Effects of surgical side and site on psychological symptoms following epilepsy surgery in adults

Abstract

This retrospective study examined the potential role of side and site of surgery in psychological symptom change after epilepsy surgery and determined the base rate of psychological change at the individual level. Two-hundred twenty-eight adults completed the Personality Assessment Inventory (PAI) before and after temporal (TLR; n=190) or frontal lobe resection (FLR; n=38). Repeated measures ANOVAs with bootstrapping examined differences in psychological outcome as a function of surgical site separately in patients who underwent left versus right-sided resections. Individual’s PAI score changes were then used to determine the prevalence of clinically meaningful postoperative symptom change. Following left-sided resections, there were significant group-by-time interactions on Somatic Complaints, Anxiety, and Anxiety Related Disorders. There was also a trend in this direction on the Depression scale. TLR patients endorsed greater preoperative symptoms than FLR patients on all of these scales, except the Somatic Complaints scale. After surgery, TLR patients reported symptom improvement on all four scales, while scores of FLR patients remained relatively stable over time. Endorsement of Mania-related symptoms increased in both TLR and FLR groups from pre-to post-surgical testing. Following right-sided resections, both groups endorsed symptom improvements on Somatic Complaints, Anxiety, and Depression scales following surgery. In addition, the TLR group endorsed more manic symptoms than the FLR group regardless of time. Patterns of meaningful change in individual patients were generally consistent with group findings, with the most frequent improvements observed following TLR. However, there were a small subset of patients who reported symptom exacerbation after surgery. Our results suggest that surgical lateralization and localization are important factors in postoperative psychological outcome and highlight the importance of considering psychological change at the individual patient level. Further research is needed to identify potential risk factors for symptom exacerbation to aid in preoperative counseling and identify those patients most in need of postoperative psychological surveillance.

Experiences of emotional and psychosocial functioning after frontal lobe resection for epilepsy

“…Existing results point toward improved quality of life after FLR and also lower scores on depression scales and reduced apathy [17][18][19]. Stability in psychological symptoms measured by personality assessment questionnaires is another finding [20].…”

Left Hemisphere Lateralization of Epileptic Focus Can Be More Frequent in Temporal Lobe Epilepsy Surgical Patients with No Consensus Associated with Depression Lateralization

“…Besides, it is also important to report any change in the number of AEDs prescribed to the patients after surgery. Prayson and colleagues [29] demonstrated that the quantity of AEDs was reduced in only 28% of the patients after surgery, whereas 58% of the patients continued with the same AEDs after surgery. It is evidenced by the literature that the non-control of epileptic seizures directly impacts the patient’s quality of life; thus, the higher the frequency/intensity of the seizures, the more prevalent are the desadaptive emotional symptoms.…”

“…Furthermore, surgical laterality and location can be predisposing factors for psychological outcomes in epileptic patients post-surgery. Prayson et al [29] elucidated more significant depression and anxiety symptoms among patients with left TLE before surgery as compared to the patients with left frontal lobe epilepsy. On the other hand, Devinsky et al [36] demonstrated no association between the presence or absence of depression and anxiety and the lateralization or localization of the seizure onset before surgery.…”

Left hemisphere lateralization of epileptic focus can be more frequent in temporal lobe epilepsy surgical patients with no consensus associated with depression lateralization

“…Besides, it is also important to report any change in the number of AEDs prescribed to the patients after surgery. Prayson and colleagues demonstrated that the quantity of AEDs was reduced in only 28% of the patients after surgery, whereas 58% of patients continued with the same AEDs after surgery [28].…”

“…Furthermore, surgical laterality and location can be predisposing factors for psychological outcomes in epileptic patients post-surgery. Prayson et al [28] elucidated more significant depression and anxiety symptoms among patients with left temporal lobe epilepsy before surgery as compared to the patients with left frontal lobe epilepsy. On the other hand, Devinsky et al [33] demonstrated no association between the presence or absence of depression and anxiety and the lateralization or localization of the seizure onset before surgery.…”