title: Psychiatric outcome of epilepsy surgery in patients with psychosis and temporal lobe drug-resistant epilepsy: a prospective case series.
abstract: OBJECTIVE
  Temporal lobe resistant epilepsy has been associated with a high incidence of psychotic disorders; however, there are many controversies; while some patients get better after surgery from their psychiatric condition, others develop psychosis or de novo depression. The aim of this study was to determine the psychiatric and seizure outcome after epilepsy surgery in patients with a previous history of psychoses.
  
  
  METHODS
  Surgical candidates with temporal lobe drug-resistant epilepsy and a positive history of psychosis diagnosed during the presurgical psychiatric assessment were included. A two-year prospective follow-up was determined after surgery. The DSM-IV Structural Interview, GAF (global assessment of functionality, DSM-IV), Ictal Classification for psychoses, and Engel's classification were used. The Student t test and chi-square-Fisher tests were used.
  
  
  RESULTS
  During 2000-2010, 89 patients were admitted to the epilepsy surgery program, 14 patients (15.7%) presented psychoses and were included in this series. After surgery, six patients (43%) did not develop any psychiatric complications, three patients (21%) with chronic interictal psychosis continued with no exacerbation, three patients (21%) developed acute and transient psychotic symptoms, and two patients (14%) developed de novo depression. Seizure outcome was Engel class I-II in 10 patients (71%). Total GAF scores were higher after surgery in patients found to be in Engel class I-II (p<0.05).
  
  
  CONCLUSIONS
  Patients with comorbid psychosis and temporal lobe drug-resistant epilepsy may benefit from epilepsy surgery under close psychiatric supervision.
authors.affiliation: Epilepsy Center, Ramos Mejía Hospital, Buenos Aires, Argentina; E de Robertis Neuroscience Institute, Epilepsy Research Laboratory, CONICET, Buenos Aires, Argentina. Electronic address: ldalessio@intramed.net.
authors.forename: Luciana
authors.initials: L
authors.lastname: D'Alessio
authors.affiliation: Epilepsy Center, Ramos Mejía Hospital, Buenos Aires, Argentina.
authors.forename: Laura
authors.initials: L
authors.lastname: Scévola
authors.affiliation: Epilepsy Center, Ramos Mejía Hospital, Buenos Aires, Argentina; E de Robertis Neuroscience Institute, Epilepsy Research Laboratory, CONICET, Buenos Aires, Argentina.
authors.forename: Mónica
authors.initials: M
authors.lastname: Fernandez Lima
authors.affiliation: Epilepsy Center, Ramos Mejía Hospital, Buenos Aires, Argentina; E de Robertis Neuroscience Institute, Epilepsy Research Laboratory, CONICET, Buenos Aires, Argentina.
authors.forename: Silvia
authors.initials: S
authors.lastname: Oddo
authors.affiliation: Epilepsy Center, Ramos Mejía Hospital, Buenos Aires, Argentina.
authors.forename: Patricia
authors.initials: P
authors.lastname: Solís
authors.affiliation: Neurosurgery Center, Ramos Mejía Hospital, Buenos Aires, Argentina.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Seoane
authors.affiliation: Epilepsy Center, Ramos Mejía Hospital, Buenos Aires, Argentina; E de Robertis Neuroscience Institute, Epilepsy Research Laboratory, CONICET, Buenos Aires, Argentina.
authors.forename: Silvia
authors.initials: S
authors.lastname: Kochen
mesh_terms: D000328:Adult; D000368:Aged; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004351:Drug Resistance; D004833:Epilepsy, Temporal Lobe / Q000150:complications* / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology* / Q000523:psychology*; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011446:Prospective Studies; D011612:Psychosurgery; D011618:Psychotic Disorders / Q000150:complications*; D012640:Seizures / Q000523:psychology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brief psychotic disorder; Interictal psychosis; Postictal psychosis; Risperidone; Schizophreniform disorder; Transient psychosis