Psychiatric comorbidity in temporal DNET and improvement after surgery

Area of Science:

• Neurology
• Psychiatry
• Neurosurgery

Background:

• Temporal lobe epilepsy (TLE) is associated with psychiatric disorders, potentially linked to "alien tissue."
• Ganglioglioma and dysembryoplastic neuroepithelial tumors (DNET) may increase the risk of post-surgical psychoses.
• Severe psychiatric disorders have traditionally contra-indicated epilepsy surgery.

Purpose of the Study:

• To assess inter-ictal psychiatric disorders in patients with temporal DNET before and after epilepsy surgery.
• To evaluate the long-term outcomes (minimum 2-year follow-up) of psychiatric conditions in these patients.

Main Methods:

• Histological confirmation of DNETs.
• Classification of psychiatric disorders using DSM-IV-TR criteria.
• Prospective evaluation of 10 consecutive patients with temporal DNET.

Main Results:

• Five patients (50%) presented with inter-ictal psychiatric disorders, including schizophrenia, borderline personality disorder, intermittent explosive disorder, and other personality disorders.
• Significant improvement in psychiatric conditions was observed post-surgery in these five patients.
• No new psychiatric behaviors or de novo psychoses occurred after surgery.

Conclusions:

• Inter-ictal psychiatric disorders are prevalent in temporal lobe DNET patients, often manifesting as personality and behavioral issues with impulsivity and verbal aggression.
• Epilepsy surgery appears to be a safe and effective treatment for temporal lobe DNET, even in patients with pre-existing psychiatric disorders.
• Severe psychiatric disorders should not be considered an absolute contra-indication for epilepsy surgery in DNET patients.