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Background Although many studies have demonstrated a high prevalence of psychiatric disorders in epileptic patients, most have used unstructured psychiatric interviews for diagnosis, which may lead to significant differences in results. Here we present a study evaluating the prevalence of major psychiatric comorbidities in a cohort of South Brazilian patients with temporal lobe epilepsy using a structured clinical interview. Methods Neuropsychiatric symptoms were analyzed in 98 patients (39 men and 59 women) with temporal lobe epilepsy. Patient mean age was 43 years old, and mean duration of epilepsy was 25 years. Patients were diagnosed according to the ILAE Classification of Epileptic Syndromes using clinical, EEG, and neuroimaging criteria. All patients participated in the Structured Clinical Interview for DSM‐IV (SCID). Results Fifty‐three patients (54.1%) presented major psychiatric comorbidities. Mood disorders were observed in 42 patients (42.9%), the most common being neuropsychiatric disorders. Anxiety disorders were the second most frequent disorders, observed in 18 patients (18.4%). Psychotic disorders and substance abuse were each observed in six patients (6.1%). There were no clinical variables regarding epilepsy characteristics (age of onset, duration, response to antiepileptic drugs) and no MRI features associated with psychiatric disorders. A seven‐fold increased risk of mood disorders was identified in patients with inter‐ictal EEG abnormalities associated with the left hemisphere. Conclusion Relative to previous reports, we identify a high prevalence of psychiatric disorders in TLE patients, although our data is similar to that observed in other studies which have used similar structured interviews in populations of epileptic patients attending tertiary centres. The wide variation in percentages is probably attributable to the different patient groups investigated and to the even greater variety of diagnostic methods. Structured psychiatric interviews may contribute to a better evaluation of the true prevalence of psychiatric comorbidities in temporal lobe epilepsy.

Muromonab CD3 (murine monoclonal antibody towards the cluster of differentiation 3 antigen; OKT3) is a murine IgG 2a monoclonal antibody from the OKT series that specifically reacts with the epsilon chain of the CD3 molecular complex on the surface of circulating T lymphocytes. OKT3 can be used as a treatment for acute allograft rejection episodes and as "rescue" therapy for steroid-resistant allograft rejection [1][2][3][4][5][6][7] . OKT3 can also be used during the perioperative period as induction therapy in sequential immunosuppressive regimens. Recently, OKT3 has elicited renewed interest due to its capacity to induce immune tolerance. This aspect will probably lead to the revaluation of OKT3 role for organ transplants 1 . We report a patient who received intraoperative inductive OKT3 in renal retransplant to improve graft viability. The patient developed a very early aseptic OKT3-related meningoencephalopathy that complicated her management during the immediate postoperative period. We were unable to find in literature such early onset of meningoencephalopathy associated with use of OKT3. CASEA 26-year old female with end-stage renal failure of undefined cause was admitted for cadaveric renal retransplant. She was on hemodialysis since 1990 and underwent to an unsuccessful renal transplantation in 1993.Short before surgery hemodialysis was optimized in order to minimize CRS. Surgery started 19:00. Midazolam (15 mg) was used as anesthetic premedication. General anesthesia was induced with etomidate (0.2 mg/kg), sulfentanil (1 mg/kg) in bolus followed by atracurium (0.5 mg/kg) that was repeated every 30 minutes. She received epidural analgesia with bipuvocaine plus dimorphine. Anesthesia was maintained with O 2 /N 2 O [1:1] and isofluorane (concentration up to 1%) under controlled mechanical ventilation. Patient was monitored according with ASA recommendations. Inductive immunosuppressive therapy (sequential therapy) was applied through intravenous intraoperative use of 500 mg of methylprednisolone, followed by 5 mg OKT3 one hour later. These drugs were used before allograft perfusion. The surgery ended at about 23:00 h and all surgical and anesthetic procedures occurred without abnormalities. At about 01:15 h the patient presented fever (37.6ºC). During the next hours her body temperature ranged from 37.6 to 38.5ºC, while arterial pressure was stable, and arterial oxygen saturation ranged from 97% to100%, with O 2 administered through a Venturi mask. Since recovery from anesthesia was quite delayed, blood tests were ordered and she was admitted into the intensive care unit, where she was seen by a neurologist.Upon this first neurological evaluation she showed response only to vigorous physical stimuli. She presented nuchal rigidity and had miotic pupils, but normal oculocephalic reflexes. Generalized hypertonia was evident and deep tendon reflexes were briskly symmetrical. Bilateral Babinski's sign was present. At this time urea was 94 mg/dL, creatinine was 5.5 mg/dL, hemoglobin was 9.4 g/dL, hematocrit wa...