Results of surgical treatment in temporal lobe epilepsy with chronic psychosis

Reutens, David C.

doi:10.1093/brain/120.11.1929

Cited by 53 publications

(28 citation statements)

References 39 publications

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“…This decision appears to be based on the lack of effect of surgery on psychosis in most patients 6,24,40,41 , on rare reports of postoperative psychiatric deterioration 22,40,[42][43][44] or on the fear that psychosis would prevent adequate preoperative evaluation and postoperative rehabilitation. More recently, .enwick has advocated surgical treatment in these cases on the basis that freedom from seizures is worthwhile despite unrelenting psychosis 45 .…”

Section: Discussionmentioning

confidence: 99%

Complete remission of epileptic psychosis after temporal lobectomy: case report

Marchetti

Tavares

Gronich

et al. 2001

Arq. Neuro-Psiquiatr.

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-We report a case of a female patient with refractory complex partial seizures since 15 years of age, recurrent postictal psychotic episodes since 35 which evolved to a chronic refractory interictal psychosis and MRI with right mesial temporal sclerosis (MTS). After a comprehensive investigation (video-EEG intensive monitoring, interictal and ictal SPECT, and a neuropsychological evaluation including WADA test) she was submitted to a right temporal lobectomy. Since then, she has been seizure-free with remission of psychosis, although with some persistence of personality traits (hiperreligiosity, viscosity) which had been present before surgery. This case supports the idea that temporal lobectomy can be a safe and effective therapeutic measure for patients with MTS, refractory epilepsy and recurrent postictal epileptic psychosis or interictal epileptic psychosis with postictal exacerbation.KEY WORDS: epilepsy, mental disorders, psychosis, temporal lobe.Remissão completa de psicose epiléptica de paciente submetida a lobectomia temporal: relato de caso RESUMO -Relatamos o caso de uma paciente que apresentava crises parciais complexas desde a idade de 15 anos, episódios psicóticos recorrentes desde os 35, evoluindo para psicose crônica interictal refratária, em quem investigação pela ressonância magnética (RM) revelou a presença de esclerose temporal mesial (ETM) direita. Após investigação abrangente (monitorização intensiva pelo vídeo-EEG, SPECT interictal e ictal e avaliação neuropsicológica incluindo teste de WADA), a paciente foi submetida a lobectomia temporal direita. Desde então, ela está sem crises e a sua psicose remitiu, persistindo apenas alguns traços de personalidade (religiosidade, viscosidade) que ela já apresentava anteriormente. Este caso dá suporte à idéia de que a lobectomia temporal pode ser uma medida terapêutica segura e eficaz para pacientes com ETM, epilepsia refratária e psicose epiléptica pós-ictal recorrente ou psicose epiléptica interictal com agravamento pós-ictal. PALAVRAS-CHAVE: epilepsia, transtornos mentais, psicose, lobo temporal. Several mental disorders may occur in patients with epilepsy. Psychoses associated with epilepsy are among those of major concern to neurologists and psychiatrists. These psychoses are classified into periictal (of which most significant are the postictal psychoses) and interictal. Postictal psychoses have onset in the late postictal period (hours or days after) of an isolated seizure or of a cluster of complex partial seizures (CPS) with or without secondary generalization. Its presentation is typically pleomorphic, with delusions and hallucinations, loose associations, mannerisms and mood swings 1,2 . Prevalence is of 4% in cases of apparently non-refractory epilepsy 3 and of 7-18% in cases of refractory epilepsy 2,4,5 . Interictal psychoses are chronic and/or recurrent, with delusions, hallucinations, thought disorders, disorganized behavior, relative absence of catatonic symptoms, mood swings, apragmatism and emotional blunting (less intense t...

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Section: Discussionmentioning

confidence: 99%

Complete remission of epileptic psychosis after temporal lobectomy: case report

Marchetti

Tavares

Gronich

et al. 2001

Arq. Neuro-Psiquiatr.

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“…94 This observation does not invalidate our hypothesis, as it is not clear that these patients have schizophrenia, and moreover, hippocampal removal (by temporal lobectomy) is never bilateral.…”

Section: Hippocampusmentioning

confidence: 68%

Neurosurgery for schizophrenia: an update on pathophysiology and a novel therapeutic target

Mikell

Sinha

Sheth

2016

JNS

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Schizophrenia is a heterogeneous disorder characterized by varying degrees of positive psychotic symptoms, negative symptoms, and cognitive impairment. 48 With a prevalence of 1.1% in the US, 93 schizophrenia is a major health burden, increasing the risk for numerous adverse outcomes, including the inability to maintain a stable residence, maintain a job, or find a spouse. 39Moreover, 10%-30% of patients with schizophrenia have little or no response to antipsychotic treatment. 68 Limited treatment options are available after first-line therapies have failed. Potential therapies for refractory schizophrenia include clozapine, electroconvulsive therapy, and repetitive transcranial magnetic stimulation (rTMS), but many patients continue to have symptoms despite maximal medical management.57 New treatment strategies are therefore needed.Although deep brain stimulation (DBS) is chiefly used in the treatment of movement disorders, its use in behavioral disorders is expanding. In 2009, the FDA awarded DBS a humanitarian device exemption (HDE) for obsessive-compulsive disorder (OCD). Given preliminary evidence of efficacy in OCD, 29,33,69,91 the use of DBS to treat other psychiatric disorders, including depression, Tourette syndrome, and even autism, is expanding. 111 Currently, interest in treating schizophrenia using DBS is growing, and a clinical trial is now open in Canada for the treatment of refractory schizophrenia. 16 Moreover, the growing use of DBS for behavioral indications has been accompanied by an expansion in understanding of the underlying pathophysiology of psychiatric disease. In the case of schizophrenia, there is increasing acceptance that the disorder is characterized by dysfunction in the hippocampus and striatum, suggesting possible targets for intervention. 54Given our increasing understanding of the neuroanatomy of schizophrenia, the time is ripe for the development of novel circuit-based therapies, including DBS.abbreviatioNs AST = associative striatum; BOLD = blood oxygen level-dependent; cSP = cortical silent period; DBS = deep brain stimulation; DLPFC = dorsolateral prefrontal cortex; fMRI = functional MRI; GABA = gamma-aminobutyric acid; HDE = humanitarian device exemption; MDD = major depressive disorder; NMDA = N-methyl-daspartate; OCD = obsessive-compulsive disorder; rCBF = regional cerebral blood flow; rTMS = repetitive TMS; SICI = short-interval intracortical inhibition; TMS = transcranial magnetic stimulation; VBM = voxel-based morphometry; VS = ventral striatum; VTA = ventral tegmental area. The main objectives of this review were to provide an update on the progress made in understanding specific circuit abnormalities leading to psychotic symptoms in schizophrenia and to propose rational targets for therapeutic deep brain stimulation (DBS). Refractory schizophrenia remains a major unsolved clinical problem, with 10%-30% of patients not responding to standard treatment options. Progress made over the last decade was analyzed through reviewing structural and functional neuroimaging s...

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“…Lastly, in patients with medically intractable TLE, surgical approach may precipitate the onset of the psychotic features [57]. This process could be qualitatively different from the previously seen signs of psychosis (if any), and, in other cases, psychiatric condition would just remain unchanged with postoperative seizure improvement [58]. …”

Section: Psychosismentioning

confidence: 99%

Epilepsy, Mental Health Disorder, or Both?

Beletsky

Mirsattari

2012

Epilepsy Research and Treatment

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Temporal lobe epilepsy (TLE), a subset of the seizure disorder family, represents a complex neuropsychiatric illness, where the neurological presentation may be complemented by varying severity of affective, behavioral, psychotic, or personality abnormalities, which, in turn, may not only lead to misdiagnosis, but also affect the management. This paper outlines a spectrum of mental health presentations, including psychosis, mood, anxiety, panic, and dissociative states, associated with epilepsy that make the correct diagnosis a challenge.

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Results of surgical treatment in temporal lobe epilepsy with chronic psychosis

Cited by 53 publications

References 39 publications

Complete remission of epileptic psychosis after temporal lobectomy: case report

Complete remission of epileptic psychosis after temporal lobectomy: case report

Neurosurgery for schizophrenia: an update on pathophysiology and a novel therapeutic target

Epilepsy, Mental Health Disorder, or Both?

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