New-Onset Psychogenic Seizures After Surgery for Epilepsy

Ney, Gershon C.; Barr, William; Napolitano, Carline; Decker, Robert W.; Schaul, Neil

doi:10.1001/archneur.55.5.726

Cited by 52 publications

(33 citation statements)

References 14 publications

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“…In our sample of patients, however, we found that neurologic problems and epileptic seizures began at a significantly later age in postsurgical NES patients compared with other surgical patients. Similarly, we did not find evidence for the previously reported finding that patients who develop NESs after resective epilepsy surgery are more likely to have low intelligence or psychotic disorders (6). The NES patients in this study were comparable to or slightly higher than other surgical patients in terms of intellectual and social functioning.…”

Section: Discussioncontrasting

confidence: 98%

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Nonepileptic Seizures After Resective Epilepsy Surgery

Glosser

Roberts

Glosser³

1999

Epilepsia

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Summary:Purpose: To identify factors that are associated with the emergence of nonepileptic seizures (NES) after resective epilepsy surgery.Methods: Twenty-two patients with medically refractory epilepsy in whom NESs were documented by EEG after resective surgery were compared with a larger series of epilepsy surgery patients on demographic, neurologic, and psychiatric variables.Results: NES tended to become apparent in the first few months after surgery. Patients who developed NESs did not differ from other epilepsy surgery patients in terms of age, IQ, or preoperative psychiatric diagnoses. However, surgical NES patients' neurologic problems and seizures began later in life, the NES group included a larger proportion of female subjects and patients with right hemisphere surgery, and NES patients were more likely to develop non-NES psychiatric problems after surgery.Conclusions: The heterogeneous collection of behaviors subsumed under the label NESs are determined by multiple factors.Several variables were found to be specifically associated with the development of NES after resective epilepsy surgery: A disproportionate number of postsurgical NES patients are female, they have primary neurologic dysfunction in the right hemisphere, and their epileptic seizures often began after adolescence. We propose that at least one group of patients with somatoform tendencies develop NESs as part of the psychiatric instability that occurs often in the few months after resective surgery. Key Words: Nonepileptic seizures-Temporal lobectomy.Nonepileptic seizures (NESs) may be defined as repeated paroxysmal behavioral events that are falsely interpreted to be epileptic seizures, either by the patient himself or herself or by others, but which are not accompanied by electrographic indicators of epilepsy on concurrent EEG. NESs are not infrequent among patients with well-documented chronic epilepsy (1-3). In several reported cases, NESs developed after resective surgery in patients with medically refractory epileptic seizures (4-7).It has been suggested that the prevalence of NES after epilepsy surgery is higher than generally recognized (3, although this problem has received relatively little attention and systematic study. This study examined a group of postsurgical epilepsy patients with EEG-documented NES to identify factors that might be associated with the development of NES after resective surgery. NES patients were compared with a larger group of unselected epilepsy surgery patients on various demographic, neurologic, and psychiatric variables.

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Section: Discussioncontrasting

confidence: 98%

“…NESs are not infrequent among patients with well-documented chronic epilepsy (1)(2)(3). In several reported cases, NESs developed after resective surgery in patients with medically refractory epileptic seizures (4)(5)(6)(7).…”

mentioning

confidence: 99%

Nonepileptic Seizures After Resective Epilepsy Surgery

Glosser

Roberts

Glosser³

1999

Epilepsia

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“…Seizure frequency has been reported to be high, and it is consistent with the pattern presented by our patient 2,4 .…”

Section: Discussionsupporting

confidence: 92%

“…The occurrence of de novo psychogenic seizures after epilepsy surgery is rare, and is estimated in 1.8% to 3.6% 2,4 . There are a few reports about its occurrence, with a total of 8 cases described in the literature 2,4-6 .…”

Section: Discussionmentioning

confidence: 99%

De novo psychogenic seizures after epilepsy surgery: case report

Montenegro

Guerreiro

Scotoni

et al. 2000

Arq. Neuro-Psiquiatr.

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-The occurrence of de novo psychogenic seizures after epilepsy surgery is rare, and is estimated in 1.8% to 3.6%. Seizures after epilepsy surgery should be carefully evaluated, and de novo psychogenic seizures should be considered especially when there is a change in the ictal semiology. We report a patient with de novo psychogenic seizures after anterior temporal lobe removal for refractory temporal lobe epilepsy. Once psychogenic seizures were diagnosed and psychiatric treatment was started, seizures stopped.KEY WORDS: psychogenic seizure, epilepsy surgery. Crises psicogênicas de novo após cirurgia de epilepsia: relato de casoRESUMO -A ocorrência de crises psicogênicas de novo após cirurgia de epilepsia é rara, e é estimada em 1,8% a 3,6%. Crises após cirurgia de epilepsia devem ser cuidadosamente avaliadas, e crises psicogênicas de novo devem ser consideradas especialmente quando houver uma mudança na semiologia ictal. Relatamos o caso de uma paciente com crises psicogênicas de novo após lobectomia temporal anterior realizada para tratamento de epilepsia temporal de difícil controle. Uma vez feito o diagnóstico de crise psicogênica e iniciado tratamento psiquiátrico, as crises foram controladas. PALAVRAS-CHAVE: crise psicogênica, cirurgia de epilepsia.Seizure recurrence following surgical treatment of refractory epilepsy is usually characterized by events which are similar to the preoperative ones, and may indicate a poor prognosis. Acute postoperative generalized tonic-clonic or focal motor seizures associated with a precipitating factor such as subtherapeutic antiepileptic drug (AED) blood levels, meningitis or metabolic disturbances often have a good prognosis 1 .Except for changes in duration of ictal and post-ictal symptomatology, seizures clinically different from those recorded before surgery are rare, and may represent psychogenic seizures 2 .We report a patient with de novo psychogenic seizures after anterior temporal lobe removal for refractory temporal lobe epilepsy. CASEAn 18 year-old right handed girl experienced her first seizure at age 11. During the following years seizures increasingly became more frequent, and by the time she was 17 years-old she had four or five complex partial seizures every 10 to 15 days. Seizures were characterized by staring,

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“…Two case series described the occurrence of psychogenic seizures after brain surgery, usually for epilepsy. 4,16 There have also been reports of conversion disorder after implantation of a spinal cord stimulator for pain. 3,11 To our knowledge, there is no reported case in the literature of conversion disorder in an operated brain tumour patient manifesting as transient monoplegia.…”

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confidence: 99%

Conversion Disorder after Surgery in a Brain Tumour Patient

Khu

Ali

Bernstein

2010

Can. j. neurol. sci.

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We describe a case of conversion disorder in a young lady who had just been operated on for a glioma. CASE REPORTA 31-year-old lady presented two years ago with seizures manifesting as jerking of her right arm and leg. Neurological examination revealed no focal deficits. Brain imaging revealed the presence of a small lesion in her left mesial posterior frontal lobe, just anterior to the motor strip ( Figure 1). The appearance was compatible with a low grade glioma. There was no perilesional edema, enhancement, or mass effect. She was treated with anti-epileptic medications with good control of her seizures. The brain tumour was managed conservatively with regular clinical and imaging follow-up.The patient remained well and asymptomatic, but her most recent magnetic resonance imaging (MRI) showed an increase in the size of the tumour (Figure 2). Awake craniotomy with cortical mapping for tumour excision was recommended and performed. Mapping over the motor cortex was positive, in that the right leg became weak when that area of cortex was stimulated. Corticotomy was made anterior to the motor cortex and aggressive subtotal resection of the tumour was achieved leaving behind a small cuff posteriorly, adjacent to the motor strip. As is our usual protocol, the patient was sedated after the mapping was performed, precluding continuous testing during tumour resection.Immediately post-operatively, the patient could not move her right leg. Motor examination was 5/5 for all limbs except for the right lower extremity which was 0/5 in all muscle groups. There was no sensory deficit. The patient had hyperreflexia bilaterally but no Babinski. She was noted to have a positive Hoover's sign, with palpable downward force of the right leg while raising the unaffected left limb. The patient's pattern of leg weakness exhibited some inconsistencies: despite a motor strength of 0/5, she was able to bear weight on her right leg and walk with support within two days. In addition, throughout the patient's hospital stay, she showed little concern about and seemed to be indifferent to her condition.Various investigations were carried out. Computed tomogram four hours after surgery and MRI 40 hours post-operatively both revealed the resection cavity in the left posterior frontal area anterior to the precentral gyrus, and a small amount of residual tumour between the surgical site and the motor strip (Figure 3). There was no hemorrhage, increase in the perilesional edema, or mass effect. Neurophysiologic studies such as nerve conduction velocity, electromyography, and motor evoked potentials done two weeks after surgery confirmed no organic brain pathology. BRIEF COMMUNICATIONSSteroids were started but there was no improvement in the patient's leg weakness. Our considerations during this time were supplementary motor cortex syndrome versus conversion disorder. Upon probing further into the patient's history, it was found that she is married with a three-year-old son. She is a high school graduate and is unemployed. She has no previous med...

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New-Onset Psychogenic Seizures After Surgery for Epilepsy

Cited by 52 publications

References 14 publications

Nonepileptic Seizures After Resective Epilepsy Surgery

Nonepileptic Seizures After Resective Epilepsy Surgery

De novo psychogenic seizures after epilepsy surgery: case report

Conversion Disorder after Surgery in a Brain Tumour Patient

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