Mental Disorders Associated with Temporal Lobe Epilepsy: The Report of Three Cases

顳葉癲癇患者之精神疾病：三例個案報告

周少華(Shaw-Hwa Jou) ； 廖以誠(Yi-Cheng Liao) ； 邱南英(Nan-Ying Chiu)

《The Changhua Journal of Medicine》 8卷2期 (2003/04) Pp. 118-122

摘要

目的：顳葉癲癇患者發作間精神症狀的報導，在國內並不多見。本文提出3例顳葉癲癇病人的長期精神症狀表現，並回顧文獻對於精神症狀與顳葉癲癇之各種病理相關因子的討論。
病例報告：3位病人都有長期癲癇症狀，病程中腦波診斷有顳葉癲癇波，因精神症狀惡化，曾多次於精神科急性病房治療。第一位是34歲女性病人，有宗教意念，迂迴言語，常無故傻笑，和幻聽的症狀；也曾表現僵呆的特徵。第二位病人是31歲男性，有誇大妄想和關係妄想。其腦部核磁共振影像發現有右顳葉內側硬化的早期病變。第三位病人是37歲男性，精神症狀包括反覆出現憂鬱症狀伴有自殺意念，不合理的思考內容，易衝動性，和人格改變等。
結論：本報告列述3位顳葉癲癇病人的發作間精神症狀表現，包括類似精神分裂症的症狀，憂鬱症狀和人格改變等。目前，對於相關的病理機轉，認為可能是多因子造成，沒有單一因子具有特殊的重要性。

關鍵字

發作間精神疾病 ； 精神分裂症 ； 複雜性局部發作 ； 顳葉癲癇

並列摘要

Objective: Few reports on chronic psychiatric disorders in patients with temporal lobe epilepsy in Taiwan exist. This paper describes the chronic interictal psychiatric symptoms of three patients with temporal lobe epilepsy. We investigated their psychiatric disturbances in relation to epilepsy phenomenology. A review of proposed psychopathology from the literature is presented.
Case report: All the three patients had episodes of seizures before the onset of psychiatric symptoms. EEG findings of temporal epileptogenic foci were documented during their illness. The first patient was a 34-year-old woman presented with religious ideations, circumstantial speech, silly laughter, auditory hallucination, and features of catatonia. The second patient was a 31-year-old man with grandiose and referential delusions. Results of his brain MRI study revealed right mesial temporal sclerosis with early changes. The third patient was a 37-year-old man who had recurrent major depressive episodes with suicide ideation, irrational thoughts, and personality changes associated with poor seizure control.
Conclusion: The psychiatric symptoms of these three patients were chronic and in the first two patients resembled schizophrenia phenomenologically. Anticonvulsant agents alone did not relieve their interictal psychiatric manifestations of delusions, personality change, depression, and suicide behavior. Epilepsy may be associated with chronic interictal psychosis through many mechanisms. The etiology of epileptic psychosis may prove to be multifactorial with no one dominant factor.

並列關鍵字

interictal psychiatric disorder ； schizophrenia ； complex partial seizure ； temporal lobe epilepsy