Post-ictal psychosis after right temporal lobectomy.

Manchanda, Rahul; Miller, Harry W.; McLachlan, Richard S.

doi:10.1136/jnnp.56.3.277

Cited by 73 publications

(27 citation statements)

References 12 publications

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“…In addition, multiple studies have examined the issue of postoperative psychosis and the laterality of surgery. Most studies report psychosis to be more common in patients following right temporal lobectomy than left [55,58]. The explanation for this lateralizing correlation is yet to be established.…”

Section: Psychosis After Epilepsy Surgerymentioning

confidence: 88%

Neuropsychiatric complications of epilepsy

Kanner

Palac

2002

Curr Neurol Neurosci Rep

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Psychiatric complications of epilepsy are multiple and result from the complex interaction between endogenous, genetic, therapeutic, and environmental factors. The relationship between epilepsy and psychiatric disorders may be much closer than previously appreciated. Recent studies have suggested the existence of a bi-directional relationship between depression and epilepsy, whereby patients with epilepsy have a higher risk than the general population of suffering from depression, not only after, but also before the onset of epilepsy. Furthermore, similar neurotransmitter changes have been identified in depression and epilepsy, suggesting the possibility that these two disorders share common pathogenic mechanisms. Although the clinical manifestations of psychiatric disorders in epilepsy are often indistinguishable from those of nonepileptic patients, certain types of depression and psychotic disorders may present with clinical characteristics that are particular to epilepsy patients. These include the psychosis of epilepsy, postictal psychotic disorders, alternative psychosis (or forced normalization), and certain forms of interictal depressive disorders.

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Section: Psychosis After Epilepsy Surgerymentioning

confidence: 88%

Neuropsychiatric complications of epilepsy

Kanner

Palac

2002

Curr Neurol Neurosci Rep

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“…This decision appears to be based on the lack of effect of surgery on psychosis in most patients 6,24,40,41 , on rare reports of postoperative psychiatric deterioration 22,40,[42][43][44] or on the fear that psychosis would prevent adequate preoperative evaluation and postoperative rehabilitation. More recently, .enwick has advocated surgical treatment in these cases on the basis that freedom from seizures is worthwhile despite unrelenting psychosis 45 .…”

Section: Discussionmentioning

confidence: 99%

Complete remission of epileptic psychosis after temporal lobectomy: case report

Marchetti

Tavares

Gronich

et al. 2001

Arq. Neuro-Psiquiatr.

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-We report a case of a female patient with refractory complex partial seizures since 15 years of age, recurrent postictal psychotic episodes since 35 which evolved to a chronic refractory interictal psychosis and MRI with right mesial temporal sclerosis (MTS). After a comprehensive investigation (video-EEG intensive monitoring, interictal and ictal SPECT, and a neuropsychological evaluation including WADA test) she was submitted to a right temporal lobectomy. Since then, she has been seizure-free with remission of psychosis, although with some persistence of personality traits (hiperreligiosity, viscosity) which had been present before surgery. This case supports the idea that temporal lobectomy can be a safe and effective therapeutic measure for patients with MTS, refractory epilepsy and recurrent postictal epileptic psychosis or interictal epileptic psychosis with postictal exacerbation.KEY WORDS: epilepsy, mental disorders, psychosis, temporal lobe.Remissão completa de psicose epiléptica de paciente submetida a lobectomia temporal: relato de caso RESUMO -Relatamos o caso de uma paciente que apresentava crises parciais complexas desde a idade de 15 anos, episódios psicóticos recorrentes desde os 35, evoluindo para psicose crônica interictal refratária, em quem investigação pela ressonância magnética (RM) revelou a presença de esclerose temporal mesial (ETM) direita. Após investigação abrangente (monitorização intensiva pelo vídeo-EEG, SPECT interictal e ictal e avaliação neuropsicológica incluindo teste de WADA), a paciente foi submetida a lobectomia temporal direita. Desde então, ela está sem crises e a sua psicose remitiu, persistindo apenas alguns traços de personalidade (religiosidade, viscosidade) que ela já apresentava anteriormente. Este caso dá suporte à idéia de que a lobectomia temporal pode ser uma medida terapêutica segura e eficaz para pacientes com ETM, epilepsia refratária e psicose epiléptica pós-ictal recorrente ou psicose epiléptica interictal com agravamento pós-ictal. PALAVRAS-CHAVE: epilepsia, transtornos mentais, psicose, lobo temporal. Several mental disorders may occur in patients with epilepsy. Psychoses associated with epilepsy are among those of major concern to neurologists and psychiatrists. These psychoses are classified into periictal (of which most significant are the postictal psychoses) and interictal. Postictal psychoses have onset in the late postictal period (hours or days after) of an isolated seizure or of a cluster of complex partial seizures (CPS) with or without secondary generalization. Its presentation is typically pleomorphic, with delusions and hallucinations, loose associations, mannerisms and mood swings 1,2 . Prevalence is of 4% in cases of apparently non-refractory epilepsy 3 and of 7-18% in cases of refractory epilepsy 2,4,5 . Interictal psychoses are chronic and/or recurrent, with delusions, hallucinations, thought disorders, disorganized behavior, relative absence of catatonic symptoms, mood swings, apragmatism and emotional blunting (less intense t...

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“…The development of psychosis or deterioration in psychiatric status after surgery is more common in patients with later age of onset, unreality or dkja vu rather than epigastric aura, preoperative evidence of bilateral brain damage, and persistence of EEG or clinical seizure activity (77). In addition, right temporal lobectomy may increase susceptibility to postictal psychosis (81), particularly in patients who do not become seizure-free after surgery (79).…”

Section: Epileptic Surgical Patients and Psychosismentioning

confidence: 99%

“…This severe complication after surgery occurs in about 1 . 3 4 8 % of patients (79,80). The development of psychosis or deterioration in psychiatric status after surgery is more common in patients with later age of onset, unreality or dkja vu rather than epigastric aura, preoperative evidence of bilateral brain damage, and persistence of EEG or clinical seizure activity (77).…”

Section: Epileptic Surgical Patients and Psychosismentioning

confidence: 99%

Behavioral, Psychotic, and Anxiety Disorders in Epilepsy: Etiology, Clinical Features, and Therapeutic Implications

1999

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Summary: This chapter deals with some aspects of psychiatric disturbances in people with epilepsy. Because depression and its treatment are extensively described later in this issue, they are not discussed here. The same pertains to forced normalization. Key Words: Epilepsy-Anxiety-PsychosisDepress ion-Qua1 i ty of 1 i fe-Ps e u do s ei zure s-A n t idepressants-Antipsychotics-Antiepileptic drugs.Although most people with epilepsy lead a normal emotional and cognitive life, neurobehavioral problems can be found in a large number of patients. Higher rates of psychopathology are observed in people with epilepsy relative to the general population (1,2), to other neurologic control groups (3), and to people with chronic nonneurologic disorders (1,4). In particular, increased psychopathology is more common in temporal lobe epilepsy (TLE) than in generalized epilepsy (5). Nevertheless, many issues remain highly controversial, owing in part to several methodologic problems, such as the nosographic approach, the sample examined, the type of control groups, the comparison among nonhomogeneous forms of epilepsy, and the different antiepileptic drugs (AEDs).Psychiatric disturbances can be related either to involvement of brain structures (biologic pathogenesis) or to the chronic characteristics of epilepsy (psychosocial pathogenesis). These psychiatric symptoms may develop in relationship to the seizures (in prodromal, ictal, or postictal periods) but more commonly are present in a chronic interictal condition.The wide range of clinical diversity is related to the anatomic foci, to patterns of spread, and to biologic or psychological differences among patients. Interictal behavioral changes in epilepsy remain controversial and difficult to define, mainly because pathogenesis may be attributable to several factors, such as epilepsy itself, possible brain lesions, the AEDs prescribed, and psychosocial problems (6). On the other hand, the existence of cognitive changes in epilepsy is well established, and Addrress correspondence and reprint requests to Dr. Riccardo Tom at Dipartimento di Neuroscienze, via Cherasco 11, 10126 Torino, Italy.sometimes the presence of cognitive disorders can facilitate the appearance of psychiatric disturbances (7).One of the most widely discussed problems is the incidence of psychiatric pathology in epilepsy, with a wide range of values in the literature related to the type of study. Epilepsy is characterized by a broad spectrum of severity. Ideally, patients for study trials should be selected consecutively from a general epilepsy population, but most epidemiologic studies are carried out in centers for epilepsy and include many refractory subjects who demonstrate a range of pathologic disturbances more severe than those observed in the general population of patients with epilepsy. In community studies, the prevalence of associated psychiatric disorders is low, whereas in specialty referral centers, particularly those serving indigent populations, the prevalence can rise to 25-50%: Among patient...

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Post-ictal psychosis after right temporal lobectomy.

Cited by 73 publications

References 12 publications

Neuropsychiatric complications of epilepsy

Neuropsychiatric complications of epilepsy

Complete remission of epileptic psychosis after temporal lobectomy: case report

Behavioral, Psychotic, and Anxiety Disorders in Epilepsy: Etiology, Clinical Features, and Therapeutic Implications

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