RESUMO
Temporal lobe epilepsy surgery has become a successful alternative in patients with refractory epilepsy. However, the outcome of epilepsy surgery may be affected by the occurrence of postsurgical psychiatric symptoms, such as psychosis. This report describes three cases of refractory temporal lobe epilepsy and hippocampal sclerosis, which, after anterior temporal lobectomy, presented with acute psychosis. One of them had a history of acute psychosis, and all of them met criteria for Cluster A personality disorder (schizoid/schizotypal) during psychiatric assessment prior to surgery. The three cases had a good seizure outcome (Engel I), but, on follow-up during the first year after surgery, developed an acute psychotic episode compatible with schizoaffective disorder; brief psychotic disorder; and a delusional disorder, respectively, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Treatment with low-dose risperidone was successful.
Assuntos
Lobectomia Temporal Anterior/efeitos adversos , Complicações Pós-Operatórias , Transtornos Psicóticos/etiologia , Adulto , Epilepsia/cirurgia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/diagnósticoRESUMO
Non-convulsive status epilepticus (NCSE) is a clinical condition characterized by continuous or intermittent state of epileptic activity without restitution, prolonged for more than thirty minutes. The main difference with convulsive status epilepticus (CSE) , is the absence of predominant motor activity. By reviewing the most recent literature, we intend to describe different aspects of NCSE: clinical presentation, classification, diagnostic criteria, differential diagnosis, imaging studies, and treatment. We emphasized the aspects most related to Psychiatry, without living aside characteristics encompassing its neurological aspects. The broad spectrum of clinical presentations, the rare knowledge about this entity , and the lack of clear diagnostic criteria are some of the difficulties to make the proper diagnosis. Because of its high morbidity and mortality, the aim of the present review is to highlight critical characteristics of NCSE, in order to take them into account during daily medical practice enabling an early and adequate treatment.