Predictors of psychiatric and seizure outcome following temporal lobe epilepsy surgery

Abstract

SUMMARYPurpose: Neurosurgery is an effective therapy for selected individuals with medically refractory temporal lobe epilepsy (TLE). De novo psychopathology may complicate the postsurgical outcome. Our aims were to identify predictors of de novo psychiatric and seizure outcome following TLE surgery. Methods: Medical records of 280 patients who underwent TLE surgery were reviewed. Preoperative and postoperative psychiatric diagnoses were identified, in addition to information on seizure recurrence and neuropsychological status. Logistic regression analysis was used to identify predictors of having a de novo psychiatric diagnosis and remaining seizure-free within 4 years following surgery. Key Findings: One hundred five patients (38%) had significant psychiatric problems within 4 years following TLE surgery. Fifty-one patients (18%) developed de novo psychopathology; half of cases presented within 6 months and 90% of psychopathologies persisted 6 months or longer. A preoperative history of secondary generalized tonic-clonic seizure(s) (SGTCS) was an independent predictor of de novo psychopathology (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.14-6.59, p = 0.02). From patients with available seizure data, 49% (127 of 258) remained seizure-free for 4 years after surgery. Patients with a history of SGTCS (OR 0.47, 95% CI 0.25-0.90, p = 0.02) and those with a preoperative psychiatric diagnosis (OR 0.53, 95% CI 0.28-0.98, p = 0.04) were significantly less likely to remain seizure-free. Significance: De novo psychopathology is a significant complication of TLE surgery. Inclusion of neuropsychiatric assessments in the presurgical evaluation may lead to increase in the power of prognostic models used to predict the neurologic outcome of TLE surgery.

Surgical Effects of Focus Resection for Patients With Intractable Epilepsy

“…15) The present and previous findings have implicated TLE and presurgical psychiatric history as important risk factors for postoperative psychiatric problems. 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.…”

“…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.…”

Remote preoperative tonic-clonic seizures do not influence outcome after surgery for temporal lobe epilepsy

“…In one previous study of 116 consecutive patients who had temporal lobe surgery for drug-resistant epilepsy and MTS 9 , the occurrence of generalized tonic-clonic seizures was significantly associated with a poor outcome. In another study of 280 patients who underwent TLE surgery 7 , patients with a history of generalized tonic-clonic seizure(s) were significantly less likely to remain seizure free (odds ratio 0.47, 95% CI 0.25-0.90, p = 0.02).…”

“…However, there are still uncertainties about which patients will benefit most [3][4][5][6] . One of the most consistent risk factors associated with poor outcome after surgery for drug-resistant TLE in the literature is a history of preoperative tonic-clonic seizures [6][7][8][9] . However, no investigators have defined what is meant by the presence of tonic-clonic seizures.…”