Nabangchang Charcrin, Sanguankiat Piradee, Katanyuwong Kamornwan, Sakoolnamarka Siraruj
Division of Neurology, Department of Pediatrics, Phramongkutklao College of Medicine, Bangkok, Thailand.
J Med Assoc Thai. 2012 May;95 Suppl 5:S186-90.
De novo psychiatric disorder following epilepsy surgery is an infrequent but very interesting phenomenon. The authors described 4 distinct cases with medically intractable epilepsy who had epilepsy surgery and developed postsurgical psychiatric disorder. The onset of psychiatric disorder was during dramatic improvement of their epilepsy after surgery. There was no history of psychiatric disorder in their familial members or in the patients prior to the surgery. Since three patients also had mental retardation, presurgical cognitive impairment may be one of the risk factors for developing postsurgical psychiatric disorder. Potential mechanisms include volume reduction of gray matter in frontal, temporal and parietal cortexes secondary to epilepsy surgery as well as forced normalization. Several other mechanisms may also play important role for this phenomenon and further studies will be required which may reveal the connection between these two aspects.
癫痫手术后新发精神障碍是一种罕见但非常有趣的现象。作者描述了4例患有药物难治性癫痫的患者，他们接受了癫痫手术，并在术后出现了精神障碍。精神障碍的发作是在手术后癫痫显著改善期间。在其家庭成员或手术前患者本人均无精神障碍病史。由于3例患者也有智力障碍，术前认知障碍可能是术后发生精神障碍的危险因素之一。潜在机制包括癫痫手术后额叶、颞叶和顶叶皮质灰质体积减少以及强制正常化。其他几种机制可能也对此现象起重要作用，需要进一步研究以揭示这两个方面之间的联系。
