Abstracts

Rationale: Postictal psychosis (PIP) and postictal affective episodes (PAE) are psychiatric manifestations that arise within one week after a seizure, last from hours to days, and occur after a lucid interval. It is unclear how epilepsy surgery will alter the unknown underlying etiology of this postictal state, however, psychosis and de novo postictal psychiatric symptoms have been reported after epilepsy surgery. There is no known reported psychiatric outcome in patients with postictal psychiatric symptoms who undergo epilepsy surgery. We evaluate effect of epilepsy surgery on the postictal psychiatric state. Methods: 90 adults with intractable epilepsy underwent epilepsy resective surgery between 2007 and 2011. 29 patient had extra temporal lesion, 23 patient had right temporal lesion and 38 patient had left temporal lesion. Three of the 90 patient (3.3%) were identified as having postictal psychiatric symptoms prior to surgery, all of which had left MTS. Language dominance was left in 2 of them and bilateral in one as determined by intravenous sodium amobarbital test. All three patients had left temporal lobe epilepsy, with clinical manifestation of complex partial seizures with secondary generalization. Postictal symptoms were psychotic in two patients and affective in one. Symptom onset ranged from two to 24 hours after the seizures. Results: Three patients with postictal psychiatric symptoms (2 with PIP, and 1 with PAE) underwent epilepsy surgery with removal of left temporal lobe with Engle Class I seizure control in all patients. None of the three patients developed psychiatric symptoms postoperatively. Conclusions: Having preoperative postictal psychiatric symptoms did not result in poor psychiatric outcome after left temporal lobe resection.