Epileptiform Discharges in Psychiatric Patients: A Controversy in Need of Resurrection

The current view of the psychiatric significance of inter-ictal spike discharges (IIS) in nonepileptic, psychiatric patients is that the discharges are “incidental” and are of no clinical significance. Hence, despite a voluminous literature suggestive that such discharges may have clinical relevance, electroencephalograms are hardly ever recorded in nonepileptic psychiatric patients. This literature is briefly summarized, and one detailed example of a disorder (i.e., autistic spectrum disorders) where such discharges are particularly common is provided. The argument is made that this is an area of psychiatry that is under-investigated and that research devoted to elucidating the mechanisms of development of IIS, their possible clinical relevance, and the role of anticonvulsants in managing such patients, could be very profitable.