EARLY AND IMMEDIATE POSTOPERATIVE PSYCHIATRIC FINDINGS IN PATIENTS SUBMITTED TO CORTICO-AMYGDALO-HIPPOCAMPECTOMY FOR REFRACTORY EPILEPSY
Abstract number :
1.456
Submission category :
Year :
2003
Submission ID :
1930
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Valeria A. Mello, Carla Baise, Cristine M. Baldauf, Meire Argentoni, Cassio R. Forster, Leila Frayman, Arthur Cukiert, Jose A. Burattini, Pedro P. Mariani, Joaquim O. Vieira, Rodio Brandao, Lauro Ceda Neurology and Neurosurgery, Hospital Brigadeiro, Sao P
Corticoamygdalohippocampectomy (CAH) is the commonest procedure carried out for the treatment of refractory epilepsy. Important limbic relays are targeted by the procedure and psychiatric alterations might be expected after it. We have studied the early and immediate postoperative findings in patients submitted to CAH.
Twenty-nine patients submitted to CAH received psychiatric evaluation 1 week prior to surgery and 1 week and 1 month after surgery. Psychiatric evaluation included a diagnostic interview (SCID), rating for the Hamilton 21 Depression Scale (HAM21), Brief Psychiatric Evaluation Protocol (BPRS) and Young Mania Scale (EAM-m). Thirteen patients were submitted to left and 16 to right CAH.
Overall, 9 patients had preoperative psychiatric disease. Seven patients presented significant psychiatric alterations during the studied period (6 within the first week and 1 after one month, postoperatively) and 3 out of these had previous psychiatric disease. Two of them have been submitted to left and 5 to right CAH. One patient developed depression 1 week after left CAH; 3 patients developed mania 1 week after CAH (2 right and 1 left CAH); 1 patient developed mania and depression after right CAH; 1 patient developed psychotic symptoms 1 week after surgery and 1 patient developed mania 1 month after surgery. All patients received treatment targeted at the specific psychiatric disturbances. All except one were off medications 1 month after surgery.
Almost a quarter of the patients submitted to CAH developed psychiatric alterations during the early and immediate postoperative periods. Right side CAH seems to be related to a higher psychiatric morbidity during the studied period. These patients often need brief medical therapy for the treatment of the psychiatric disorder, especially patients with hypomania/mania. A larger series might consolidate the statistical analysis.
[Supported by: Sao Paulo Secretary of Health]