Pre-Surgical Neuropsychiatric Evaluation in Epilepsy Surgery

Abstract

ObjectiveTo describe a sample of patients being considered for Epilepsy surgery, in terms of psychopathology and quality of life.MethodSample: patients being considered for Epilepsy surgery and subjected to a pre-surgical neuropsychiatric assessment in the last 12 months, at Hospital Egas Moniz in Lisbon, Portugal. Evaluation: unstructured psychiatric interview and history; MINI International Neuropsychiatric Interview; SCL-90-R Symptom Checklist; QOLIE-31 Quality of Life in Epilepsy Inventory; SDS Sheehan Disability Scale.Results17 patients were included in this study, 7 male and 10 female. All patients had complex partial seizures. The most common etiology associated with refractory Epilepsy in this group was Mesial Temporal Sclerosis, as evidenced by neuroimaging studies. 9 patients were diagnosed with at least one mental disorder. The most common diagnostic groups were mood disorders and anxiety disorders. One patient was diagnosed with Delusional Disorder and two were diagnosed with a personality disorder. We found higher mean SCL-90-R scores for the Obsessive-Compulsive, Depression and Paranoid Ideation dimensions, and lower mean scores for the Phobic Anxiety, Psychoticism and Hostility dimensions. Lower mean scores were found in the Seizure Worry and Medication Effects dimensions of the QOLIE-31. The SDS revealed greater dysfunction in the Work domain.ConclusionInterictal psychopathology is frequent in patients with refractory Epilepsy: 24–35% develop mood and anxiety disorders and 6% develop psychotic disorders. 18–22% are diagnosed with a personality disorder. The prevalence of these disorders depends on the type of Epilepsy and associated brain lesions psychotic disorders, for instance, are more common in temporal lobe epilepsy. A pre-surgical neuropsychiatric evaluation is essential for the timely diagnosis and treatment of these disorders, which can influence the surgery outcomes and the successful management of the epileptic seizures. A possible association between certain psychopathological phenotypes and the anatomy of structural lesions in epilepsy remains understudied.