てんかん外科手術後に間歇性爆発性障害を呈した内側側頭葉てんかんの2例

Intermittent Explosive Disorder after Epilepsy Surgery for Mesial Temporal Lobe Epilepsy

抄録

　難治性の内側側頭葉てんかんに対する側頭葉切除術後に，間歇性爆発性障害を発症した2例について報告した。2例とも手術により良好な発作コントロールが得られていたにもかかわらず，家族のみにほぼ限定された激しい攻撃性，衝動性を間歇的に認めた。これらの症状は薬物療法と心理社会的支援により徐々に安定した。側頭葉切除後に発症した間歇性爆発性障害の報告はなく，扁桃核海馬切除術は情動の表出や制御に関与する神経ネットワークに機能的不均衡を来しうると考えられた。てんかん手術後には発作コントロールのみでなく，患者の持つ心理社会的困難を含めた精神医学的評価も必要不可欠である。

Summary

　Although some organic brain syndromes are associated with intermittent explosive disorder, there have been no reports of epilepsy patients who have developed this disorder after temporal lobectomy. We conducted a descriptive analysis of two patients in whom intermittent explosive disorder developed after surgical treatment for mesial temporal lobe epilepsy. Despite a favorable outcome with regard to seizure control, these patients developed severe aggression and impulsiveness that was shown only to their family members. These symptoms gradually stabilized as a result of pharmacotherapy and psychosocial support. Amygdalohippocampectomy, a surgical procedure that ameliorates mesial temporal lobe epilepsy, may result in an imbalance in the neural networks involved in emotional control. We suggest that during the postoperative period clinical attention should be paid to the patient's psychosocial difficulties as well as to seizure control.