Reutens D C, Savard G, Andermann F, Dubeau F, Olivier A
Montreal Neurological Hospital and Institute, Quebec, Canada.
Brain. 1997 Nov;120 ( Pt 11):1929-36. doi: 10.1093/brain/120.11.1929.
The combination of psychosis and refractory temporal lobe epilepsy is not rare. However, patients with chronic interictal psychosis and refractory epilepsy are rejected from many epilepsy surgery programmes purely on psychiatric grounds. It is often assumed that disturbed behaviour will prevent adequate preoperative evaluation or that the patients are unable to provide informed consent for preoperative investigations and for surgery. The observation that the psychosis usually does not improve after operation and fears of an exacerbation of psychosis with post-surgical seizure remission, analogous to 'forced normalization', are further deterrents to surgery in these patients. We describe five patients with the dual diagnoses of medically intractable temporal lobe epilepsy and chronic psychosis who underwent temporal lobe resection. The patients were able to provide informed consent and were easily managed during preoperative investigation. Seizure outcome has been excellent in all. Neither temporal lobe resection nor remission of seizures influenced the nature or evolution of the psychosis. Subjectively the patients functioned better in activities of daily living and freedom from seizures improved integration into psychiatric treatment facilities. With appropriate psychiatric intervention, patients with chronic psychosis and refractory epilepsy can participate in presurgical investigation successfully, and can undergo surgery uneventfully.
精神病与难治性颞叶癫痫并存的情况并不罕见。然而，患有慢性发作间期精神病和难治性癫痫的患者常常因纯粹的精神科原因而被许多癫痫手术项目拒之门外。人们通常认为，行为紊乱会妨碍进行充分的术前评估，或者认为患者无法对术前检查和手术给予知情同意。另外，观察发现精神病通常在术后并无改善，且担心术后癫痫发作缓解会使精神病加剧，类似于“强制性正常化”，这些因素进一步阻碍了对这些患者进行手术。我们描述了5例患有药物难治性颞叶癫痫和慢性精神病双重诊断的患者，他们接受了颞叶切除术。这些患者能够给予知情同意，并且在术前检查期间易于管理。所有人的癫痫发作结果都非常好。颞叶切除术和癫痫发作缓解均未影响精神病的性质或演变。主观上，患者在日常生活活动中的功能有所改善，摆脱癫痫发作后能更好地融入精神科治疗机构。通过适当的精神科干预，患有慢性精神病和难治性癫痫的患者能够成功参与术前检查，并能顺利接受手术。
