted treatment with lamotrigine ( ltg ) , but it was ineffective .
in addition , ltg caused insomnia and dizziness and , therefore , was withdrawn . in may 2010 , we coadministered cbz ( 550  mg ) with gradually increasing doses of clobazam ( clb ) . at this point
, the seizures gradually decreased , and in april 2012 , she was seizure - free . at the same time , the mental symptoms disappeared , and the occurrence of her symptoms was 10 times so far . regarding the mental symptoms , three types of symptoms were present , with each symptom occurring independently or in simultaneous combinations .
one of the symptoms was a distortion in the sense of time , which she described as , 
i feel that time is moving slowly , and i ca n't wait for the traffic signal to change .
the signal seems to not change to green for as long as i am looking at it .
this symptom was divided into two types in that she felt that time moved too slowly or quickly ; the former was more frequent than the latter .
when watching tv , i feel that  the next scene is supposed to be in a particular way. however , if the scene does not progress in the same way as i imagined , then i feel very anxious .
 what she predicted was spontaneous , and she had no intention of specifically predicting something . regarding the third symptom
, she mentioned  there does n't exist a thing where it is actually supposed to be , and there exists another thing where it is not supposed to be .
for example , something necessary often disappears when required , but it abruptly appears when i do n't need it .
further , when opening a drawer , there does n't exist a thing that is supposed to be in it .
however , i feel it 's strange and reopen the drawer to find the thing this time .  in this situation , what disappeared was more often what she took care of than what she unconsciously recognized ; however , it was not always consistent .
in addition , several objects disappeared , and they were not necessarily the ones that she owned : a bottle on the table , a particular instrument in the drawer , even a telephone pole on the street , etc . to summarize the characteristics of the three mental symptoms , their onsets and offsets were unclear , and they continued from a few hours to a few days .
in september 2013 , we performed magnetoencephalography ( meg ) but did not find any specific dipoles
. furthermore , in march 2010 , on performing head magnetic resonance imaging ( mri ) , we did not find any specific organic abnormal findings .
we also conducted interictal single - photon emission computed tomography ( spect ) with i - iomazenil , which did not identify any specific accumulating change between the early and delayed phases .
however , we did find a reduction of blood flow in the right parietal lobe and in the entire left hemisphere in both the early and delayed phases .
electroencephalography ( eeg ) findings varied with time . in october 2003 , the findings showed sharp- and slow - wave complexes predominantly at the right fp electrode or the right fp , f , and at electrodes . in november 2004
, they also showed sharp waves at the right at , mt , and bilateral fp electrodes . at the same time
subsequently , in january 2008 , when the mental symptoms had not yet emerged , the eeg findings showed spikes at the left fp and at electrodes and showed independent spikes at the right pt electrode .
after the emergence of the mental symptoms , in november 2013 , neither eeg nor 72-h long - term eeg findings revealed any epileptiform abnormalities .
thus , these findings along with her seizure types led to the diagnosis of tle . in 1989 ,
the classification of the international league against epilepsy referred to tle as symptomatic localization - related epilepsy . because the eeg findings were inconsistent in the present study , the focus remained undetermined .
in the present work , we report a patient with tle who showed rare mental symptoms . we generally investigated the characteristics of these symptoms ; in addition , we discussed each symptom in detail while citing previous research .
we have listed the characteristics of the mental symptoms that first emerged when the patient 's epilepsy began 26  years ago .
the symptom duration ranged from a few hours to a few days , and we could not clearly identify their onsets or offsets ; the symptoms did not follow specific unconsciousness . according to these characteristics
, we should judge the phenomena not by the seizures but by the mental symptoms , although we could not perform an eeg during the emergence of the symptoms .
for example , in the first 3  months , each mental symptom followed seizures .
however , subsequently , the mental symptoms emerged a few days after a series of gtcs , or by contrast , they could be followed by a series of gtcs .
therefore , we could consider these mental symptoms as acute episodic psychosis but not as subtypes , such as postictal or interictal psychoses .
a distortion in the sense of time has been previously reported by mullan and penfield .
however , no recent reports are available on it in the english literature , while a few reports are available in the japanese literature . regarding psychic seizures ,
several japanese studies have reported that  the focus was often found in the frontotemporal lobe in eeg if there are any foci ,   the type of seizures and interictal eeg imply the tle ,  and  a rapid type of distortion in time sense is followed by epileptic discharge , involving mesial temporal structures . 
furthermore , regarding an additional mental symptom , a case report of a patient with postictal psychosis is available . in this case report
, the authors showed that the patient recognized a distortion in the sense of time , which was followed by a dreamy state , depersonalization , and ictal fear for 2  days after a series of seizures . in our case report , we diagnosed the patient with tle and observed several similarities with findings of previous reports .
the eeg findings varied , but foci were presumed to be in the left or in the right frontotemporal lobe during a certain period ; no specific contradictions were observed . regarding the symptom described as 
the next scene is supposed to be in a particular way ,  we assessed it as a symptom similar to dj vu because we believed that the patient felt she had known in advance what would soon happen .
what should be there disappears ,  we anticipated that the symptom was related to jamais vu or a dreamy state .
therefore , we asked her to discuss this in detail ; however , she clearly denied the relationship .
we assessed that the symptom meant that although something actually existed , she could not recognize it , rather than the symptom being due to a change in familiarity . therefore , the symptom should not be considered as jamais vu .
we report this symptom as a new finding because we could not retrieve any similar reports during a literature search .
we report that the patient had several symptoms that are difficult to symptomatologically formulate , such as  a distortion in the sense of time ,   the next scene is supposed to be in a particular way ,  and  what should be there disappears . 
although little research is available on the mental symptoms of patients with epilepsy , it is necessary to study this further from several aspects .
this is a case report of a 38-year - old woman with temporal lobe epilepsy and epileptic psychoses . 
 the psychoses consisted of three rare symptoms that were  a distortion in the sense of time ,  
  what should be there disappears ,  and  the next scene is supposed to be in a particular way . 
  there have been few reports that included these symptoms ; therefore , we report the course of this patient in detail .