A case of de novo psychosis ten years following successful epilepsy surgery

http://dx.doi.org/10.1016/j.seizure.2016.06.017 1059-1311/Crown Copyright 2016 Published by Elsevier Ltd on behalf of Briti The relationship between epilepsy and psychosis has been recognised since the mid-nineteenth century. For pragmatic reasons, psychotic symptoms are always grouped according to their temporal relationship to seizures: ictal, peri/para-ictal and interictal psychoses (IIP). Psychoses without a clear relationship to seizures are usually defined IIP and they usually account for 10– 30% of all psychoses of epilepsy in unselected case series with a combined prevalence rate of 5.6% in unselected samples, up to 7.0% when considering only temporal lobe epilepsy. Temporal lobectomy is an established treatment for patients with intractable epilepsy but ever since the early series, the possibility that surgery may be associated with the occurrence of psychiatric disorders, in particular psychoses, has been discussed. For this reason every epilepsy surgery centre should include neuropsychiatric assessment as part of the presurgical evaluation and postsurgical follow up programme. The rate of de novo postoperative psychoses is low, but it represents an eminently harmful condition which may affect up to 2% of patients after epilepsy surgery [1]. Whereas mood and anxiety complications typically arise in the early months following surgery, postsurgical psychotic episodes often develop later (i.e. at least six months after surgery), and are independent of seizure outcome. The severity of psychotic symptomsmay vary fromworried-sceptical mistrusts to paranoid-hallucinatory schizophrenia-like syndromes with increased risk of self-harm behaviours. We describe a case of de novo psychosis ten years after successful epilepsy surgery, in a 55 year-old lady with a previous