Yrondi Antoine, Valton Luc, Bouilleret Viviane, Aghakhani Nozar, Curot Jonathan, Birmes Philippe Jean
Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.
Explorations Neurophysiologiques, Hôpital Pierre Paul Riquet, CHU Purpan, Toulouse, France.
Front Psychiatry. 2020 Apr 28;11:351. doi: 10.3389/fpsyt.2020.00351. eCollection 2020.
A plethora of data show that the hippocampus and the amygdala are involved in post-traumatic stress disorder (PTSD). Neural dysfunctions leading to PTSD (e.g. how the amygdala and the hippocampus are altered) are only partially known. The unusual case of a patient presenting with refractory epilepsy and developing PTSD immediately after surgery is described. Such symptoms in epileptic patients may help to explore PTSD mechanisms.
A 41-year-old male suffering from partial refractory temporal lobe epilepsy was operated in May 2017. A right amygdala, hippocampus, and temporal pole selective resection was performed. He experienced intense PTSD symptoms 1 month after surgery. He complained about repetitive intrusive memories of abuse. The PTSD checklist score was equal to 62/80. He reported a history of childhood abuse: physical and emotional abuse as well as emotional negligence, assessed with the Childhood Trauma Questionnaire. No other medical history was recorded. He never complained about PTSD or any other psychiatric symptoms before surgery.
this case indicates that PTSD may occur after temporal lobe epilepsy surgery and may specifically stem, as in this context, from the excision of part of the medial temporal lobe structures. Although rarely reported, PTSD may be undiagnosed when not selectively detected multi-disciplinary neurological and psychiatric management, in the preoperative period and the immediate and delayed postoperative period.
大量数据表明，海马体和杏仁核与创伤后应激障碍（PTSD）有关。导致创伤后应激障碍的神经功能障碍（例如杏仁核和海马体如何改变）仅部分为人所知。本文描述了一名患有难治性癫痫的患者在手术后立即出现创伤后应激障碍的罕见病例。癫痫患者出现的此类症状可能有助于探索创伤后应激障碍的机制。
一名41岁男性患有部分难治性颞叶癫痫，于2017年5月接受手术。进行了右侧杏仁核、海马体和颞极选择性切除术。术后1个月，他出现了强烈的创伤后应激障碍症状。他抱怨反复出现受虐的侵入性记忆。创伤后应激障碍检查表得分等于62/80。他报告有童年受虐史：身体和情感虐待以及情感忽视，通过儿童创伤问卷进行评估。未记录其他病史。手术前他从未抱怨过创伤后应激障碍或任何其他精神症状。
该病例表明，创伤后应激障碍可能在颞叶癫痫手术后发生，并且在这种情况下可能具体源于内侧颞叶结构部分切除。尽管报道很少，但如果在术前以及术后即刻和延迟期没有通过多学科神经科和精神科管理进行选择性检测，创伤后应激障碍可能无法被诊断出来。
