Reversibility by Temporal-Lobe Resection of the Behavioral Abnormalities of Temporal-Lobe Epilepsy

Abstract Aggression and psychosis were frequent preoperative complications in over 250 patients with temporal-lobe epilepsy who underwent unilateral temporal lobectomy. Pathological findings in the resected specimens, which included the hippocampus and the lateral amygdala, were mesial temporal sclerosis in about 1/2, hamartomas in 1/4, miscellaneous lesions such as scars and infarcts in 1/10, and nonspecific lesions in the remainder. Follow-up evaluations after six to 20 years were carried out independently by psychiatrists. In a series of 100 patients, 27 had aggression, which was relieved most often after operation in patients who had mesial temporal sclerosis (seven of 13). In the first 100 patients psychosis complicated long standing temporal-lobe epilepsy due to many substrates in 12 cases and was benefited by operation in seven. When a schizophrenia-like state supervenes, the substrate is likely to be a hamartoma. In patients with schizophrenia, operation relieved epilepsy, but the psychosis persisted although to a lesser degree. (N Engl J Med 289:451–455, 1973)