Nonepileptic Seizures After Resective Epilepsy Surgery

Abstract

Summary:Purpose: To identify factors that are associated with the emergence of nonepileptic seizures (NES) after resective epilepsy surgery.Methods: Twenty-two patients with medically refractory epilepsy in whom NESs were documented by EEG after resective surgery were compared with a larger series of epilepsy surgery patients on demographic, neurologic, and psychiatric variables.Results: NES tended to become apparent in the first few months after surgery. Patients who developed NESs did not differ from other epilepsy surgery patients in terms of age, IQ, or preoperative psychiatric diagnoses. However, surgical NES patients' neurologic problems and seizures began later in life, the NES group included a larger proportion of female subjects and patients with right hemisphere surgery, and NES patients were more likely to develop non-NES psychiatric problems after surgery.Conclusions: The heterogeneous collection of behaviors subsumed under the label NESs are determined by multiple factors.Several variables were found to be specifically associated with the development of NES after resective epilepsy surgery: A disproportionate number of postsurgical NES patients are female, they have primary neurologic dysfunction in the right hemisphere, and their epileptic seizures often began after adolescence. We propose that at least one group of patients with somatoform tendencies develop NESs as part of the psychiatric instability that occurs often in the few months after resective surgery. Key Words: Nonepileptic seizures-Temporal lobectomy.Nonepileptic seizures (NESs) may be defined as repeated paroxysmal behavioral events that are falsely interpreted to be epileptic seizures, either by the patient himself or herself or by others, but which are not accompanied by electrographic indicators of epilepsy on concurrent EEG. NESs are not infrequent among patients with well-documented chronic epilepsy (1-3). In several reported cases, NESs developed after resective surgery in patients with medically refractory epileptic seizures (4-7).It has been suggested that the prevalence of NES after epilepsy surgery is higher than generally recognized (3, although this problem has received relatively little attention and systematic study. This study examined a group of postsurgical epilepsy patients with EEG-documented NES to identify factors that might be associated with the development of NES after resective surgery. NES patients were compared with a larger group of unselected epilepsy surgery patients on various demographic, neurologic, and psychiatric variables.

Long-Term Psychiatric Outcomes After Epilepsy Surgery in Adults

“…They suggested that a low full-scale IQ, preoperative psychiatric comorbidity, and major surgical complications could be potential risk factors. In a study of 220 patients, 22 (10 %) developed postsurgical de novo PNES [ 35 ]. In this study, preoperative psychopathology was not identifi ed, in contrast to the other studies and our own data (see above) [ 11 ].…”

De Novo Nonepileptic Seizures after Cranial Surgery for Epilepsy: Incidence and Risk Factors

“…Previous studies have identified potential risk factors for the development of NES after cranial surgery to treat intractable epilepsy (6,8,9). We compared the patients in the present study with patients in a larger group representative of our surgical population, and found that there were no significant differences with respect to ages at the time of surgery and epilepsy onset, duration of epilepsy, FSIQ, proportion of each sex, side of surgery, seizure outcome, and proportion with IDD preoperatively.…”

“…Glosser et al included in their series of 9 patients whose NES morphology consisted solely of minor symptoms: 6 patients experienced panic, 1 anxiety, 1 somnolence, and 1 visual hallucinations (6). These symptoms indeed may occur as simple partial seizure events but their inclusion as NES can be questioned.…”

“…Several potential risk factors for their development have been identified. Glosser et al reported 22 cases and identified later age of onset of epilepsy, female sex, right side of resection, and postoperative psychiatric changes, consisting mainly of a "transient mixed mood disorder," as risk factors (6). Ney et al, reporting five cases, found low Full Scale Intelligence Quotient (FSIQ), serious preoperative psychiatric disorders, and the occurrence of operative complications to increase risk (8).…”

Takotsubo cardiomyopathy associated with nonepileptic seizure after percutaneous endoscopic lumbar discectomy under general anesthesia

“…Some anesthetic agents can also trigger seizures [4]. Glosser et al [5] reported nonepileptic seizures after cranial surgery to treat intractable epilepsy. Despite these previous reports, nonepileptic seizures are rare complication after general anesthesia and are classified as either physiologic or psychogenic in origin.…”