Psychiatric outcome of epilepsy surgery in patients with psychosis and temporal lobe resistant epilepsy: A prospective case series
D`ALESSIO, SCÉVOLA L, FERNANDEZ LIMA M, ODDO S, SOLÍS P, SEOANEE, KOCHEN S
EPILEPSY & BEHAVIOR (PRINT)
ACADEMIC PRESS INC ELSEVIER SCIENCE
Lugar: Amsterdam; Año: 2014 vol. 35 p. 165 - 170
Objectives: Temporal lobe resistant epilepsy has been associated with a high incidence of psychotic disorders; however, there are many controversies; while some patients get better after surgery from their psychiatric con- dition, others develop psychosis or de novo depression. The aim of this study was to determine the psychiatric and seizure outcome after epilepsy surgery in patients with a previous history of psychoses. Methods: Surgical candidates with temporal lobe drug-resistant epilepsy and a positive history of psychosis diag- nosed during the presurgical psychiatric assessment were included. A two-year prospective follow-up was deter- mined after surgery. The DSM-IV Structural Interview, GAF (global assessment of functionality, DSM-IV), Ictal Classification for psychoses, and Engel´s classification were used. The Student t test and chi-square?Fisher tests were used. Results: During 2000?2010, 89 patients were admitted to the epilepsy surgery program, 14 patients (15.7%) presented psychoses and were included in this series. After surgery, six patients (43%) did not develop any psychi- atric complications, three patients (21%) with chronic interictal psychosis continued with no exacerbation, three pa- tients (21%) developed acute and transient psychotic symptoms, and two patients (14%) developed de novo depression. Seizure outcome was Engel class I-II in 10 patients (71%). Total GAF scores were higher after surgery in patients found to be in Engel class I?II (p b 0.05). Conclusions: Patients with comorbid psychosis and temporal lobe drug-resistant epilepsy may benefit from epilepsy surgery under close psychiatric supervision.