Chirurgia dell'epilessia temporale e psicosi

Temporal Lobe Epilepsy is often associated with psychiatric disorders. Several studies proposed that this association is due to anatomical factors involving limbic sistem disfunctions. Also surgical treatment appears to be related to postoperative psychiatric complications. To determine interactions between psychiatric disorders before surgical treatment and incidence of psychosis after surgery, we identify a sample of drug-resistent Temporal Lobe Epilepsy patients treated surgically. In particular, our sample is composed of 7 patients (2 f.; 5 m.) with a diagnosis of psychosis one year after surgery (T2). We investigate psychological diagnosis before surgical treatment (T0) and six months (T1) after surgical treatment; we consider also treated lobe (left; right) and Engels's classification of postoperative outcome. At T2 all patients of our sample show a psychosis diagnosis. Regarding postoperative outcome, only one patient is completely seizure-free since surgery (Ia); it is treated right lobe for 71% and left lobe for 29%. T0: one patient shows a distimic disorder; another one a cluster A personality disorder; one patient no disorder; 4 patients a psychosis diagnosis. T1: the patient with distimic disorder show now a psycosis diagnosis; the other patients are stable. We conclude that patients with psycosis diagnosis before surgery are stable after surgery. Patients without disorders or with a no-psychosis disorder show an evolution in psycosis one year after surgery. This findings underline that a psychiatric disorders before surgical treatment should develop in psychosis after surgery, in particular involving temporal areas. Our sample doesn't show a completely seizure-free postoperative outcome, unless for a single case. Right lobe is the most common site of surgery in our sample. However, it is important to make also a quantitative analysis of psychiatric profile in preoperative stage, in particular in Temporal Lobe Epilepsy Disorder.