Neuropsychiatric Manifestation of Lobar Epilepsy: A Case Report

Background: Temporal lobe epilepsy due to mesial temporal sclerosis (MTS) is a well-recognized cause of drug-resistant seizures. In some cases, associated behavioral and psychiatric symptoms may obscure the diagnosis and delay appropriate treatment. Case Presentation: We report a 29-year-old male with a history of recurrent seizures over 2 to 3 months, described mainly as episodes of lip smacking and occasional head banging, occurring several times per day. These events were suggestive of orofacial automatisms. He also complained of hearing voices of religious and ancestral figures. Because of these symptoms, he was evaluated multiple times in psychiatric settings and was started on antipsychotic medications, following which his condition appeared to worsen. He required repeated hospital admissions and did not show sustained improvement. Initial metabolic and hematological investigations were unremarkable. Magnetic resonance imaging brain with epilepsy protocol showed findings consistent with MTS. Electroencephalography (EEG) findings were in keeping with the imaging and supported a diagnosis of temporal lobe epilepsy. The patient was treated with multiple antiepileptic drugs, including levetiracetam, sodium valproate, and carbamazepine, but seizure control remained suboptimal. Clobazam was later added in a low dose, after which a noticeable reduction in both frequency and severity of seizures was seen. He is currently on follow-up and showing clinical improvement. Conclusion: This case underlines how temporal lobe epilepsy can present with prominent psychiatric features, leading to delays in diagnosis. A careful clinical assessment, along with timely neuroimaging and EEG, is important in such cases. Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India