Postictal psychosis as a risk factor for mood disorders after temporal lobe surgery

This study investigated the psychiatric consequences of 38 consecutive patients who had surgery for intractable temporal lobe epilepsy with special attention to postoperative mood disorders. A close interrelation between preoperative postictal psychosis and postoperative manic or depressive episodes was suggested. Left sided lobectomy augmented this correlation. Because the first sign of postoperative manic and depressive episodes appeared within 1 month and 2 months respectively, cautious psychiatric follow up for several months after surgery proved to be crucial to prevent postoperative suicides. Postoperative manic depressive episodes disappeared within the first 2 years after operation without exception, if treated suitably. This suggests that we do not have to preclude patients with postictal psychosis as surgical candidates, but measures must be taken to prevent postoperative depressions.