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Right temporal lobe epilepsy surgery activates suppressed post-traumatic stress disorder 31 years after a robbery

  • Case Report - Functional Neurosurgery - Epilepsy
  • Published:
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Abstract

Hippocampus and amygdala play central roles in the development of post-traumatic stress disorder (PTSD). Changes in neurological structures due to surgery leading to PTSD have previously been reported. In this case, we present a patient that develops PTSD right after epilepsy surgery in the right temporal lobe. The case adds knowledge to the mechanisms of storage of PTSD memories. A 56-year-old male suffering from refractory temporal lobe epilepsy was treated with an anteromesial temporal lobe resection on the right side. A few weeks after the surgery, he developed strong PTSD symptoms. They included flashbacks from a robbery he was subjected to three decades ago when he was 25 years old. In addition, he suffered from hypervigilance, irritability, and avoidance behavior. Psychotherapy eventually eased his symptoms. No previous disorders were recorded. No psychiatry symptoms were present before surgery. This case is one of few reports on the sudden occurrence of PTSD after epilepsy-surgery in the form of right-sided anteromesial temporal lobe resection. The disorder may not have been detected if not included in the Danish Epilepsy-Surgery-Protocol, among them both the pre-surgery psychiatric management and in the post-operative monitoring.

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Data was used with informed consent from the patient in this case.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

    Jeppe Lohfert Haslund-Vinding, Christina Malling Engelmann & Morten Ziebell

  2. National Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark

    Martin BalslevJørgensen

  3. Psychiatric Centre Copenhagen and Department of Clinical Medicine, Copenhagen University Hospital, Copenhagen, Denmark

    Ask Elklit

Authors
  1. Jeppe Lohfert Haslund-Vinding
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  2. Martin BalslevJørgensen
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  3. Christina Malling Engelmann
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  4. Morten Ziebell
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  5. Ask Elklit
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Contributions

AE and JHV drafted the article; MZ operated the patient; MBJ and AE treated the patient post-operatively; CME aided with neuropsychological expertise; and all authors accepted the final manus.

Corresponding author

Correspondence to Jeppe Lohfert Haslund-Vinding.

Ethics declarations

Ethics statement

The project was accepted by the RIO, IRB.

The use of this clinical case history was approved of by the Scientific Ethical Committee of the SDU (IRB #21/23011). Informed consent was given by the patient for the publication of this case report.

Competing interests

The authors declare no competing interests.

Additional information

Comments

In the present case report, the authors describe how a right temporal lobe epilepsy surgery activates a suppressed post-traumatic stress disorder (PTSD) 31 years after a robbery. The 56-year-old male patient, who suffered from a refractory temporal lobe epilepsy, was treated by a right-sided anteromesial temporal lobe resection (AMTR). Two weeks after the operation, flashbacks from a traumatic robbery, which the patient experienced 31 years earlier at the age of 25 years, appeared together with other PTSD symptoms. These PTSD symptoms, which first showed an increasing frequency and intensity, went in remission after psychotherapeutical treatment. The patient had no anamnesis of psychiatric illness before surgery. The authors based their interpretation of the course in the present case, on reports in the literature, that extinction of fear is not a passive forgetting but rather an active new learning and that absence of fear could be maintained through interhemispheric connectivity from the contralateral amygdala or hippocampus. Thus, they assume that the trauma-induced fear in this case could have been inhibited from the amygdala or hippocampus in the right hemisphere and then disinhibited as a result of the surgical removal of these structures. Furthermore, the authors emphasize that even if patients rarely develop PTSD in association with AMTR, you should be vigilant on this possible risk in clinical praxis, when taking decisions on right-sided neurosurgery in patients who have experienced PTSD.

This case report is of dual interest since it illustrates aspects of the neural correlates of the processing of post-traumatic memories described in the literature and beside this theoretical angle also adds to a good clinical praxis.

Åsa Bergendal

Stockholm, Sweden

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This article is part of the Topical Collection on Functional Neurosurgery - Epilepsy

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Haslund-Vinding, J.L., BalslevJørgensen, M., Engelmann, C.M. et al. Right temporal lobe epilepsy surgery activates suppressed post-traumatic stress disorder 31 years after a robbery. Acta Neurochir 164, 549–554 (2022). https://doi.org/10.1007/s00701-021-05091-9

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  • DOI: https://doi.org/10.1007/s00701-021-05091-9

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