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Gershon C. Ney, MD; William B. Barr, PhD; Carline Napolitano, MSW; Robert Decker, MD; Neil Schaul, MD

Arch Neurol. 1998;55:726-730.

Background  The emergence of psychogenic seizures after surgery for epilepsy is not well recognized.

Objectives  To identify the frequency of psychogenic seizures in an 11-year surgical experience and to characterize the patients with this complication.

Methods  Ninety-six patients underwent surgery for epilepsy between 1985 and 1996. The surgical database was reviewed and all patients who experienced postoperative psychogenic seizures were identified. Patients were characterized by sex, age, psychopathologic conditions, full-scale IQ, duration of epilepsy, surgical procedure, and operative complications. Patients were compared with the surgical group as a whole for these variables.

Setting  A comprehensive epilepsy center.

Results  Five patients were identified: 3 men and 2 women. Mean full-scale IQ was 73 (range, 66-82). Mean age was 29.8 years (range, 22-36 years). Three patients were diagnosed as having psychosis, 1 with borderline personality disorder and 1 with generalized anxiety. Operations included 4 anterior temporal lobectomies and 1 occipital lobectomy. Two patients experienced operative complications. Compared with the surgical cohort, patients had a higher frequency of preoperative psychopathologic conditions, lower mean full-scale IQ, and a greater occurrence of operative complications.

Conclusions  (1) Patients can develop new-onset psychogenic seizures after surgery for epilepsy. (2) Low full-scale IQ, serious preoperative psychopathologic conditions, and major surgical complications may be risk factors. (3) Atypical postoperative seizures should be evaluated with video electroencephalographic monitoring before concluding that they are epileptic.

From the Departments of Neurology (Drs Ney, Barr, and Schaul and Ms Napolitano), Neurosurgery (Dr Decker), and Psychiatry (Dr Barr), Long Island Jewish Medical Center, and Hillside Hospital (Dr Barr), Albert Einstein College of Medicine, New Hyde Park, NY.

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