Constellation of psychic symptoms in one patient with mesial temporal lobe epilepsy with hippocampal sclerosis and the artistic representation of the patient’s pre and post surgical experiences
PDF
XML

Keywords

Anomia
Temporal lobectomy
Depersonalization
Epileptic syndromes
Hallucinations
Hemianopsia
Hippocampal sclerosis
Illusions
Personality
Retrograde degeneration

Abstract

Introduction: We describe a constellation of psychic symptoms in a professional painter with mesial temporal lobe epilepsy and hippocampal sclerosis, rarely described together in one patient, as well as the patient’s artistic representation of these symptoms.

Case presentation: Prior to surgery, our patient experienced visual hallucinations, precognitions, out-of-body experiences, right unilateral mydriasis, and severe headaches, which led to a diagnosis of drug-resistant temporal lobe epilepsy. After surgery, she developed a visual field defect, retrograde trans-synaptic degeneration, anomic aphasia, foreign language syndrome, mirror writing, and Geschwind syndrome.

Discussion: Each symptom is presented in comparison with previous reports of patients with similar symptoms related to temporal lobe pathology.

Conclusion: Patients with temporal lobe disease may suffer from numerous and varied symptoms that often go unrecognized by physicians due to their unusual presentation. Young epileptic patients with temporal lobe disease may also express these symptoms through their artistic production.

https://doi.org/10.22379/anc.v41i4.1923

PDF
XML

References

Fukao K. Psychic seizures and their relevance to psychosis in temporal lobe epilepsy. In: Stevanovic D, editor. Epilepsy – Histological, Electroencephalographic and Psychological Aspects. InTech;2012:199–216. https://doi.org/10.5772/18777

Nadkarni S, Arnedo V, Devinsky O. Psychosis in epilepsy patients. Epilepsia. 2007;48(s9):17-19. https://doi.org/10.1111/j.1528-1167.2007.01394.x

Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, et al. Operational classification of seizure types by the International League Against Epilepsy: Position paper of the ILAE commission for classification and terminology. Epilepsia. 2017 Apr;58(4):522-530. https://doi.org/10.1111/epi.13670

Riney K, Bogacz A, Somerville E, Hirsch E, Nabbout R, Scheffer IE, et al. International League Against Epilepsy classification and definition of epilepsy syndromes with onset at a variable age: Position statement by the ILAE task force on nosology and definitions. Epilepsia. 2022 Jun;63(6):1443-1474. https://doi.org/10.1111/epi.17240

de Tisi J, Bell GS, Peacock JL, McEvoy AW, Harkness WF, Sander JW, et al. The long-term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: A cohort study. Lancet. 2011;378(9800):1388-1395. https://doi.org/10.1016/S0140-6736(11)60890-8

Arruda F, Cendes F, Andermann F, Dubeau F, Villemure JG, Jones-Gotman M, et al. Mesial atrophy and outcome after amygdalohippocampectomy or temporal lobe removal. Ann Neurol. 1996 Sep;40(3):446-450. https://doi.org/10.1002/ana.410400314

Tecoma ES, Laxer KD, Barbaro NM, Plant GT. Frequency and characteristics of visual field deficits after surgery for mesial temporal sclerosis. Neurology. 1993;43(6):1235-1238. https://doi.org/10.1212/WNL.43.6.1235

Hughes TS, Abou-Khalil B, Lavin PJ, Fakhoury T, Blumenkopf B, Donahue SP. Visual field defects after temporal lobe resection: A prospective quantitative analysis. Neurology. 1999;53(1):167-172. https://doi.org/10.1212/WNL.53.1.167

Schmeiser B, Daniel M, Kogias E, Bohringer D, Egger K, Yang S, et al. Visual field defects following different resective procedures for mesiotemporal lobe epilepsy. Epilepsy Behav. 2017;76:39-45. https://doi.org/10.1016/j.yebeh.2017.08.037

Quigg M, Barbaro NM, Ward MM, Chang EF, Broshek DK, Langfitt JT, et al. Visual field defects after radiosurgery versus temporal lobectomy for mesial temporal lobe epilepsy: Findings of the ROSE trial. Seizure. 2018 Dec;63:62-67. https://doi.org/10.1016/j.seizure.2018.10.017

Nilsson D, Malmgren K, Rydenhag B, Frisen L. Visual field defects after temporal lobectomy - comparing methods and analysing resection size. Acta Neurol Scand. 2004;110:301-307. https://doi.org/10.1111/j.1600-0404.2004.00331.x

Mengesha T, Abu-Ata M, Haas KF, Lavin PJ, Sun DA, Konrad PE, et al. Visual field defects after selective amygdalohippocampectomy and standard temporal lobectomy. J Neuroophthalmol. 2009;29(3):208-213. https://doi.org/10.1097/WNO.0b013e3181b41262

Kanamori A, Nakamura M, Matsui N, Nagai A, Nakanishi Y, Kusuhara S, et al. Optical coherence tomography detects characteristic retinal nerve fiber layer thickness corresponding to band atrophy of the optic discs. Ophthalmology. 2004;111(12):2278 -2283. https://doi.org/10.1016/j.ophtha.2004.05.035

Guedes ME, Almeida AC, Patricio MS, Marques-Costa J. Acquired retrograde transsynaptic degeneration. BMJ Case Rep. 2011 Sep 28;2011:bcr0820114653. https://doi.org/10.1136/bcr.08.2011.4653

Jindahra P, Petrie A, Plant GT. Retrograde trans-synaptic retinal ganglion cell loss identified by optical coherence tomography. Brain. 2009;132(3):628-634 . https://doi.org/10.1093/brain/awp001

de Vries-Knoppert WA, Baaijen JC, Petzold A. Patterns of retrograde axonal degeneration in the visual system. Brain. 2019 Sep;142(9):2775-2786. https://doi.org/10.1093/brain/awz221

Dinkin M. Trans-synaptic retrograde degeneration in the human visual system: Slow, silent, and real. Curr Neurol Neurosci Rep. 2017 Feb;17(2):16. https://doi.org/10.1007/s11910-017-0725-2

Anderson JM, Gilmore R, Roper S, Crosson B, Bauer RM, Nadeau S, et al. Conduction aphasia and the arcuate fasciculus: A reexamination of the Wernicke-Geschwind model. Brain Lang. 1999;70(1):1-12. https://doi.org/10.1006/brln.1999.2135

Devinsky O, D'Esposito M. Neurology of cognitive and behavioral disorders (21st ed.). Oxford University Press;2003.

Nardo D, Holland R, Leff AP, Price CJ, Crinion JT. Less is more: Neural mechanisms underlying anomia treatment in chronic aphasic patients. Brain. 2017 Nov;140(11):3039-3054. https://doi.org/10.1093/brain/awx234

Salamah MK, Mortier E, Wassenberg R, Strik J. Lost in another language: A case report. J Med Case Rep. 2022;16:25. https://doi.org/10.1186/s13256-021-03236-z

Schott GD. Mirror writing: Neurological reflections on an unusual phenomenon. J Neurol Neurosurg Psychiatry. 2007;78(1):5-13. https://doi.org/10.1136/jnnp.2006.094870

Balfour S, Borthwick S, Cubelli R, Della-Sala S. Mirror writing and reversing single letters in stroke patients and normal elderly. J Neurol. 2007;254:436-441. https://doi.org/10.1007/s00415-006-0384-8

Schott GD, Schott JM. Mirror writing, left-handedness, and leftward scripts. Arch Neurol. 2004;61(12):1849-1851. https://doi.org/10.1001/archneur.61.12.1849

Heilman KM, Howell G, Valenstein E, Rothi L. Mirror-reading and writing in association with right-left spatial disorientation. J Neurol Neurosurg Psychiatry. 1980;43(9):774-780. https://doi.org/10.1136/jnnp.43.9.774

Pflugshaupt T, Nyffeler T, von Wartburg R, Wurtz P, Luthi M, Hubl D, et al. When left become right and vice versa: Mirrored vision after cerebral hypoxia. Neuropsychologia. 2007;45(9):2078-2091. https://doi.org/10.1016/j.neuropsychologia.2007.01.018

Trimble M, Freeman A. An investigation of religiosity and the Gastaut-Geschwind syndrome in patients with temporal lobe epilepsy. Epilepsy Behav. 2006;9(3):407-414. https://doi.org/10.1016/j.yebeh.2006.05.006

Waxman SG, Geschwind N. The interictal behavior syndrome of temporal lobe epilepsy. Arch Gen Psych. 1975;32(12):1580-1586. https://doi.org/10.1001/archpsyc.1975.01760300118011

Benson DF. The Geschwind syndrome. Adv Neurol. 1991;55:411-421.

Tebartz van Elst L,Krishnamoorthy ES, Bäumer D, Selai C, von Gunten A, Gene-Cos N, et al. Psychopathological profile in patients with severe bilateral hippocampal atrophy and temporal lobe epilepsy: Evidence in support of the Geschwind syndrome? Epilepsy Behav. 2003;4(3):291-297. https://doi.org/10.1016/S1525-5050(03)00084-2

Carrizosa-Moog J, Mameniškien? R, Puteikis K. Painting epilepsy - The essence of disease by participants of the Latin American Summer School on Epilepsy (LASSE XIII). Epilepsy Behav. 2020;104(A):106878. https://doi.org/10.1016/j.yebeh.2019.106878

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Downloads

Download data is not yet available.