De novo Postoperative Postictal Psychosis Improved with Vagal Nerve Stimulation: A Case Report

Abstract

Post-ictal psychosis can manifest in patients with intractable temporal lobe epilepsy following temporal lobectomy, presenting with psychiatric symptoms such as hallucinations, depression, and aggressive behavior. This case study details a 43-year-old male with refractory focal epilepsy who developed de novo post-ictal psychosis after undergoing left anterior temporal lobectomy and hippocampal ablation. Initially, the patient achieved seizure control, but later experienced recurrent focal seizures and subsequent post-ictal psychosis, characterized by aggression, paranoia, and hallucinations. Despite multiple hospitalizations and trials of antipsychotic medications, no improvement was observed. Following the placement of a vagal nerve stimulator, the patient’s psychotic episodes ceased, allowing for the discontinuation of antipsychotic medications. This case highlights the critical need for psychiatric monitoring in epilepsy patients post temporal lobectomy and underscores the potential of vagal nerve stimulator in managing peri-ictal psychotic episodes. Further research is essential to elucidate the mechanisms by which vagal nerve stimulator exerts its antipsychotic effects and to establish guidelines for its use in this patient population.