Psychiatric and Neuropsychological Problems in Epilepsy Surgery: Analysis of 100 Cases That Underwent Surgery

Mayanagi, Yoshiaki; Watanabe, Eiju; Nagahori, Yukihiro; Nankai, Masahiro

doi:10.1046/j.1528-1157.2001.0420s6019.x

Cited by 31 publications

(7 citation statements)

References 7 publications

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“…There is general agreement that psychosis in epilepsy is neither increased nor decreased by surgical intervention (13)(14)(15). None of the patients in whom psychotic symptoms developed had a history of psychosis before introduction of LEV.…”

Section: Discussionmentioning

confidence: 99%

Levetiracetam Efficacy in Refractory Partial‐onset Seizures, Especially after Failed Epilepsy Surgery

Motamedi

Nguyen²,

Zaatreh³

et al. 2003

Epilepsia

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Summary:Purpose: We conducted a retrospective study to evaluate the efficacy of levetiracetam as adjunctive therapy in patients with localization-related epilepsy, and specifically in the subset of patients for whom epilepsy surgery failed.Methods: Eighty-two patients with uncontrolled partial-onset seizures treated with levetiracetam were identified; epilepsy surgery had failed for 21 (25.6%; group I), and 61 (74.4%) had no prior surgery (group II). Group I and group II patients were comparable in age (mean, 40.7 vs. 41.5 years) and age at seizure onset (mean, 14.4 vs. 18.2 years). Patients who had Ն50% reduction in seizure frequency were considered responders; the remaining patients were considered nonresponders.Results: In patients (group I) for whom surgery had failed, responder rate was 76.1% (16 of 21), including 10 (47.6%) patients who became seizure free. In nonsurgical patients (group II), responder rate was 34.3% (21 of 61), including nine (14.7%) patients who became seizure free. In group I, 11 (91.6%) of 12 temporal resection patients were responders, of whom eight were seizure free; of the remaining nine operated (extratemporal) patients, five (55.5%) were responders, and two were seizure free. In three responders, all in group I, a severe, delayed psychotic syndrome developed 4 to 9 months after levetiracetam introduction, leading to its discontinuation.Conclusions: These findings suggest that adjunctive levetiracetam therapy should be considered early after failed epilepsy surgery, especially after temporal resection, and may have implications for its use before surgical intervention. Patients should be under close psychiatric observation in this clinical setting.

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Section: Discussionmentioning

confidence: 99%

Levetiracetam Efficacy in Refractory Partial‐onset Seizures, Especially after Failed Epilepsy Surgery

Motamedi

Nguyen²,

Zaatreh³

et al. 2003

Epilepsia

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Although interpretation of the literature is complicated by the different definitions of psychosis used, several key issues of practical and theoretical importance have emerged. Firstly, several studies report a preponderance of congenital lesions, such as dysembryoblastic neuroepithelial tumours, in the excised lobe rather than the typical pathology of mesial temporal sclerosis which underlies most cases of temporal lobe epilepsy.…”

Section: Introductionmentioning

confidence: 99%

Schizophrenia-like psychosis arising de novo following a temporal lobectomy: timing and risk factors

Shaw

Mellers²,

Henderson³

et al. 2004

Journal of Neurology, Neurosurgery & Psychiatry

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Objectives: To clarify risk factors for the development of schizophrenia-like psychotic disorders following temporal lobectomy, and to explore the possibility that the early postoperative period is a time of high risk for the onset of such chronic psychotic disorders. Methods: Patients who developed schizophrenia-like psychosis were identified from a series of 320 patients who had a temporal lobectomy for medically intractable epilepsy. The relationship of their disorders to both the operation and subsequent seizure activity was examined. Using a retrospective casecontrol design, risk factors for the development of schizophrenia-like psychosis were established. Results: Eleven patients who developed schizophrenia-like psychosis postoperatively were identified and compared with 33 control subjects who remained free of psychosis postoperatively. The onset of de novo psychotic symptoms was typically in the first year following the operation. No clear relationship between postoperative seizure activity and fluctuations in psychotic symptoms emerged. Compared with the controls, patients who become psychotic had more preoperative bilateral electroencephalogram (EEG) abnormalities, pathologies other than mesial temporal sclerosis in the excised lobe and a smaller amygdala on the unoperated side. Conclusions: Temporal lobectomy for medically intractable epilepsy may precipitate a schizophrenia-like psychosis. Patients with bilateral functional and structural abnormalities, particularly of the amygdala, may be at particular risk for the development of such psychoses.

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“…Few studies have taken a longitudinal approach to assessing depression following surgery, with most either measuring a single time point (Hermann & Wyler, 1989; Anhoury et al., 2000; Derry et al., 2000; Glosser et al., 2000; Quigg et al., 2003; Reuber et al., 2004), or averaging across follow‐up times (Falconer & Serafetinides, 1963; Jensen & Larsen, 1979; Stevens, 1990; Stub Naylor et al., 1994; Altshuler et al., 1999; Ionue & Mihara, 2001; Mayanagi et al., 2001). The occurrence of depression may vary over the course of postoperative recovery, highlighting the need for longitudinal research to identify periods of greatest risk.…”

mentioning

confidence: 99%

Profiling the evolution of depression after epilepsy surgery

2011

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SUMMARYPurpose: Both neurobiologic and psychosocial factors have been proposed to account for the high prevalence of depression surrounding epilepsy surgery. Using a prospective longitudinal approach, this study aimed to profile the evolution of depression after epilepsy surgery at multiple time points, including early and longer-term follow-up. We also sought to identify neurobiologic and psychosocial predictors of depression before and after surgery, including whether patients undergoing mesial temporal lobe resection (MTR) were at greater risk of depression than patients undergoing nonmesial temporal lobe resection (NMTR). Methods: Sixty patients undergoing epilepsy surgery (38 MTR, 22 NMTR) for the treatment of medically intractable seizures were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively in the Comprehensive Epilepsy Program of Austin Health. The diagnosis of depression was based on DSM-IV criteria for major depressive disorder, as assessed from a mental state examination. The Austin CEP Interview was used to obtain a detailed psychosocial assessment of each patient and family members. Key Findings: Before surgery, 43% of patients had a lifetime prevalence of depression, with no difference between the proportion of patients in the MTR (40%) and NMTR groups (50%). Predictive factors included a family history of psychiatric illness (p = 0.015) and financial dependence of either family members or government income benefits (p = 0.024). Discriminant function analysis indicated that these factors classified 69% of cases correctly (p = 0.006, partial g 2 = 0.06). In the 12 months following surgery, 37% of MTR and 27% of NMTR patients experienced major depression, with no significant difference between the two groups. The majority of depressed patients (70%) were diagnosed in the first 3 months and in 65% of diagnosed cases, the depression persisted for at least 6 months within the follow-up period. The pattern of recurrent and de novo depression differed significantly between the groups, with 13% of MTR patients developing de novo major depression in comparison to no NMTR patients (p = 0.05). A preoperative history of depression (p = 0.003) and poor postoperative family dynamics (1 month, p < 0.001; 3 months, p = 0.007; 6 months, p = 0.021; 12 months, p = 0.097) were predictive of depression after surgery. These factors correctly classified 78% of cases (p = 0.000, partial g 2 = 0.19). Significance: The findings of this study confirm high rates of major depression before and after epilepsy surgery, the etiology of which is multifactorial. They highlight the need for thorough assessment and diagnosis before surgery, as well as the provision of routine follow-up and psychological support, particularly early after surgery. When estimating level of risk for depression, patients should be counseled about the role of both neurobiologic and psychosocial factors. Before surgery, these include a family history of psychiatric illness and financial dependence, whereas poor family adjustment to lif...

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Psychiatric and Neuropsychological Problems in Epilepsy Surgery: Analysis of 100 Cases That Underwent Surgery

Cited by 31 publications

References 7 publications

Levetiracetam Efficacy in Refractory Partial‐onset Seizures, Especially after Failed Epilepsy Surgery

Levetiracetam Efficacy in Refractory Partial‐onset Seizures, Especially after Failed Epilepsy Surgery

Schizophrenia-like psychosis arising de novo following a temporal lobectomy: timing and risk factors

Profiling the evolution of depression after epilepsy surgery

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