Epilepsia temporal estudo psiquiátrico evolutivo de uma série tratada cirurgicamente

Rossi, Cláudio; Marino Jr., Raul

doi:10.1590/S0004-282X1988000100008

Resumos

Os autores estudaram do ponto de vista psiquiátrico, no pré e no pós-operatório, série de 31 casos operados por epilepsia temporal incontrolável. Esta, com seu substrato fisiopatológico, está associada a irritabilidade patológica, tenacidade afetiva, impulsividade, disfunção cognitiva epiléptica e deficiências de abstração nos processos intelectuais. As altas incidências dessas psicopatologias nos doentes estudados demonstram essa associação e sugerem fortemente a existência de relação causal entre elas e a epilepsia temporal. As lobectomias temporais unilaterais se mostraram eficazes para o controle das crises epilépticas, cuja freqüência se reduziu intensamente no pós-operatório. As cirurgias promoveram intensa e útil redução nas manifestações da irritabilidade patológica, da impulsividade, da disfunção cognitiva epiléptica e das instabilidades da capacidade de abstração promovidas por impactos afetivos. A tenacidade afetiva foi pouco alterada pelas operações, embora tenha ocorrido efeito favorável. Incapacidades de abstração, estáveis, não foram afetadas pelas cirurgias. A presença de focos em ambos os lobos temporais não diminuiu a eficácia da cirurgia, nem quanto a seu efeito sobre as crises, nem quanto a seu efeito sobre as alterações psicopatológicas estudadas.

The authors have studied psychiatrically, pre and post-operatively, a series of 31 cases operated upon for temporal lobe epilepsy. They have concluded that medically uncontrolable limbic epilepsy is associated in its physiopathological substrate to: pathological irritability, affective tenacity, impulsiveness, epileptic cognitive dysfunction and abstraction deficiencies of intellectual process. The high incidence of these events in the patients studied demonstrate the existence of a causal relationship between these abnormalities and the limbic epilepsy. Unilateral temporal lobectomies have been demonstrated to be very efficient for the control of epileptic seizures, whose frequency was remarkably reduced post-operatively. The operation resulted in a major reduction of the psychiatric manifestations of pathological irritability, impulsiveness, epileptic cognitive dysfunction and the instability of abstraction capacity produced by affective impacts. Affective tenacity was ill affected by the surgical procedure, although a favourable effect was noticed. The presence of bilateral temporal foci did not decrease the efficacy of the surgical intervention, nor its effect on the seizures or the effect of surgery on the studied psychopathological changes.

Cláudio Rossi^I; Raul Marino Jr.^II

^IMédico Assistente, Mestre em Psiquiatria - Divisão de Neurocirurgia Funcional do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Psiquiatria

^IIProfessor Adjunto, Disciplina de Psiconeurocirurgia - Divisão de Neurocirurgia Funcional do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Psiquiatria

RESUMO

Os autores estudaram do ponto de vista psiquiátrico, no pré e no pós-operatório, série de 31 casos operados por epilepsia temporal incontrolável. Esta, com seu substrato fisiopatológico, está associada a irritabilidade patológica, tenacidade afetiva, impulsividade, disfunção cognitiva epiléptica e deficiências de abstração nos processos intelectuais. As altas incidências dessas psicopatologias nos doentes estudados demonstram essa associação e sugerem fortemente a existência de relação causal entre elas e a epilepsia temporal. As lobectomias temporais unilaterais se mostraram eficazes para o controle das crises epilépticas, cuja freqüência se reduziu intensamente no pós-operatório. As cirurgias promoveram intensa e útil redução nas manifestações da irritabilidade patológica, da impulsividade, da disfunção cognitiva epiléptica e das instabilidades da capacidade de abstração promovidas por impactos afetivos. A tenacidade afetiva foi pouco alterada pelas operações, embora tenha ocorrido efeito favorável. Incapacidades de abstração, estáveis, não foram afetadas pelas cirurgias. A presença de focos em ambos os lobos temporais não diminuiu a eficácia da cirurgia, nem quanto a seu efeito sobre as crises, nem quanto a seu efeito sobre as alterações psicopatológicas estudadas.

SUMMARY

The authors have studied psychiatrically, pre and post-operatively, a series of 31 cases operated upon for temporal lobe epilepsy. They have concluded that medically uncontrolable limbic epilepsy is associated in its physiopathological substrate to: pathological irritability, affective tenacity, impulsiveness, epileptic cognitive dysfunction and abstraction deficiencies of intellectual process. The high incidence of these events in the patients studied demonstrate the existence of a causal relationship between these abnormalities and the limbic epilepsy. Unilateral temporal lobectomies have been demonstrated to be very efficient for the control of epileptic seizures, whose frequency was remarkably reduced post-operatively. The operation resulted in a major reduction of the psychiatric manifestations of pathological irritability, impulsiveness, epileptic cognitive dysfunction and the instability of abstraction capacity produced by affective impacts. Affective tenacity was ill affected by the surgical procedure, although a favourable effect was noticed. The presence of bilateral temporal foci did not decrease the efficacy of the surgical intervention, nor its effect on the seizures or the effect of surgery on the studied psychopathological changes.

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Full text available only in PDF format.

Trabalho realizado na Divisão de Neurocirurgia Funcional do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Departamento de Psiquiatria

Divisão de Neurocirurgia Funcional Instituto de Psiquiatria, Hospital das Clínicas, FMUSP - Caixa Postal 8091 - 01051 São Paulo SP - Brasil.

1. Andy OJ, Jurko M - The human amygdala: excitability state and aggression. In Sweet WH, Obrador S, Martin Rodriguez IG (eds): Neurosurgical Treatment in Psychiatry, Pain, and Epilepsy. University Park, Baltimore, 1977.
2. Bear DM - Temporal lobe epilepsy: a syndrome of sensory-limbic hyperconnection. Cortex 15: 357, 1979.
3. Bianchi M - La cura chirurgica delle epilepsie. Min Med 71: 1131, 1980.
4. Blumer D, Walker AE - Sexual behavior in temporal lobe epilepsy. Arch Neurol 16:37, 1967.
5. Blumer D - Changes in sexual behavior related to temporal lobe disorder in man. J Sex Res 6: 173, 1970.
6. Blumer D - Hipersexual episodes in temporal lobe epilepsy. Am J Psychiat 126: 1099, 1970.
7. Blumer D - Organic personality disorder. In J Lion: Severe Personality Disorders. Williams & Wilkins, Baltimore, 1974.
8. Blumer D - Temporal lobe epilepsy and its psychiatric significance. In Blumer D, Benson DF (eds): Psychiatric Aspects of Neurological Disease. Grune & Stratton, New York, 1975.
9. Camargo CP, Riva D, Radvany J, Marino R Jr - Epileptic cognitive dysfunction and the psychiatric effects of epilepsy surgery. In Hitchcock ER (ed): Modern Concepts in Psychiatric Surgery. Elsevier / North-Holland, Amsterdam, 1979.
10. Diez-Cuervo A, Caro JS, Ramos PR, Goullaut J, Portellano JA - Foco temporal, epilepsia y transtornos psiquicos. Arch Neurobiol 44: 95, 1981.
11. Downer JL - Interhemispheric integration in the visual system. In Mountcastle V (ed): Interhemispheric Relations and Cerebral Dominance. Johns Hopkins Press, Baltimore, 1962.
12. Falconer MA, Serafetinides EA - A follow up study of surgery in temporal lobe epilepsy. J Neurol Neurosurg Psychiat 26: 154, 1963.
13. Falconer MA - The surgical treatment of temporal lobe epilepsy. Neurochirurgia 8: 161, 1965.
14. Falconer MA, Hill D, Meyer A, Mitchell W, Rond DA - Treatment of temporal-lobe epilepsy by temporal lobectomy. Lancet 1: 827, 1955.
15. Falconer MA - Reversibility by temporal lobe resection of the behavior abnormalities of temporal lobe epilepsy. N Engl J Med 289: 451, 1973.
16. Fernandez FA - Fundamentos de la Psiquiatria Actual. Paz Montalvo, Madrid, 1977.
17. Gastaut H, Roger J, Lesèvre N - Différenciation psychologique des épileptiques en fonction des formes électrochniques de leur maladie. Rev Psychol Appl 3: 237, 1953.
18. Gastaut H, Morin G, Lesèvre N - Étude du comportement des épileptiques psychomoteurs dans l'intervalle de leurs crises: les troubles globales et de la sociabilité. Ann Med Psychol 113: 1, 1955.
19. Gibbs FA - Ictal and nonictal psychiatric disorders in temporal lobe epilepsy. J Nerv Ment Dis 113: 522, 1951.
20. Goddard GV, Mclntyre DC - Some properties of a lasting epileptogenic trace kindled by repeated electrical stimulation of the amygdala in mammals. In Laitinen LV, Livingston KE (eds): Surgical Approaches in Psychiatry. University Park, Baltimore, 1972.
21. Greene VT - Temporal lobe epilepsy and the clinical psychiatrist. J Irish Med Assoc 69: 90, 1976.
22. Guerrant J, Anderson WW, Fisher A, Weinstein MR, Jaros RM, Deskins A - Personality in Epilepsy. Charles C Thomas, Springfield, 1962.
23. James IP - Temporal lobectomy íor temporal lobe epilepsy. J Mental Sci 106:543, 1960.
24. Jensen I - Temporal lobe surgery around the world; results; complications and mortality. Acta Neurol Scand 52: 354, 1975.
25. Juul-Jensen P - Epilepsy: a clinical and social analysis of 1020 adult patients with epileptic seizures. Acta Neurol Scand 40: 1, 1964.
26. Kluver H, Bucy PC - Preliminary analysis of functions of the temporal lobes in man. Arch Neurol Psychiat 42:979, 1939.
27. Livingston KE - Limbic system dysfunction induced by «Kindling»: its significance for psychiatry. In Sweet WH. Obrador S, Martin-Rodriguez JG (eds): Neurosurgical Treatment in Psychiatry, Pain, and Epilepsy.
28. Marino R Jr. Riva D, Camargo CP, Yamashita M, Ragazzo PC, Gronich G, Rossi C, Assis LM - O tratamento cirúrgico das epilepsias: experiência com 71 casos operados. Rev Paul Med 97: 141, 1981.
28a. Marino R Jr, Cukietr A, Pinho E - Aspectos epidemiológicos da epilepsia em São Paulo: um estudo de prevalência. Arq Neuro-Psiquiat (São Paulo) 44: 243, 1986.
28b. Marino R Jr - O tratamento cirúrgico das epilepsias. In Marino R Jr: Epilepsias. Sarvier, São Paulo, 1983, pg 77.
28c. Marino R Jr - Fisiologia das Emoções. Sarvier, São Paulo, 1975.
29. Marlowe WB, Mancall EL, Thomas JJ - Complete Kluver-Bucy syndrome in man. Cortex 11: 53, 1975.
30. Mark VH, Ervin FR - Violence and the Brain. Harper & Row, New York, 1970.
31. Mignone RS, Donnelly EF, Sadowsky D - Psychological and neurological comparisons of psychomotor and nonpsychomotor epileptic patients. Epilepsia 11: 345, 1970.
32. Narabayashi H, Nagao T, Saito Y, Yoshida M, Nagaya M - Stereotaxic amygdalectomy for behavior disorders. Arch Gen Psychiat 9: 11, 1963.
33. OMS - L'épilepsie dans les pays en dévelopement. Chronique OMS 33: 193, 1979.
34. Paim I - Curso de Psicopatologia. Fundo de Cultura, Rio de Janeiro, 1969.
35. Penfield W, Flanigin H - Surgical therapy of temporal lobe seizures. Arch Neurol Psychiat 64: 491, 1950.
36. Penfield W, Baldwin M - Temporal lobe seizures and the technique of subtotal temporal lobectomy. Ann Surg 136: 625, 1952.
37. Penfield W, Paine K - Results of surgical therapy for focal epileptic seizures. Canada Med Assoc J 73: 515, 1955.
38. Perrin RG, Hoffman HJ - Temporal lobe epilepsy and kindling. Estud Med Biol Mex 30: 197, 1979.
39. Pinel JPJ, Treit D, Rovner LI - Temporal lobe aggression in rats. Science 197: 1088, 1977.
40. Rasmussen T - The role of surgery in the treatment of focal epilepsy. Clin Neurosurg 16 :288, 1969.
41. Rossi C, Marino R Jr, Yazigi L - Personality studies in surgery for epilepsy. In Hitchcock ER, Ballantine HT Jr & Meyerson BA (eds): Modern Concepts in Psychiatric Surgery. Elsevier North-Holland, Amsterdam, 1979.
42. Schneider K - Psicopatologia Clínica. Mestre Jou, São Paulo, 1968.
43. Serafetinides EA - Aggressiveness in temporal lobe epileptics and its relation to cerebral dysfunction and environmental factors. Epilepsia 6:33, 1965.
44. Serafetinides EA, Falconer MA - The effects of temporal lobectomy in epileptic patients with psychosis. J Mental Sci 108: 584, 1962.
45. Stevens JR - Psychiatric implications of psychomotor epilepsy. Arch Gen Psychiat 14: 461, 1966.
46. Taylor DC - Mental state and temporal lobe epilepsy. Epilepsia 13: 727, 1972.
47. Vislie H, Henrikson GF - Psychic disturbances in epileptics. In Haas L (ed): Lectures in Epilepsy. Elsevier, Amsterdam, 1958.

Epilepsia temporal estudo psiquiátrico evolutivo de uma série tratada cirurgicamente

Temporal lobe epilepsy: psychiatric evolutive study of a surgically treated series

Datas de Publicação

Publicação nesta coleção
22 Jun 2011
Data do Fascículo
Mar 1988

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Andy OJ, Jurko M - The human amygdala: excitability state and aggression. In Sweet WH, Obrador S, Martin Rodriguez IG (eds): Neurosurgical Treatment in Psychiatry, Pain, and Epilepsy. University Park, Baltimore, 1977.

[2] 2. Bear DM - Temporal lobe epilepsy: a syndrome of sensory-limbic hyperconnection. Cortex 15: 357, 1979.

[3] 3. Bianchi M - La cura chirurgica delle epilepsie. Min Med 71: 1131, 1980.

[4] 4. Blumer D, Walker AE - Sexual behavior in temporal lobe epilepsy. Arch Neurol 16:37, 1967.

[5] 5. Blumer D - Changes in sexual behavior related to temporal lobe disorder in man. J Sex Res 6: 173, 1970.

[6] 6. Blumer D - Hipersexual episodes in temporal lobe epilepsy. Am J Psychiat 126: 1099, 1970.

[7] 7. Blumer D - Organic personality disorder. In J Lion: Severe Personality Disorders. Williams & Wilkins, Baltimore, 1974.

[8] 8. Blumer D - Temporal lobe epilepsy and its psychiatric significance. In Blumer D, Benson DF (eds): Psychiatric Aspects of Neurological Disease. Grune & Stratton, New York, 1975.

[9] 9. Camargo CP, Riva D, Radvany J, Marino R Jr - Epileptic cognitive dysfunction and the psychiatric effects of epilepsy surgery. In Hitchcock ER (ed): Modern Concepts in Psychiatric Surgery. Elsevier / North-Holland, Amsterdam, 1979.

[10] 10. Diez-Cuervo A, Caro JS, Ramos PR, Goullaut J, Portellano JA - Foco temporal, epilepsia y transtornos psiquicos. Arch Neurobiol 44: 95, 1981.

[11] 11. Downer JL - Interhemispheric integration in the visual system. In Mountcastle V (ed): Interhemispheric Relations and Cerebral Dominance. Johns Hopkins Press, Baltimore, 1962.

[12] 12. Falconer MA, Serafetinides EA - A follow up study of surgery in temporal lobe epilepsy. J Neurol Neurosurg Psychiat 26: 154, 1963.

[13] 13. Falconer MA - The surgical treatment of temporal lobe epilepsy. Neurochirurgia 8: 161, 1965.

[14] 14. Falconer MA, Hill D, Meyer A, Mitchell W, Rond DA - Treatment of temporal-lobe epilepsy by temporal lobectomy. Lancet 1: 827, 1955.

[15] 15. Falconer MA - Reversibility by temporal lobe resection of the behavior abnormalities of temporal lobe epilepsy. N Engl J Med 289: 451, 1973.

[16] 16. Fernandez FA - Fundamentos de la Psiquiatria Actual. Paz Montalvo, Madrid, 1977.

[17] 17. Gastaut H, Roger J, Lesèvre N - Différenciation psychologique des épileptiques en fonction des formes électrochniques de leur maladie. Rev Psychol Appl 3: 237, 1953.

[18] 18. Gastaut H, Morin G, Lesèvre N - Étude du comportement des épileptiques psychomoteurs dans l'intervalle de leurs crises: les troubles globales et de la sociabilité. Ann Med Psychol 113: 1, 1955.

[19] 19. Gibbs FA - Ictal and nonictal psychiatric disorders in temporal lobe epilepsy. J Nerv Ment Dis 113: 522, 1951.

[20] 20. Goddard GV, Mclntyre DC - Some properties of a lasting epileptogenic trace kindled by repeated electrical stimulation of the amygdala in mammals. In Laitinen LV, Livingston KE (eds): Surgical Approaches in Psychiatry. University Park, Baltimore, 1972.

[21] 21. Greene VT - Temporal lobe epilepsy and the clinical psychiatrist. J Irish Med Assoc 69: 90, 1976.

[22] 22. Guerrant J, Anderson WW, Fisher A, Weinstein MR, Jaros RM, Deskins A - Personality in Epilepsy. Charles C Thomas, Springfield, 1962.

[23] 23. James IP - Temporal lobectomy íor temporal lobe epilepsy. J Mental Sci 106:543, 1960.

[24] 24. Jensen I - Temporal lobe surgery around the world; results; complications and mortality. Acta Neurol Scand 52: 354, 1975.

[25] 25. Juul-Jensen P - Epilepsy: a clinical and social analysis of 1020 adult patients with epileptic seizures. Acta Neurol Scand 40: 1, 1964.

[26] 26. Kluver H, Bucy PC - Preliminary analysis of functions of the temporal lobes in man. Arch Neurol Psychiat 42:979, 1939.

[27] 27. Livingston KE - Limbic system dysfunction induced by «Kindling»: its significance for psychiatry. In Sweet WH. Obrador S, Martin-Rodriguez JG (eds): Neurosurgical Treatment in Psychiatry, Pain, and Epilepsy.

[28] 28. Marino R Jr. Riva D, Camargo CP, Yamashita M, Ragazzo PC, Gronich G, Rossi C, Assis LM - O tratamento cirúrgico das epilepsias: experiência com 71 casos operados. Rev Paul Med 97: 141, 1981.

[29] 28a. Marino R Jr, Cukietr A, Pinho E - Aspectos epidemiológicos da epilepsia em São Paulo: um estudo de prevalência. Arq Neuro-Psiquiat (São Paulo) 44: 243, 1986.

[30] 28b. Marino R Jr - O tratamento cirúrgico das epilepsias. In Marino R Jr: Epilepsias. Sarvier, São Paulo, 1983, pg 77.

[31] 28c. Marino R Jr - Fisiologia das Emoções. Sarvier, São Paulo, 1975.

[32] 29. Marlowe WB, Mancall EL, Thomas JJ - Complete Kluver-Bucy syndrome in man. Cortex 11: 53, 1975.

[33] 30. Mark VH, Ervin FR - Violence and the Brain. Harper & Row, New York, 1970.

[34] 31. Mignone RS, Donnelly EF, Sadowsky D - Psychological and neurological comparisons of psychomotor and nonpsychomotor epileptic patients. Epilepsia 11: 345, 1970.

[35] 32. Narabayashi H, Nagao T, Saito Y, Yoshida M, Nagaya M - Stereotaxic amygdalectomy for behavior disorders. Arch Gen Psychiat 9: 11, 1963.

[36] 33. OMS - L'épilepsie dans les pays en dévelopement. Chronique OMS 33: 193, 1979.

[37] 34. Paim I - Curso de Psicopatologia. Fundo de Cultura, Rio de Janeiro, 1969.

[38] 35. Penfield W, Flanigin H - Surgical therapy of temporal lobe seizures. Arch Neurol Psychiat 64: 491, 1950.

[39] 36. Penfield W, Baldwin M - Temporal lobe seizures and the technique of subtotal temporal lobectomy. Ann Surg 136: 625, 1952.

[40] 37. Penfield W, Paine K - Results of surgical therapy for focal epileptic seizures. Canada Med Assoc J 73: 515, 1955.

[41] 38. Perrin RG, Hoffman HJ - Temporal lobe epilepsy and kindling. Estud Med Biol Mex 30: 197, 1979.

[42] 39. Pinel JPJ, Treit D, Rovner LI - Temporal lobe aggression in rats. Science 197: 1088, 1977.

[43] 40. Rasmussen T - The role of surgery in the treatment of focal epilepsy. Clin Neurosurg 16 :288, 1969.

[44] 41. Rossi C, Marino R Jr, Yazigi L - Personality studies in surgery for epilepsy. In Hitchcock ER, Ballantine HT Jr & Meyerson BA (eds): Modern Concepts in Psychiatric Surgery. Elsevier North-Holland, Amsterdam, 1979.

[45] 42. Schneider K - Psicopatologia Clínica. Mestre Jou, São Paulo, 1968.

[46] 43. Serafetinides EA - Aggressiveness in temporal lobe epileptics and its relation to cerebral dysfunction and environmental factors. Epilepsia 6:33, 1965.

[47] 44. Serafetinides EA, Falconer MA - The effects of temporal lobectomy in epileptic patients with psychosis. J Mental Sci 108: 584, 1962.

[48] 45. Stevens JR - Psychiatric implications of psychomotor epilepsy. Arch Gen Psychiat 14: 461, 1966.

[49] 46. Taylor DC - Mental state and temporal lobe epilepsy. Epilepsia 13: 727, 1972.

[50] 47. Vislie H, Henrikson GF - Psychic disturbances in epileptics. In Haas L (ed): Lectures in Epilepsy. Elsevier, Amsterdam, 1958.