Cultural Beliefs Delaying Treatment of Temporal Lobe Epilepsy with Psychosis: A Case Report

Abstract

Epilepsy is a chronic neurological disorder frequently associated with psychiatric comorbidity and substantial social stigma, particularly in low- and middle-income countries. Cultural interpretations of seizures as supernatural or spiritual phenomena may influence how patients and families understand the illness and may delay engagement with medical care. This report describes a patient with temporal lobe epilepsy whose treatment was significantly delayed because her family attributed the seizures to spiritual causes. A 30-year-old woman presented to a psychiatric outpatient clinic with behavioral changes including mood instability, suspiciousness, hallucinations, and progressive social withdrawal. Her first seizure occurred thirteen years earlier following eclampsia, and recurrent seizures continued without consistent neurological treatment. For many years the family sought help from a religious healer who performed spiritual rituals, as they believed the episodes were caused by spirit possession. During this period the patient experienced progressive seizures, cognitive decline, and the emergence of psychotic symptoms. Neuroimaging revealed bilateral mesial temporal sclerosis and electroencephalography demonstrated epileptogenic activity in the temporal regions. The patient received antipsychotic medication together with psychotherapy and psychoeducation directed toward both the patient and her family. This case illustrates how cultural beliefs surrounding epilepsy may contribute to prolonged delays in treatment and may allow neurological and psychiatric complications to develop. Clinicians working in culturally diverse settings should approach such beliefs with cultural sensitivity and dialogue rather than judgment, as respectful engagement with families may facilitate earlier acceptance of medical care and improve long term outcomes.