Postictal psychosis can be a serious complication following epileptic seizure, but the risk factors for such events are unclear. In a retrospective analysis of the clinical records of 684 patients with temporal lobe epilepsy, Hilger et al. identified 48 patients with a history of postictal psychosis, and revealed several associated risk factors including young age at epilepsy onset, presence of ictal fear, and ictal and interictal epileptiform activity. Risk of postictal psychosis was not, however, associated with MRI measures of brain pathology.