title: Electroconvulsive therapy for psychosis in a patient with epilepsy related to hypothalamic hamartoma.
abstract: Psychosis is more common in people with temporal lobe epilepsy than it is in the general population. Treatment can be difficult in these patients because of the complex interactions between antipsychotic and antiepileptic drugs. Some antipsychotic drugs also decrease the seizure threshold. We report the case of a 49-year-old man with a hypothalamic hamartoma, with a history of both gelastic and temporal lobe seizures. The patient was rendered seizure-free after three neurosurgical procedures but developed a drug-resistant paranoid psychosis. He was treated with electroconvulsive therapy (ECT). After two weeks with six stimulations that resulted in seizures, the psychiatric phenomena disappeared completely. There was no relapse of either the psychiatric symptoms or the seizures during the 42 months of follow-up. This case report suggests that ECT might be safe for psychosis in patients with a history of seizures that have previously been successfully treated with neurosurgery, although caution should be exercised in drawing general conclusions from a single case report.
authors.affiliation: Neurology Department, University Hospital of Strasbourg and Medical School of Strasbourg, Institut des Neurosciences Cellulaires et Intégratives CNRS UPR 3212, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ruppert
authors.forename: Laurence
authors.initials: L
authors.lastname: Lalanne
authors.forename: Jack
authors.initials: J
authors.lastname: Foucher
authors.forename: Marie-Agathe
authors.initials: MA
authors.lastname: Zimmermann
authors.forename: Edouard
authors.initials: E
authors.lastname: Hirsch
authors.forename: Pierre
authors.initials: P
authors.lastname: Vidailhet
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D000078306:Clobazam; D003702:Delusions / Q000209:etiology / Q000523:psychology; D004351:Drug Resistance; D004565:Electroconvulsive Therapy / Q000379:methods*; D004827:Epilepsy / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D006222:Hamartoma / Q000150:complications* / Q000523:psychology / Q000601:surgery; D006801:Humans; D007029:Hypothalamic Neoplasms / Q000150:complications* / Q000523:psychology / Q000601:surgery; D000077213:Lamotrigine; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000188:drug therapy / Q000628:therapy*; D016634:Radiosurgery; D013702:Temporal Lobe / Q000601:surgery; D014227:Triazines / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D014150:Antipsychotic Agents; D014227:Triazines; D001569:Benzodiazepines; D000078306:Clobazam; D000077213:Lamotrigine