De novo psychogenic seizures after epilepsy surgery: case report

Abstract

-The occurrence of de novo psychogenic seizures after epilepsy surgery is rare, and is estimated in 1.8% to 3.6%. Seizures after epilepsy surgery should be carefully evaluated, and de novo psychogenic seizures should be considered especially when there is a change in the ictal semiology. We report a patient with de novo psychogenic seizures after anterior temporal lobe removal for refractory temporal lobe epilepsy. Once psychogenic seizures were diagnosed and psychiatric treatment was started, seizures stopped.KEY WORDS: psychogenic seizure, epilepsy surgery. Crises psicogênicas de novo após cirurgia de epilepsia: relato de casoRESUMO -A ocorrência de crises psicogênicas de novo após cirurgia de epilepsia é rara, e é estimada em 1,8% a 3,6%. Crises após cirurgia de epilepsia devem ser cuidadosamente avaliadas, e crises psicogênicas de novo devem ser consideradas especialmente quando houver uma mudança na semiologia ictal. Relatamos o caso de uma paciente com crises psicogênicas de novo após lobectomia temporal anterior realizada para tratamento de epilepsia temporal de difícil controle. Uma vez feito o diagnóstico de crise psicogênica e iniciado tratamento psiquiátrico, as crises foram controladas. PALAVRAS-CHAVE: crise psicogênica, cirurgia de epilepsia.Seizure recurrence following surgical treatment of refractory epilepsy is usually characterized by events which are similar to the preoperative ones, and may indicate a poor prognosis. Acute postoperative generalized tonic-clonic or focal motor seizures associated with a precipitating factor such as subtherapeutic antiepileptic drug (AED) blood levels, meningitis or metabolic disturbances often have a good prognosis 1 .Except for changes in duration of ictal and post-ictal symptomatology, seizures clinically different from those recorded before surgery are rare, and may represent psychogenic seizures 2 .We report a patient with de novo psychogenic seizures after anterior temporal lobe removal for refractory temporal lobe epilepsy. CASEAn 18 year-old right handed girl experienced her first seizure at age 11. During the following years seizures increasingly became more frequent, and by the time she was 17 years-old she had four or five complex partial seizures every 10 to 15 days. Seizures were characterized by staring,

Psychogenic non-epileptic seizures (PNES) in the context of concurrent epilepsy – making the right diagnosis

“…PNES have been reported to develop for the first time after 1.8 to 8.8% epilepsy surgical procedures [14,[38][39][40][41][42][43][44].…”

De novo psychogenic nonepileptic attacks after adult epilepsy surgery: An underestimated entity

“…PNEAs, developing de novo after epilepsy surgery, have not been well studied. Two case reports and four retrospective series have been published with a total of 44 patients with postsurgical PNEA (Ferguson & Rayport, ; Krahn et al., ; Ney et al., ; Parra et al., ; Glosser et al., ; Montenegro et al., ). In one more recent postsurgical series, patients after anterotemporal lobectomy were screened for postoperative PNEA (Kanner et al., ).…”