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

Abstract

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...

Validity and Responsiveness of Generic Preference-based HRQOL Instruments in Chronic Epilepsy

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Surgical Effects of Focus Resection for Patients With Intractable Epilepsy

“…1,5,9,14) In contrast to the present results, some earlier studies identified poor seizure outcome and surgical side as strong predictive factors. 1,2,15) The findings of the types of postoperative disorders have also varied: earlier papers more commonly report milder psychiatric issues 9) and transient mood disorders such emotional lability and depression, 5) whereas we predominately observed conditions requiring treatment with antipsychotic drugs. The follow-up period and patient selection criteria might partly explain these discrepancies, as our subgroup of patients with postoperative psychiatric disorders was limited to patients who received psychotropic drugs 2 or more years after the surgery.…”

“…[1][2][3][4][5][6]9,11,[13][14][15]17,19) These problems have recently become a focus of interest, as intractable epilepsy is recognized as a chronic encephalopathy in which one seizure induces other seizures. 7) Therefore, we need to analyze the overall effects on the quality of life to demonstrate the benefits of surgery.…”

Epilepsy, antiepileptic drugs and suicidality

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