Psychiatric comorbidity in temporal DNET and improvement after surgery

• Published in: Neuro-chirurgie 2016-06, Vol.62 (3), p.165-170
• Main Authors: Landais, A, Crespel, A, Moulis, J.-L, Coubes, P, Gelisse, P
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anterior Temporal Lobectomy; Borderline Personality Disorder - etiology; Chirurgie de l’épilepsie; Disruptive, Impulse Control, and Conduct Disorders - drug therapy; Disruptive, Impulse Control, and Conduct Disorders - etiology; DNET; Drug Resistant Epilepsy - drug therapy; Drug Resistant Epilepsy - etiology; Drug Resistant Epilepsy - surgery; Epilepsy surgery; Epilepsy, Temporal Lobe - drug therapy; Epilepsy, Temporal Lobe - etiology; Epilepsy, Temporal Lobe - surgery; Female; Human health and pathology; Humans; Intellectual Disability - etiology; Life Sciences; Limbic System - surgery; Magnetic Resonance Imaging; Male; Neoplasms, Neuroepithelial - diagnostic imaging; Neoplasms, Neuroepithelial - psychology; Neoplasms, Neuroepithelial - surgery; Neuroimaging; Neurons and Cognition; Neurosurgery; Personality Disorders - etiology; Psychiatric disorders; Psychotropic Drugs - therapeutic use; Remission Induction; Schizophrenia - drug therapy; Schizophrenia - etiology; Supratentorial Neoplasms - diagnostic imaging; Supratentorial Neoplasms - psychology; Supratentorial Neoplasms - surgery; Surgery; Temporal Lobe - diagnostic imaging; Temporal Lobe - surgery; Troubles psychiatriques
• ISSN: 0028-3770; 1773-0619
• DOI: 10.1016/j.neuchi.2016.02.002

Abstract Background “Alien tissue” may be responsible for a higher frequency of psychiatric disorders in patients with temporal lobe epilepsy (TLE). Also, ganglioglioma and dysembryoplastic neuroepithelial tumors (DNET) could represent a risk-factor for the development of post-surgical psychoses. Classically, severe psychiatric disorders contra-indicate epilepsy surgery. Objectives Assessment of inter-ictal psychiatric disorders in 10 consecutive patients with temporal DNET, before and after epilepsy surgery with a minimum of a 2-year follow-up evaluation. Methods DNETs were confirmed on histological examination. Psychiatric disorders were classified according to the DSM-IV-TR. Results Five patients presented inter-ictal psychiatric disorders with, according to the DSM-IV-TR, undifferentiated schizophrenia (one case), “borderline” personality (two cases), intermittent explosive disorder with slight mental retardation (one case), and personality disorders not otherwise specified but with some traits of dependent personality and with mythomania (one case). The condition of these five patients dramatically improved after surgery. No psychiatric behavior or “de novo” psychosis was observed after surgery in any of the patients. Conclusion The prevalence of inter-ictal psychiatric disorders appears to be high in epileptic patients with a temporal lobe DNET primarily in relation to personality and behavioral problems with some degree of impulsivity and verbal aggressiveness. The improvements after surgery suggest that this therapy could be performed in these patients and severe psychiatric disorders do not contra-indicate this procedure.