Psychiatric outcome after refractory temporal lobe epilepsy surgery

D`ALESSIO L, SCÉVOLA L, ODDO S, KAUFFMAN M, PAPAYANNIS C, SOLÍS P, SEOANE E, CONSALVO D, KONOPKA H, DONNOLI V, KOCHEN S

Cartagena, Colombia

Congreso; 6º Congreso Latinoamericano de Epilepsia; 2010

Liga Internacional Contra la Epilepsia

  Introduction Patients with RTLE (refractory temporal lobe epilepsy) who underwent epilepsy surgery have a high prevalence of psychiatric disorders such as psychosis. However, psychiatric contraindications for epilepsy surgery are not clear, and there are many controversies in the literature; while some patients become better after surgery from their psychiatric condition, others can develop psychosis de novo.     Objectives To determine the subtypes of psychotic disorders in a population with RTLE, surgical candidates, an determine the psychiatric outcome after surgery, in patients with a history of psychotic disorders (PG) and patients without psychosis (CG)   Material and Methods All patients included in this study underwent a complete clinical, electrophysiological, and image evaluation to confirm RTLE diagnoses. Psychiatric assessment was performed before and after surgery (one year), and DMS IV Structural Interview for psychiatric disorders for Axis I and II in combination with Ictal classification for psychosis was used.     Results 40 RTLE patients who underwent epilepsy surgery were included in this study. 15 patients had a positive history of psychosis (the most common one was brief psychotic disorder). 25 patients without psychosis were considered as a control group. After surgery 4 patients of PG and 0 patients of CG developed psychosis sympthomatology (p<0.05)     Conclusion The presence of a positive history of psychosis before surgery was associated with the development of psychotic sympthomatology after surgery. Patients with psychotic symptoms got better with the administration of low doses of risperidone.