側頭葉前部切除術後の精神症状  [in Japanese] Psychiatric Symptoms Following Anterior Temporal Lobectomy  [in Japanese]

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Author(s)

    • 川崎 淳 KAWASAKI Jun
    • 国立療養所宇多野病院関西てんかんセンター Utano National Hospital, Kansai Regional Epilepsy Center
    • 武内 重二 TAKEUCHI Juji
    • 国立療養所宇多野病院関西てんかんセンター 脳神経外科 Kansai Regional Epilepsy Center, Utano National Hospital
    • 河合 逸雄 KAWAI Itsuo
    • 国立療養所宇多野病院関西てんかんセンター Utano National Hospital, Kansai Regional Epilepsy Center

Abstract

難治側頭葉てんかんのため本院で手術を受け1年以上経過した22例の患者について術後の精神症状を検討した。その結果, (1) 術前に精神病状態を体験したことのない患者で術後新規に精神病状態を体験した患者が3例あり, いずれも右切除例であった, (2) 際立った精神症状をきたした患者では, 実体的意識性, 夢様状態を前兆とするものが比較的多かった, (3) うつ状態は術後3カ月以内には出現し, 時には自殺企図を伴うほど重症になった, (4) 術前に敵意・攻撃性が目立った患者は, 術後には改善がみられた, (5) 精神症状の大部分は1年以内には消失したが, 軽症化したものの2年以上遷延した例が2例みられた。以上の結果を文献例と比較し, 術後精神病を心因論だけからは説明することが難しいことを指摘するとともに, 側頭葉てんかんに対する外科手術後に, 神経学的, 神経心理学的評価だけでなく, 精神科的評価が不可欠であることを考察で論じた。

Psychiatric manifestations following temporal lobectomy in twenty two patients were examined. Three patients experienced <I>de novo</I> psychosis after right temporal lobectomy. Depression occured within three months after the temporal lobectomy and lead to suicide attempt in extreme cases. Preoperative agression and hostility were ameliorated. Although most of the postoperative psychiatric symptoms disappeared within a year following surgery, abnormal mental states continued to be present for more than twelve months in two cases.<BR>The comparison between the group of patients with postoperative abnormal mental states (n=10) and that without (n=12) revealed abundance of ictal fear as well as dreamy state and predominance of the history of presurgical psychotic episode in the former. In view of the postoperative psychosis described in the literature, the current study suggested that postoperative psychiatric manifestations could not be explained fully by the psychogenic theory, and that not only neurological and neuropsy-chological but also psychiatric assessments were essential following temporal lobectomy. Most of the postoperative psychotic episodes could be shortened or aborted by an appropriate medical therapy. Recognition of them as early as possible is all the more important for it.

Journal

  • Journal of the Japan Epilepsy Society

    Journal of the Japan Epilepsy Society 13(3), 202-210, 1995-10-31

    JAPAN EPILEPSY SOCIETY

References:  19

Cited by:  1

Codes

  • NII Article ID (NAID)
    10008555455
  • NII NACSIS-CAT ID (NCID)
    AN10043823
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    09120890
  • Data Source
    CJP  CJPref  J-STAGE 
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