Psychiatric aspects of temporal lobe epilepsy before and after anterior temporal lobectomy

Summary:Purpose: Depression sometimes occurs after surgical treatment for medically intractable partial epilepsy. The risk of pre-and postsurgical depression may vary by laterality of seizure focus. We reviewed the pre-and postsurgical psychological assessments and clinical courses of patients to identify those at highest risk for postsurgical mood disorders.Methods: Depression status was assessed in a consecutive series of epilepsy patients before and 1 year after epilepsy surgery with the use of Scale 2 of the MMPI-2 and a clinical depression index (CDI) scoring the occurrence of depressive symptoms, psychiatric referral, or attempted/completed suicide. Outcome at 1 year was modeled by regression techniques as functions of preoperative mood measurements, side of epilepsy surgery, and preoperative verbal intelligence.Results: The CDI and Scale 2 MMPI-2 correlated significantly (r ‫ס‬ 0.341; p Յ 0.01). Left (n ‫ס‬ 54 subjects) and right (n ‫ס‬ 53) surgery groups did not differ by sex, seizure outcome, age, education, age at first seizure, duration of epilepsy, or intellect. Higher presurgical depressive morbidity (p ‫ס‬ 0.0037) and right-sided surgery (p ‫ס‬ 0.0003) predicted higher postoperative CDI. Higher preoperative Scale 2 scores, indicating worse depressive traits, predicted worse postoperative Scale 2 scores (p < 0.0001). Although side of surgery did not predict Scale 2 scores, Scale 2 scores of patients with preoperative right-sided foci tended to have worse postsurgical Scale 2 scores (p ‫ס‬ 0.08). Findings for the temporal lobectomy subgroup (n ‫ס‬ 90) were similar to those of the overall sample.Conclusions: Patients undergoing right hemispheric epilepsy surgery, especially those with high presurgical depressionrelated morbidity, may be particularly susceptible to clinical depression. Our findings support other studies that show an interhemispheric modulation of depressive traits and symptoms.

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“…Other studies, however, found that the interictal, presurgical rate of depression is higher in right-sided temporal lobe epilepsy (9,10).…”

Section: Discussionmentioning

confidence: 91%

“…The side of epilepsy surgery may affect subsequent psychiatric morbidity, with depression having a greater prevalence after right-sided surgery (3,(9)(10)(11).…”

mentioning

confidence: 99%

Depression in Intractable Partial Epilepsy Varies by Laterality of Focus and Surgery

Quigg¹,

Broshek

Heidal‐Schiltz

et al. 2003

Epilepsia

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“…Furthermore, the mechanism by which RS renders an anticonvulsant effect is incompletely understood. While the cognitive effects of open surgery for MTLE have been extensively studied, [19][20][21] they have not been adequately delineated for RS. 22 In order to address these issues, we report in detail the serial MRI radiographic changes in our prospective, multicenter study of RS for MTLE.…”

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confidence: 99%

Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy

Chang

Quigg

et al. 2010

Neurology

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“…nın [8] yaptığı çalışmada ATL öncesi %65 oranında depresyon, anksiyete ve kişilik bozuklukları saptanırken ilk 3 ayda bunun %31'e indiğini, 6.ayda %15'e indiğini göstermişler-dir. Postoperatif ilk 3 ayda cerrahi tedaviye, yeni yaşam koşularına, gelecekle ilgili kaygılara bağlı psikososyal sorunlar daha yoğundur.…”

Section: Discussionunclassified

Surgical Treatment of Temporal Lobe Epilepsy Before and After Depression, Anxiety and Quality of Life Evaluation

Capraz¹,

Bilir²,

Erdem³

2011

Epilepsi

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ÖzetAmaç: Depresyon ve anksiyete dirençli temporal lob epilepsisinde (TLE) en sık izlenen psikiyatrik hastalıklardır. Bu çalışmada, dirençli temporal lob epilepsili olgularda anterior temporal lobektomi (ATL) öncesi ve sonrası depresyon, anksiyete ve yaşam kalitesi (YK) değerlendirildi. Gereç ve Yöntem:Çalışmamızda dirençli TLE olan 23 olgu prospektif olarak incelendi. Olguların klinik nöbet özellikleri, temporal lob lokalizasyonu, nöbet sıklığı, eğitim düzeyleri, sosyoekonomik durumları, antiepileptik ilaçları (AEİ), kraniyal manyetik rezonans görüntülemeleri ve patoloji sonuçları incelendi. Cerrahi öncesi ve cerrahiden sonra standart aralıklarla Beck depresyon envanteri (BDE), Beck anksiyete envanteri (BAE) ve Short Form 36 (SF-36) ölçekleri uygulandı. Bulgular: Çalışmamızda cerrahi tedavi öncesi depresyon ve anksiyete oranı %43.5 olarak bulundu. Olgularda depresyon ve anksiyetenin, demografik ve klinik özellikler açısından sadece nöbet sıklığı ile ilişkili olduğu saptandı. Nöbet sıklığı arttıkça depresyon ve anksiyete oranı da artmaktadır (sırası ile p<0.001 ve p=0.012). ATL sonrası depresyon ve anksiyetenin belirgin olarak düzeldiği izlendi. Bu düzelme cerrahi tedavi sonrası nöbetsizlik halini sağlamakla doğrudan bağlantılı idi (p<0.001). SF-36'nın alt ölçeklerinin tümünde cerrahi tedavi sonrası belirgin düzelme izlendi.Sonuç: Bu seride titizlikle seçilmiş dirençli TLE olgularında ATL'nin sadece epileptik nöbetlerin düzelmesini değil aynı zamanda psikopatolojinin de düzelmesini sağladığı görülmüştür. Cerrahi tedavi sonrası nöbetsizlik hali, depresyon, anksiyete ve YK'da düzelmenin en güçlü prediktörüdür.Anahtar sözcükler: Anterior temporal lobektomi; temporal lob epilepsisi; yaşam kalitesi. SummaryObjectives: Depression and anxiety are the most common psychiatric disorders in patients with drug resistant temporal lobe epilepsy. This study evaluated depression, anxiety and quality of life in patients with temporal lobe epilepsy before and after ATL.Methods: This prospective study was performed in 23 patient with resistant temporal lobe epilepsy. Clinical seizure characteristics, temporal lobe localization, seizure frequency, educational and socioeconomic status, antiepileptic medication, cranial MRI and pathology of cases were evaluated. BDE, BAI and SF-36 scales administered before and after ATL with standard interval. Results:We found a rate of 43.5% for depression and anxiety before surgical treatment. Depression and anxiety were found to be related only seziure frequency in terms of clinical and demographic features. The rate of depression and anxiety increased with increased frequency of seizures (p<0.001 and p=0.012 respectively). Depression and anxiety improved markedly following ATL in our cases. This improvement is directly associated with attaining a seizure-free state following surgical treatment (p<0.001). We found a marked improvement in all subscales of SF 36. Conclusion:We found in this series that ATL can benefit carefully-chosen drug resistant TLE cases both with an improvement in epileptic s...

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Psychiatric aspects of temporal lobe epilepsy before and after anterior temporal lobectomy

Cited by 199 publications

References 29 publications

Depression in Intractable Partial Epilepsy Varies by Laterality of Focus and Surgery

Depression in Intractable Partial Epilepsy Varies by Laterality of Focus and Surgery

Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy

Surgical Treatment of Temporal Lobe Epilepsy Before and After Depression, Anxiety and Quality of Life Evaluation

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