Long-term seizure, cognitive, and psychiatric outcome following trans-middle temporal gyrus amygdalohippocampectomy and standard temporal lobectomy.

OBJECT: Previous comparisons of standard temporal lobectomy (STL) and selective amygdalohippocampectomy (SelAH) have been limited by inadequate long-term follow-up, variable definitions of favorable outcome, and inadequate consideration of psychiatric comorbidities. METHODS: The authors performed a retrospective analysis of seizure, cognitive, and psychiatric outcomes in a noncontemporaneous cohort of 69 patients with unilateral refractory temporal lobe epilepsy and MRI evidence of mesial temporal sclerosis after either an STL or an SelAH and examined seizure, cognitive, and psychiatric outcomes. RESULTS: The mean duration of follow-up for STL was 9.7 years (range 1-18 years), and for trans-middle temporal gyrus SelAH (mtg-SelAH) it was 6.85 years (range 1-15 years). There was no significant difference in seizure outcome when "favorable" was defined as time to loss of Engel Class I or II status; better seizure outcome was seen in the STL group when "favorable" was defined as time to loss of Engel Class IA status (p=0.034). Further analysis revealed a higher occurrence of seizures solely during attempted medication withdrawal in the mtg-SelAH group than in the STL group (p=0.016). The authors found no significant difference in the effect of surgery type on any cognitive and most psychiatric variables. Standard temporal lobectomy was associated with significantly higher scores on assessment of postsurgical paranoia (p=0.048). CONCLUSIONS: Overall, few differences in seizure, cognitive, and psychiatric outcome were found between STL and mtg-SelAH on long-term follow-up. Longer exposure to medication side effects after mtg-SelAH may adversely affect quality of life but is unlikely to cause additional functional impairment. In patients with high levels of presurgical psychiatric disease, mtg-SelAH may be the preferred surgery type.

Mesial temporal sclerosis after status epilepticus due to milk alkali syndrome.

Seizures induced by hypercalcemia are rare. A few case reports of seizures associated with hypercalcemia have been published, but none due to the milk alkali syndrome. This is the first report regarding seizures associated with calcium carbonate overuse. The two patients described in this article, who had no risk factors for developing epilepsy, suffered from status epilepticus probably induced by hypercalcemia. Subsequently, they both developed complex partial seizures, and were later found to have mesial temporal sclerosis on MRI. There are no reports linking hypercalcemia to mesial temporal sclerosis. While this may be a coincidence, there is reason to suspect that the development of persistent epilepsy, possibly due to mesial temporal sclerosis, was caused by prolonged seizures induced by hypercalcemia.

Lamotrigine intoxication provoking status epilepticus in an adult with localization-related epilepsy.

BACKGROUND: Various anticonvulsant medications have been associated with paradoxical aggravation of epileptic seizures in therapeutic doses and toxic concentrations. Lamotrigine has been reported to exacerbate seizures and myoclonic seizures in generalized epilepsy in a child with localization-related epilepsy. OBJECTIVE: To describe lamotrigine intoxication paradoxically producing status epilepticus in an adult with localization-related epilepsy. DESIGN: Observational case report. SETTING: Neurology service, inpatient hospitalization, and outpatient follow-up in a neurology clinic. PATIENT: A patient with known localization-related epilepsy who ingested an overdose of lamotrigine tablets in a suicide attempt. INTERVENTION: None. MAIN OUTCOME MEASURE: Observation of the course of the patient's reaction to lamotrigine intoxication, monitoring of lamotrigine levels, and monitoring of ictal and postictal status. RESULTS: The patient developed a prolonged convulsive status epilepticus, which was eventually controlled with benzodiazepines. The patient also developed transient obtundation and severe ataxia, all of which resolved completely within 96 hours. CONCLUSIONS: To our knowledge, in addition to being the first case report to describe convulsive status epilepticus after lamotrigine intoxication, this is the first report of the proconvulsant effect of lamotrigine in a case of localization-related epilepsy in an adult. The effects of accidental or suicidal ingestion of lamotrigine tablets seem to be reversible.

A patient with post-traumatic stress disorder developing stiff person syndrome: is there a correlation?

Stiff person syndrome (SPS) is an uncommon disorder characterized by progressive muscle stiffness, rigidity, and axial muscle spasms. It is presumed to be an autoimmune process, with glutamic acid decarboxylase antibodies present in most cases. Here, we present a case report of a patient diagnosed with post-traumatic stress disorder (PTSD) acquired by sexual trauma and by exposure to the severely wounded soldiers she attended as a nurse. Subsequently, she developed SPS confirmed by serology. The possibility of an association between PTSD and SPS is theorized, given their relationship to the GABAergic system. Further studies examining the relation between PTSD and SPS should be initiated.