Shirley M. Ferguson

Similarities in mental content of psychotic states, spontaneous seizures, dreams, and responses to electrical brain stimulation in patients with temporal lobe epilepsy.

&NA; The present study was guided by the hypothesis that temporal lobe epilepsy psychosis is associated with a definable syndrome of deficits in the higher cortical functions. Comparison was made of the mental content and mechanisms observed during psychotic episodes, seizures, dreams, and responses to electrical brain stimulation occurring in diverse combinations in 5 patients with drug‐refractory temporal lobe epilepsy referred for neurosurgical treatment. Neurological, neuroradiological, EEG, and neuropsychiatric base lines were available before onset of the psychosis. Psychiatric manifestations were related to the interaction of disturbances in specific higher cortical functions and individual dynamic configurations. Interpatient variation in psychotic symptomatology arose from significant elements in the patients past and current emotional life which provided the psychosis with form and content.

Outcomes and Indications of Corpus callosum Section for Intractable Seizure Control

Callosotomy (CCS) was performed in 9 cases of rigorously classified drug-refractory epilepsy not eligible for focal cortical resection. Complete CCS was carried out in two stages in 8 patients. 1 case had an anterior CCS only. None of the 9 patients has become seizure free. In 7, seizure frequency has diminished by a factor of 3-60 for at least one seizure type. Drop attacks in 2 cases have ceased. Clinical seizure patterns appeared more helpful in predicting outcome than preoperative EEG and stereoelectroencephalographic studies. Complete CCS may result in prolonged behavioral disturbances in the areas of language, hemisphere competition and attention-memory sequencing with impact on the sphere of daily living.

Typical cerebral hemisphere disconnection deficits following corpus callosum section despite sparing of the anterior commissure

Abstract Cerebral corpus callosum section is possibly as therapeutically effective as multiple cerebral commissurotomy while, according to the report of Risse et al. (Neuropsychologia 16, 23–31, 1978), allowing a substantially greater retention of the important adaptive function of inter-hemispheric exchange of information. We report results of visual, auditory and tactile tasks administered to three callosotomy patients. Results show typical “split-brain” deficits, in each modality. These results suggest that the anterior commissure is not an affective commissure in the transfer of stimulation effects over the follow-up period studied.

Neuropsychiatric Observations on Behavioral Consequences of Corpus Callosum Section for Seizure Control

The epilepsy group at the Medical College of Ohio has been concerned both with the effectiveness of corpus callosum section (CCS) for seizure control and with its repercussions on the patient’s personality and cognitive functions. We have considered the possible effects of the divided state of the brain on the whole person.

Life after surgery for temporolimbic seizures.

Publisher Summary This chapter presents data in regard to postoperative outcome in terms of effect on seizures and on facets of the patients life, including his self-evaluation, psychiatric symptoms, marital experiences, and functioning in the spheres of education and work. The neuropsychiatrist carried out Dr. Rayports dedication by addressing the mechanisms of behavioral problems in terms of brain dysfunction interacting with the patients life history and psychodynamics. This contrasts with the more frequent approach of neurological surgery epilepsy centers that emphasizes painstaking definition of the epileptic process and careful surgery, but accumulates behavioral data objectively, mainly from the neuropsychologist, who focuses almost exclusively on cognitive function. If behavioral responses are investigated, the methodology consists of limited interviews and/or questionnaires. Outcome is often reported after short periods of observation.

Corpus Callosum Section for Control of Clinically and Electroencephalo-Graphically Classified Intractable Seizures

Among 55 consecutive patients with drug-refractory epileptic seizures referred to the multidisciplinary Epilepsy Program of the Medical College of Ohio for possible neurosurgical intervention for seizure control, 17 (30.90%) of those completing the multidisciplinary assessment were found to have seizure mechanisms unsuitable for treatment by focal cortical excision. Because these patients had a clear need for additional antiseizure therapy, we felt compelled to reexamine our hesitation to perform corpus callosum section (CCS) for seizure control. Viewing CCS from a background in cortical resection for seizure control, with its defined case selection criteria, known outcome probabilities for seizure control, and low neurological and neuropsychological morbidity and operative mortality (Rasmussen, 1975; Talairach et al., 1974), we experienced concern over (1) the neuropsychological consequences of callosal commisurotomy (e.g., Gazzaniga, 1970), (2) the surgical morbidity and mortality in the early series (Van Wagenen and Herren, 1940; Akelaitis, 1941a,b, 1943; Akelaitis etal., 1942; Smith and Akelaitis, 1942; Bogen and Vogel, 1962, 1975; Bogen et al., 1965; Luessenhop, 1970; Luessenhop et al., 1970; Gordon

ID, EGO, and Temporal Lobe Revisited

Publisher Summary This chapter discusses the relevance of observations during electrical brain stimulation (EBS) in patients with intractable partial temporolimbic seizures to unconscious mental processes as these were elaborated and defined by Sigmund Freud. The chapter briefly outlines Freuds evolution from neurobiologist to neurologist to psychoanalytic psychiatrist. Exploration of the patients experience of his seizures in relation to his psychodynamics provides an illustration of the physiological underpinnings of Freuds ego structure. Reflected in the seizure-related behavior may be emotional trauma of early life, negative feelings toward specific individuals because of past incidents or situations, extrapolation from the content of the seizure, and/or present emotional stress. Elimination of the seizures made it possible for the patient to respond to life situations, with reality oriented ego function and without the disruptive intrusion of id and superego.

Olfactory gustatory responses evoked by electrical stimulation of amygdalar region in man are qualitatively modifiable by interview content: case report and review.

Publisher Summary This chapter addresses the question of whether olfactory or gustatory sensations evoked by electrical brain stimulation (EBS) would be susceptible to qualitative alteration by modification of the affective tone of the subjects mental content by a structured interview. The chapter reports on a case wherein this hypothesis was tested. In a patient undergoing presurgical seizure monitoring for intractable partial seizures with implanted temporal and parietal depth electrodes, olfactory and gustatory sensations evoked by electrical stimulation of the amygdaloid region were modified by the affective tone of the subjects mental content in an interview setting addressing topics “pleasant” and “unpleasant” to him. Both “pleasant” and “unpleasant” olfactory and gustatory sensations can be elicited by electrical stimulation of the amygdale. For gustatory sensations and probably also for the olfactory, the quality of the evoked sensation was modified by interview-induced changes in the affective tone of the patients attention and mental content. Prior descriptions of predominantly unpleasant sensations in man evoked by EBS and spontaneous partial seizures originating in the amygdale may have to be reconsidered in light of these findings.

Pathogenesis of Psychosis in Epilepsy. The “Seesaw” Theory: Myth or Reality?

Publisher Summary This chapter provides an example of continuing controversy about the nature of behavioral symptomatology in the patient with temporal lobe epilepsy. Broad hypothesizing about behavior has often replaced observations made as closely as possible to the brain–mind interface. In the past, impedimenta were understandable because different types of epilepsy had not been defined and nor was there any measure of brain electrical activity in order to correlate changes in brain function with behavior. In the present, behavioral data are often intentionally retrieved as separately as possible from brain events with the rationalization that the behavioral observations not be contaminated by the effects of a seizure. Patients with seizures arising in the temporal lobe area of the brain are especially prone to behavioral problems including psychosis. There is agreement that psychotic thinking may be associated with seizure activity or occur after termination of that activity.

Memory Function after Temporal Lobectomy for Seizure Control: A Comparative Neuropsychiatric and Neuropsychological Study

Publisher Summary This chapter deals with often differing data and prognosis provided by the neuropsychiatrist and the neuropsychologist. It reflects the general psychology literature that raises the question as to whether laboratory testing of memory function truly reflects memory function in everyday life. Present practice in surgical epilepsy centers is a preoperative neuropsychological evaluation, particularly of memory function. The longitudinal study of epilepsy patients who have undergone temporal lobectomy at the Medical College of Ohio has emphasized utilization of neuropsychiatric evaluation as well as neuropsychological testing. Data and prognosis reported by the neuropsychologist are frequently in contrast with neuropsychiatric assessment, which provides subjective reports by the patient as well as review of performance-demanding memory ability, in the spheres of education and work. Comparisons of neuropsychological and neuropsychiatric data were expressed in terms of concordant or discordant findings.