A Case Report of Psychosis as an Expression of Focal Impaired Awareness Seizure (FIAS) In Elderly Patient

Azeem NC, Saiveri NFA, Izanini ABM and Muhamad-Norie MH

Published on: 2026-03-18

Abstract

Formerly known as complex partial seizures, focal impaired awareness seizures (FIAS) are defined as focal seizures that originate in one hemisphere of the brain and are associated with an impairment of consciousness. FIAS is frequently misdiagnosed as a functional psychiatric disorder due to its affective, behavioral, and cognitive symptoms, especially when there is absence of motor manifestation of seizure or that part of history was omitted. This case portrayed a case of a geriatric patient with FIAS presenting as psychotic and behavioral disturbance.

This case illustrates a 68-year-old lady with a background history of hypertension and hyperlipidemia presented with acute behavioral disturbance associated with auditory hallucinations and persecutory delusion. Detailed history revealed that she has been experiencing recurrent fitting episodes which was   described   as   tonic-clonic seizure with impaired awareness 2 to 3 times a month since about 20 years ago. Notwithstanding, her recurrent episodes of fitting she was still able to fully function independently as well as managing the household. There were no episodes of affective or behavioral disturbance. This year though, the fitting episode became more frequent in which she was also reported to have cognitive decline with episodes of riotous behavioral disturbance and psychosis that lead her to first medical and psychiatry contact.

A thorough clinical assessment is crucial, especially in geriatric patients that exhibits symptoms of psychosis, altered   mental state, with concomitant chronic   medical conditions. For patients with atypical presentations of seizure disorders, a high index of suspicion is necessary to effectively manage and avoid future seizure episodes, especially when there is no conclusive diagnostic instrument available at the time of seizure activity