Focal impaired awareness seizures in the context of postpartum psychosis and double maternal filicide.

Post partum psychosis is a rare but severe psychiatric emergency, and its comorbidity with a new onset focal seizure disorder can pose a profound diagnostic and therapeutic challenge. We present a tragic traumatic case where a 30-year-old multiparous woman, 12 weeks postpartum, with delusions of control, persecution, and an EEG-confirmed focal impaired awareness seizure (complex partial seizure), killed her two children. She was referred to our facility by the police 3 days after the tragic event in a confused and disoriented state. She had no previous history of psychiatric or neurological disorders. A multidisciplinary team of psychiatrists, neurologists, and clinical psychologists successfully managed her condition, and the associated police investigation was concluded without a formal prosecution because her family and the law enforcement agencies opted to drop the case. This case report emphasizes the need for a multidisciplinary collaboration to identify and manage neurological disorders in patients presenting with first episode psychiatric disorders, especially in the postpartum period. It highlights the forensic implications of the overlap between neurological and psychiatric disorders.