Epilepsy and brain injury: A case report of a dramatic neuropsychiatric vicious circle

Abstract

Primary objective: Early treatment of epilepsy is warranted to avoid possible severe consequences. This study aimed to assess the value of treatment in a patient who developed epilepsy after major brain surgery.

Design: Case description. A 51 years-old man had a history of putative petit mal seizures since adolescence and left frontotemporal lobectomy after a major traffic accident at age 17. He subsequently developed quickly generalizing partial complex seizures, associated with severe behavioural alterations and personality changes; the condition was left untreated. A further seizure-related loss of consciousness led to another traffic accident at age 47.

Methods and procedures: The patient was administered 200 mg/day topiramate, 600 mg/day quetiapine, 1000 mg/day valproate, 1200 mg/day gabapentin and 800 mg/day carbamazepine.

Main outcomes and results: The instituted anti-epileptic treatment reduced seizure frequency and severity, but did not affect psychiatric symptomatology, which even worsened. An association between anti-epileptic drugs with mood stabilizing properties and an atypical anti-psychotic dramatically improved psychiatric symptoms, but did not prevent the patient from needing long-term healthcare.

Conclusions: Long-term untreated epilepsy may expose to accident proneness and further psychiatric deterioration. Early diagnosis and treatment of epilepsy may help in avoiding a potentially lethal vicious circle.

• Epilepsy
• traumatic brain injury
• aggression
• brain surgery
• frontotemporal lobectomy
• anti-epileptic drugs

Acknowledgements

We thank Ms Mimma Ariano, Tiziana Mattei and Ms Felicia Proietti, Librarians of the Sant’Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, for providing us with precious bibliographical material.