Depression in Temporal Lobe Epilepsy Before Epilepsy Surgery

Summary:Purpose: Depression sometimes occurs after surgical treatment for medically intractable partial epilepsy. The risk of pre-and postsurgical depression may vary by laterality of seizure focus. We reviewed the pre-and postsurgical psychological assessments and clinical courses of patients to identify those at highest risk for postsurgical mood disorders.Methods: Depression status was assessed in a consecutive series of epilepsy patients before and 1 year after epilepsy surgery with the use of Scale 2 of the MMPI-2 and a clinical depression index (CDI) scoring the occurrence of depressive symptoms, psychiatric referral, or attempted/completed suicide. Outcome at 1 year was modeled by regression techniques as functions of preoperative mood measurements, side of epilepsy surgery, and preoperative verbal intelligence.Results: The CDI and Scale 2 MMPI-2 correlated significantly (r ‫ס‬ 0.341; p Յ 0.01). Left (n ‫ס‬ 54 subjects) and right (n ‫ס‬ 53) surgery groups did not differ by sex, seizure outcome, age, education, age at first seizure, duration of epilepsy, or intellect. Higher presurgical depressive morbidity (p ‫ס‬ 0.0037) and right-sided surgery (p ‫ס‬ 0.0003) predicted higher postoperative CDI. Higher preoperative Scale 2 scores, indicating worse depressive traits, predicted worse postoperative Scale 2 scores (p < 0.0001). Although side of surgery did not predict Scale 2 scores, Scale 2 scores of patients with preoperative right-sided foci tended to have worse postsurgical Scale 2 scores (p ‫ס‬ 0.08). Findings for the temporal lobectomy subgroup (n ‫ס‬ 90) were similar to those of the overall sample.Conclusions: Patients undergoing right hemispheric epilepsy surgery, especially those with high presurgical depressionrelated morbidity, may be particularly susceptible to clinical depression. Our findings support other studies that show an interhemispheric modulation of depressive traits and symptoms.

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“…Other studies, however, found that the interictal, presurgical rate of depression is higher in right-sided temporal lobe epilepsy (9,10).…”

Section: Discussionmentioning

confidence: 83%

“…The side of epilepsy surgery may affect subsequent psychiatric morbidity, with depression having a greater prevalence after right-sided surgery (3,(9)(10)(11).…”

mentioning

confidence: 99%

Depression in Intractable Partial Epilepsy Varies by Laterality of Focus and Surgery

Quigg¹,

Broshek

Heidal‐Schiltz

et al. 2003

Epilepsia

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“…Some studies indicated a higher rate of interictal depression in epileptic patients with left-sided foci [25,26,27]; conversely other studies identified a higher rate of interictal depression in right-sided TLE [28, 29] or no relationship at all [24]. In our study, although no particular side or focus predominance was found in the group of epileptic patients with depression as a whole, moderate to severe depression tended to be more often associated with a temporal or frontal right-sided focus, but this association did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Psychiatric Comorbidity in Patients Evaluated for Chronic Epilepsy: A Differential Role of the Right Hemisphere?

et al. 2009

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Introduction: Psychiatric disorders are known to occur frequently in chronic epilepsy. The aim of this study is to investigate the prevalence of psychiatric comorbidity and its relationship to regional cerebral dysfunction in patients admitted to a tertiary epilepsy center for epilepsy surgery. Methods: 217 patients were investigated. A presurgical workup was performed and allowed precise localization of the epileptogenic focus in 156 patients. Sixty-one patients had multifocal or generalized discharges. After 1–3 psychiatric interviews, a psychiatric diagnosis was made (DSM-IV classification). Results: Psychiatric comorbidity was found in 85 patients (39%), more often in those with right or bilateral hemispheric dysfunction (74%, p = 0.04) with no difference between temporal or extratemporal foci location frequency. Additionally, patients with psychiatric disorders were less likely to undergo epilepsy surgery compared to ‘epilepsy-only’ patients (p = 0.003), despite similar good outcome in patients with and without psychiatric comorbidity. Conclusions: Right-sided or bilateral foci seem to represent a risk factor for psychiatric comorbidity in epilepsy, although we did not find any particular association between a psychiatric syndrome and focus localization. Recognition and treatment of psychiatric comorbidity is of major importance since its presence may interfere with patient’s decision making for epilepsy surgery treatment.

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“…More complex analyses suggest patients with left temporal lobe epilepsy, along with other factors such as being female (68) or concurrent frontal lobe dysfunction (67,69), are predisposed to depressive symptoms. To complicate matters, a recent report (70) found that depression was more prominent in patients with right temporal lobe epilepsy. The lack of clarity on the issue of depression and laterality merits further study.…”

Section: Discussionmentioning

confidence: 99%

Moderators of the Effect of Preoperative Emotional Adjustment on Postoperative Depression After Surgery for Temporal Lobe Epilepsy

2000

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Summary:Purpose: Other outcome measures besides seizure control must be considered when assessing the benefit of epilepsy surgery. We investigated the effect of preoperative psychosocial adjustment on postoperative depression in epilepsy patients followed up prospectively for 2 years after temporal lobectomy.Methods: The Washington Psychosocial Seizure Inventory (WPSI) evaluated psychosocial functioning; the Centre for Epidemiological Studies Depression Scale (CES-D) measured depression. Both were completed at baseline and follow-up.Results: Follow-up occurred in 39 temporal lobectomy patients at 2 years after surgery. Greatest improvement in depression scores was limited to patients with good seizure outcomes (seizure free, or marked reduction in seizure frequency), and seizure outcome was a significant predictor of postoperative depression. Despite this, preoperative scores on the emotional adjustment scale of the WPSI were most highly correlated with depression 2 years after surgery. To clarify this relation, moderated hierarchic regression suggested that good preoperative emotional adjustment (WPSI) was generally associated with less depression after surgery. Moreover, poorer preoperative adjustment combined with older age, generalized seizures, the finding of preoperative neurologic deficits, a family history of psychiatric illness, and/or a family history of seizures was related to higher depression scores 2 years after surgery.Conclusions: Depression after temporal lobectomy is dependent on a complex interaction of variables and can have a significant effect on indices of postoperative adjustment. The WPSI emotional adjustment scale may help to predict which patients are likely to be chronically depressed after surgery. Key Words: Epilepsy surgery-Depression-Emotional adj ustment-Prediction .Temporal lobectomy is an effective treatment for controlling medically intractable seizures of temporal lobe origin (1-S). The primary reasons for undergoing temporal lobectomy are to provide seizure relief and to improve quality of life (6-4, but improvements in psychosocial function may not be fully evident for several months or years after surgery (1). Postoperatively, the development, recurrence, or exacerbation of psychological problems is not uncommon, and several studies now suggest that individual differences in outcomes can be predicted by preoperative indicators of mental and physical health (9-15).Depressive symptoms are a common occurrence in the population with epilepsy and may persist despite good seizure control (16). Admissions of patients with epilepsy to psychiatric centers are often due to depression (17), and the suicide rate is higher in those with epilepsy than in the general population (1 8). Depression in epiAccepted July 2, 1999. Address correspondence and reprint requests to Dr. P. A. Deny at Department of Psychology, London Health Sciences Centre, University Campus, 339 Windermere Rd., London, Ontario, Canada. E-mail: pderry @julian.uwo.ca lepsy is most commonly an interictal phenomenon aris...

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Depression in Temporal Lobe Epilepsy Before Epilepsy Surgery

Cited by 29 publications

References 51 publications

Depression in Intractable Partial Epilepsy Varies by Laterality of Focus and Surgery

Depression in Intractable Partial Epilepsy Varies by Laterality of Focus and Surgery

Psychiatric Comorbidity in Patients Evaluated for Chronic Epilepsy: A Differential Role of the Right Hemisphere?

Moderators of the Effect of Preoperative Emotional Adjustment on Postoperative Depression After Surgery for Temporal Lobe Epilepsy

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