Psychoses in drug-resistant temporal lobe epilepsy.

Abstract

S U M MAR Y In the survey of 74 Danish patients with temporal lobe epilepsy who underwent temporal lobectomy, a total of 20 patients were psychotic. Nine of these became psychotic during the follow-up period, six of them after cessation of their epileptic seizures. There were 13 schizophrenia-like psychoses, six paranoid delusional and depressive psychoses, and one childhood psychosis. Operation was on the right side in 39 and on the left side in 35 patients. When the various psychotic groups were compared with each other or with the nonpsychotic patients, the side of operation was no,t found to be statistically important. The patients with psychoses were older at operation and showed a higher rate of focal lesions in the resected specimens. Although more psychotic patients were bright or normally gifted, and had achieved a higher standard of schooling than nonpsychotic patients, their social status after operation was inferior. Surgery had no effect on psychosis present preoperatively nor on its possible postoperative onset. The diagnosis of psychosis was not considered to be a contraindication to temporal lobectomy.

Complete remission of epileptic psychosis after temporal lobectomy: case report

“…Lesions of embryologic origin such as hamartomas and cortical dysgenesis 23,24 or hippocampal sclerosis, also known as mesial temporal sclerosis (MTS) 7,34 have…”

“…Prevalence in general population studies varies from 2-7,1% [8][9][10] , in general clinics from 0,8-9,2% [13][14][15][16][17][18][19][20] and in neurological or epilepsy clinics from 8,8-27% [21][22][23][24][25][26] . The purpose of this paper is to report the case of a patient with refractory epilepsy and epileptic psychosis and the value of therapeutic surgery such as temporal lobectomy in her treatment.…”

Psychiatric Outcome of Temporal Lobectomy for Epilepsy: Incidence and Treatment of Psychiatric Complications

“…In a series of 100 of Falconer's patients, Taylor reported seven with de novo postoperative psychosis (16). The report from the Danish series of 74 patients with temporal lobectomy (17,18) of six patients with de novo postoperative psychosis and of six suicide attempts during the first postoperative month is striking. Trimble (19) reviewed all data available from temporal lobectomy series, calculated that postoperative de novo psychoses developed in 3.8-35.7% (mean, 7.6%) of patients and concluded that in at least some cases a causal relation (by way of "forced normalization") may be suggested.…”

Depression in Patients With Epilepsy

“…Table 20 (Taylor 1975), except when a patient was left handed (Trimble and Perez 1983 -personal communication). There are, however, several studies which have come up with negative results in this regard, in particular those of Mignone et al (1970), Jensen and Larsen (1979b) and Shukla and Katiyar (1980). The point has been made, that none of these latter authors examined in detail the phenomenology, using only clinical criteria for assessment: the authors that have demonstrated a lateralit-~ -126 -effect have tended to be predominantly British, whose diagnostic criteria for the assessment of schizophrenifo::'.'ID.…”

“…Several authors have noted a decrease seizure frequency prior to the onset of psychosis (Pond 1957;Flor Henry 1969;Bruens 1971;Sigal 1976;Kristensen and Sindrup 1978;Jensen and Larsen 1979b). The greatest area of controversy is as to whether the schizophrenia-like psychoses are associated with TLE or not: authors in favour of the argument are Slater et al (1963), Bruens (1971), Sigal (1976), Toone and Driver (1980), Ounsted and Lindsay (1981) and Trimble and Perez (1982).…”