Surgical treatment of temporal lobe epilepsy with interictal psychosis: results of six cases

Marchetti, R.; Fiore, Lia Arno; Valente, Kette D.; Gronich, Gary; Nogueira, Adriano Barreto; Tzu, Wen Hung

doi:10.1016/s1525-5050(03)00021-0

Cited by 25 publications

(9 citation statements)

References 39 publications

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“…They should not be regarded as contraindications to surgery for patients with medically intractable seizures. However, they do require clinicians' awareness and often need treatment [64,69].…”

Section: Treatment Of Depressionmentioning

confidence: 99%

Complex partial seizures and depression

Greenlee¹,

Ferrell

Kauffman³

et al. 2003

Curr Psychiatry Rep

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A long-recognized association exists between epilepsy and affective disturbance, especially depression. People with complex partial seizures that result from temporal lobe seizure foci are highly vulnerable to psychiatric disorders. Accurate diagnosis of such disorders is an important key to treatment. Interictal depression or dysphoria is the most clinically significant problem of this type. Pharmacotherapeutic treatments that have positive effects in other types of depressive illness are also effective for depression associated with epilepsy. Electroconvulsive therapy is helpful to some patients with depression that is refractory to drug treatment or psychotherapy. Surgical resection of seizure foci may lead to psychiatric improvement for some individuals, but can also have psychiatric complications.

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Section: Treatment Of Depressionmentioning

confidence: 99%

Complex partial seizures and depression

Greenlee¹,

Ferrell

Kauffman³

et al. 2003

Curr Psychiatry Rep

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“…What is difficult clinically is predicting when the associated psychoses will improve with resection of the lesion. 19 If the lesion and symptoms are both acute in onset, the temporal association may support a causal link. However, in a case such as discussed here, in which the psychotic symptoms and tumor are both chronic in nature and time of onset may be variable, subjective, and/or unknown, the conundrum of causality remains.…”

Section: Discussionmentioning

confidence: 99%

“…Although there is general agreement that limbic tumors can cause both epilepsy and occasionally psychotic symptoms, whether resection can relieve psychotic symptoms in chronic interictal psychosis is not clear. 19 We report an illustrative case of a patient with longstanding epilepsy, chronic interictal psychosis, and a nonenhancing amygdalar tumor who had immediate improvement of psychotic symptoms after removal of his amygdalar tumor. epilepsy workup and pharmacological seizure treatment at an outside institution, as described below.…”

mentioning

confidence: 99%

Improved psychotic symptoms following resection of amygdalar low-grade glioma: illustrative case

Andrews

Wozny

Yue

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Epilepsy-associated psychoses are poorly understood, and management is focused on treating epilepsy. Chronic, interictal psychosis that persists despite seizure control is typically treated with antipsychotics. Whether resection of a mesial temporal lobe lesion may improve interictal psychotic symptoms that persist despite seizure control remains unknown. OBSERVATIONS In a 52-year-old man with well-controlled epilepsy and persistent comorbid psychosis, brain magnetic resonance imaging (MRI) revealed an infiltrative, intraaxial, T2 fluid-attenuated inversion recovery intense mass of the left amygdala. The patient received an amygdalectomy for oncological diagnosis and surgical treatment of a presumed low-grade glioma. Pathology was ganglioglioma, World Health Organization grade I. Postoperatively, the patient reported immediate resolution of auditory hallucinations. Patient has remained seizure-free on 2 antiepileptic drugs and no antipsychotic pharmacotherapy and reported lasting improvement in his psychotic symptoms. LESSONS This report discusses improvement of psychosis symptoms after resection of an amygdalar glioma, independent of seizure outcome. This case supports a role of the amygdala in psychopathology and suggests that low-grade gliomas of the limbic system may represent, at minimum, partially reversible etiology of psychotic symptoms.

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“…4 Marchetti et al achieved full remission of post-operative psychosis and depression using 18 bilateral ECT with citalopram in a 36-year-old man who had a right temporal lobectomy for intractable complex partial seizures from right mesial temporal sclerosis. 5…”

Section: Discussionmentioning

confidence: 99%