title: Epilepsy and brain injury: a case report of a dramatic neuropsychiatric vicious circle.
abstract: OBJECTIVE
  Early treatment of epilepsy is warranted to avoid possible severe consequences. This study aimed to assess the value of treatment in a patient who developed epilepsy after major brain surgery.
  
  
  METHODS
  Case description. A 51 years-old man had a history of putative petit mal seizures since adolescence and left frontotemporal lobectomy after a major traffic accident at age 17. He subsequently developed quickly generalizing partial complex seizures, associated with severe behavioural alterations and personality changes; the condition was left untreated. A further seizure-related loss of consciousness led to another traffic accident at age 47.
  
  
  METHODS
  The patient was administered 200 mg/day topiramate, 600 mg/day quetiapine, 1000 mg/day valproate, 1200 mg/day gabapentin and 800 mg/day carbamazepine.
  
  
  RESULTS
  The instituted anti-epileptic treatment reduced seizure frequency and severity, but did not affect psychiatric symptomatology, which even worsened. An association between anti-epileptic drugs with mood stabilizing properties and an atypical anti-psychotic dramatically improved psychiatric symptoms, but did not prevent the patient from needing long-term healthcare.
  
  
  CONCLUSIONS
  Long-term untreated epilepsy may expose to accident proneness and further psychiatric deterioration. Early diagnosis and treatment of epilepsy may help in avoiding a potentially lethal vicious circle.
authors.affiliation: Department of Neuropsychiatry, Villa Rosa, Suore Hospitaliere of the Sacred Heart of Jesus, Viterbo, Italy. rapinesi.chiara@libero.it
authors.forename: Chiara
authors.initials: C
authors.lastname: Rapinesi
authors.forename: Antonio
authors.initials: A
authors.lastname: Del Casale
authors.forename: Daniele
authors.initials: D
authors.lastname: Serata
authors.forename: Giorgio D
authors.initials: GD
authors.lastname: Kotzalidis
authors.forename: Paola
authors.initials: P
authors.lastname: Scatena
authors.forename: Antonio
authors.initials: A
authors.lastname: Muzi
authors.forename: Simone
authors.initials: S
authors.lastname: Lazanio
authors.forename: Valeria
authors.initials: V
authors.lastname: Savoja
authors.forename: Paolo
authors.initials: P
authors.lastname: Carbonetti
authors.forename: Claudio
authors.initials: C
authors.lastname: Fensore
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferracuti
authors.forename: Gloria
authors.initials: G
authors.lastname: Angeletti
authors.forename: Roberto
authors.initials: R
authors.lastname: Tatarelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
mesh_terms: D000063:Accidents, Traffic / Q000523:psychology; D000374:Aggression / Q000523:psychology; D000588:Amines / Q000627:therapeutic use; D038481:Anterior Temporal Lobectomy / Q000009:adverse effects; D000927:Anticonvulsants / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology; D002220:Carbamazepine / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003987:Dibenzothiazepines / Q000627:therapeutic use; D018450:Disease Progression; D042241:Early Diagnosis; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D005632:Fructose / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D000069348:Quetiapine Fumarate; D013997:Time Factors; D000077236:Topiramate; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D003987:Dibenzothiazepines; D000077236:Topiramate; D000069348:Quetiapine Fumarate; D005632:Fructose; D002220:Carbamazepine; D005680:gamma-Aminobutyric Acid; D014635:Valproic Acid; D000077206:Gabapentin