Organic Mood Disorder Following Left Anterior Temporal Lobectomy with Amygdalohippocampectomy

One third of patients with antiepileptic-resistant temporal lobe epilepsy (TLE) will have to undergo surgery for a better seizure control. Anterior temporal lobectomy (ATL) is done for mesial temporal sclerosis that is the most common histopathological lesion associated with TLE. Psychiatric manifestations following ATL are not uncommon with depressive symptoms more common with left ATL and manic symptoms following right ATL. Mr. A is a 42-year-old left cerebral dominant (Confirmed by WADA test) male with no past history of psychiatric illness who had undergone anterior temporal lobectomy with amygdalohippocampectomy. He started having manic episodes post operatively which subsided with antipsychotics. He had multiple such episodes over the next 13 years with minimal inter episodic symptoms. This is a rare instance of manic symptoms following left-sided ATL that emphasizes the need for better understanding of the cerebral laterality of affective symptoms.