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Epilepsy Surgery in Patients With Additional Psychogenic Seizures
Markus Reuber, MD;
Martin Kurthen, PhD;
Guillén Fernández, MD;
Johannes Schramm, MD;
Christian E. Elger, MD, FRCP
Arch Neurol. 2002;59:82-86.
Objective To assess whether surgery to reduce or control epileptic seizures is
safe and effective in patients known to have additional psychogenic seizures.
Design We reviewed our computerized database of 1342 patients examined for
epilepsy surgery and identified 13 patients with both epileptic and psychogenic
seizures on whom postoperative outcome data were available. Data were gathered
from the patients' records. Mean postoperative follow-up was 56 months.
Results Epilepsy surgery led to clinically relevant improvements in 11 of 13
patients. Seven patients became free of epileptic and psychogenic seizures,
2 patients became free of epileptic seizures but continued to have infrequent
psychogenic seizures, 1 patient reported more than an 80% improvement in epileptic
seizure frequency and an abolishment of psychogenic attacks, and in 1 patient
nondisabling epileptic seizures persisted at lower frequency but psychogenic
seizures stopped. In 2 of 13 patients, epilepsy surgery failed to produce
notable improvements. Although 1 patient became free of epileptic attacks
and the other had fewer than 3 epileptic seizures per year, the severity or
frequency of psychogenic seizures and pseudo–status epilepticus increased
postoperatively. One of these patients had a preoperative diagnosis of somatization
disorder; in the other, pathological illness behavior had been noted.
Conclusion A diagnosis of additional psychogenic seizures should not be considered
an absolute contraindication to epilepsy surgery, although patients should
undergo careful preoperative psychiatric evaluation.
From the Departments of Epileptology (Drs Reuber, Kurthen, Fernández,
and Elger) and Neurosurgery (Dr Schramm), University of Bonn, Bonn, Germany.
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