POST-ICTAL PSYCHOSIS AFTER TEMPORAL RESECTION
Abstract number :
2.409
Submission category :
Year :
2003
Submission ID :
3968
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Paul A. Garcia, Nicholas M. Barbaro, John A. Walker Neurology, University of California, San Francisco, San Francisco, CA; Neurosurgery, University of California, San Francisco, San Francisco, CA
On rare occasions, patients with refractory temporal lobe epilepsy develop the tendency to post-ictal psychosis after temporal lobectomy1,2. Right-sided surgery1 and residual seizures from the contralateral temporal lobe2 have been proposed as important risk factors. We report the clinical and electrophysiological factors related to the development of post-ictal psychosis after temporal lobectomy in our surgical series.
We reviewed the post-operative course in 97 left and 105 right anterior temporal lobectomy patients. Patients with pre-existing post-ictal psychosis were excluded. Pathological, neurophysiological, anatomical and clinical factors were assessed in patients with new, post-ictal psychoses.
Two patients developed post-ictal psychoses after surgery. Both had lesionectomies and anterior temporal resections that included the amygdala and a portion of the hippocampus. Patient 1 had seizures arising from the right temporal lobe and a right temporal pleomorphic xanthoastrocytoma. Patient 2 had seizures arising from the left temporal lobe and a left posterior temporal cavernous malformation. Both had frequent complex partial seizures prior to surgery with very rare progression to secondarily generalized tonic-clonic seizures. After surgery, both had very rare seizures that always generalized. Patient 1 was hospitalized for two episodes of post-ictal psychosis and patient 2 had two episodes that required hospitalization and several more that were attenuated with prophylactic neuroleptics and did not require hospitalization. Patient 1 had adjustments in her medications that resulted in her becoming seizure-free and she has now been free from auras and seizures for more than two years. Patient 2 had repeat video/EEG monitoring demonstrating residual seizures from the left (operated) temporal lobe. She had further resection of the peri-lesional, neocortical tissue and mesial temporal structures. She continued to have seizures that were further changed in character such that they were rare, brief, complex partial seizures. After clonazepam was added to her regimen, she became completely free from seizures and auras.
Post-ictal psychosis is a very rare complication of temporal lobectomy. Pooling of information from multiple centers will be necessary to better define the risk factors for this condition. Nevertheless, our finding of post-operative, post-ictal psychosis in patients with either left or right-sided, lesional temporal lobe epilepsy suggests that side of surgery and contralateral residual seizure activity are not the only factors involved in the pathogenesis of this condition. The change in character of our patients[apos] seizures (frequent complex partial seizures to rare convulsions) may have been an important contributing factor.
References:
1) Manchanda R, et al. Post-ictal psychosis after right-temporal lobectomy. J Neurol Neurosurg Psychiatry 1993;56:277-9
2) Christodoulou C, et al. Post-ictal psychosis after temporal lobectomy. Neurology 2002;59:1432-5