The influence of temporal lobectomy on the mental state of patients with psychomotor epilepsy. T. Alajouanine, J. Nehlil, R. Houdart. Revue Neurol 1958;98(3):165–171

Autor: T. Alajouanine
Rok vydání: 2009
Předmět:
Zdroj: Epilepsy & Behavior. 16:47-49
ISSN: 1525-5050
DOI: 10.1016/j.yebeh.2009.03.003
Popis: It is known that in the course of temporal lobe epilepsy, psychic disorders independent of the actual seizures have considerable importance. However, opinions vary on the influence of lobectomy on psychic behavior. Pond and Hill stated, ‘‘We also performed operations on a small group of patients. These patients had their seizures under control, but they presented a psychotic mental disorder. . . Up to the present, we have only operated on a few cases and, frankly, we are not very satisfied with the results as far as an improvement in the mental state is concerned. Apparently, the operation might play a role in preventing a deterioration of the personality. Therefore, the reasons for operating epileptic foci in the temporal lobe region rather than those in other regions of the brain are that the seizures in this region are difficult to control and there is considerable risk for marked psychosis. At this stage of our limited experience, we consider this a rational method of treatment for the most common form of epilepsy with onset in the adult”. Penfield recognized the frequency of abnormal behavior in individuals with temporal lobe lesions, whether it be memory disorders, nervousness, irritability, furor, confusion, depression, or neuroses. He believed that it was possible to obtain some gradual improvement in these disorders after surgery; in contrast, in one case memory disorders were pronounced, at least temporarily, and one female patient experienced a depressive state that was cured some months after the lobectomy. He only mentioned subjects with psychoses and stated, ‘‘As a general rule, it was not possible for us to accept patients from asylums. One reason was that our approach for radical treatment depended on the patient’s understanding and cooperation in the operating room as well as outside it. . . However, insofar as our experience with this type of patient permits, we are obliged to conclude that when there is a prolonged tendency toward psychotic behavior, operation of the temporal lobe region, even if successful in stopping the seizures, has little chance of changing the patient’s behavior”. At the end of the chapter, Penfield concluded that these considerations favored complete and early removal of the temporal foci, before mental and psychopathic disorders appeared. While these authors only concede that a temporal lobectomy can be of value as a preventive measure, others do not hesitate to value it as curative. Of these authors, the statistics of Bailey
Databáze: OpenAIRE
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