Long-Term Psychiatric Outcomes After Epilepsy Surgery in Adults

Abstract

Psychiatric aspects of epilepsy surgery are very complex and have a pleomorphic expression, as an anterotemporal lobectomy (ATL) can be followed by remission, exacerbation in severity or recurrence of a presurgical psychiatric disorder, or the development of de novo psychopathology. Furthermore, presurgical psychiatric history appears to be associated with postsurgical persistence of epileptic seizures.There is a dearth of studies on the long-term (>5 years) psychiatric trajectories of epilepsy surgery candidates. Most studies in this fi eld report follow-up periods of 2 years or less. Postsurgical depression and/or anxiety disorders are the most frequent psychiatric disorders identifi ed after resective surgeries, particularly following ATL, as 30 % are expected to experience depressive and/or anxiety episodes within the fi rst 3-6 months. A presurgical psychiatric history has been found to be associated with an increased risk of postsurgical recurrences or exacerbations. In a majority of patients, symptoms are expected to remit by 1 year, though persistent psychopathology has been found in up to 15 % of patients. De novo postsurgical psychotic episodes and psychogenic non-epileptic seizures (PNES) on the other hand have been identifi ed with a relatively low frequency.Despite the relatively high frequency of postsurgical psychiatric complications (PPC), they remain under-recognized and undertreated. Furthermore, patients and families are often not informed of their potential occurrence. In this chapter, we review the prevalence of the various postsurgical psychiatric complications and their risk factors.