Surgery May Help Epilepsy and Psychoses

Surgical Rounds®August 2014

Surgery to address drug-resistant epilepsy may improve psychoses, according to a study.

The finding that patients with epilepsy have a higher incidence of delusions, hallucinations, and disorganized behaviors than the general population is controversial as some researchers suggest this is an apparent overrepresentation because of sampling errors or inadequate control groups.

However, most researchers acknowledge that drug-resistant temporal lobe epilepsy has been linked to increased risk of psychotic disorders. Up to 18% of these patients have psychoses. If the disorders are truly linked, one might think patients with comorbid epilepsy and psychoses who undergo surgery for their epilepsy would also see improvements in their psychoses. This is not always the case. Instead, some patients develop new psychoses or depression.

Argentinean researchers published findings in the July 2014 issue of the journal Epilepsy & Behavior indicating surgery to address drug-resistant epilepsy may improve psychoses.

The researchers identified surgical candidates with drug-resistant temporal lobe epilepsy and comorbid psychoses between 2000 and 2010 and followed participants, prospectively, for 2 years after surgery. During the study period, 89 patients were admitted to the epilepsy surgery program, 14 of which (15.7%) were identified as having comorbid psychoses.

After surgery, 71% of patients had good epilepsy outcomes as measured by reduced seizure activity and improved functioning; 6 patients (43%) were free of psychiatric complications; 3 patients (21%) with chronic interictal psychosis experienced the same level of psychiatric illness as they had preoperatively; 3patients (21%) developed acute and transient psychotic symptoms; and 2 patients (14%) developed depression.

Traditionally, neurosurgeons were less likely to operate on epileptics with preexisting psychosis, believing surgery would not improve and may worsen psychiatric symptoms postoperatively. In recent years, neurosurgeons are more likely to consider these patients, especially if psychiatric supervision is provided.

The authors report that approximately half of patients with transient psychotic episodes before surgery had good psychiatric outcomes. Although, half of patients had mild psychiatric complications, they were managed successfully with antipsychotics, antidepressants, topiramate reduction, or their presurgical antipsychotic regimens.

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