Psychiatric Outcome of Temporal Lobectomy for Epilepsy: Incidence and Treatment of Psychiatric Complications

Abstract

Summary: Purpose: To determine the incidence of psychiatric disorders before and after surgical treatment for partial epilepsy and to document the effectiveness of their treatment.Methods: Fifty consecutive patients treated surgically for focal epilepsy (44 temporal and six frontal) were evaluated by established neuropsychiatric methods before surgery and over a mean period of 2 years after surgery. The patients with interictal dysphoric disorders, with or without psychotic episodes, were treated witli tricyclic antidepressant medication alone or combined with serotonin selective reuptake inhibitors and, if necessary, with the addition of risperidone.Results: Before surgery, 25 (57%) of the 44 patients with temporal lobe epilepsy had dysphoric disorders. After surgery, 17 (

Psychiatric Outcome After Temporal Lobectomy: A Predictive Study

“…In addition to these findings, weak evidence was found in support of the prediction that psychiatric outcome would be related to surgical success (in terms of seizure abatement), in line with previous findings in this area (3,15). More specifically, we found that patients with a past psychiatric history and de novo psychiatric symptoms postoperatively were marginally less likely to achieve 90% seizure reduction than were patients with a good psychiatric outcome.…”

“…Certain methodological problems have characterised many of the studies conducted to date, not the least being the failure to evaluate the psychiatric status of patients both before and after surgery. There are, however, clear reports of de novo psychiatric symptoms after epilepsy surgery, including depression, psychosis, and personality change (3). Conversely, there have been some reports of improvements in psychiatric status after epilepsy surgery, particularly with respect to aggression (6).…”

“…Several studies have shown that improvements in seizure control postoperatively might favourably influence psychiatric outcome (3,15). Accordingly, our fifth hypothesis was that a positive neurological outcome (in terms of seizure abatement) would be related to a good psychiatric outcome.…”

“…A number of studies suggest that epilepsy surgery may be associated with considerable psychiatric complications (2)(3)(4), although the immediate-and long-term complication rates vary among investigations (5). Certain methodological problems have characterised many of the studies conducted to date, not the least being the failure to evaluate the psychiatric status of patients both before and after surgery.…”

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

“…The interval of our study was Ն1 year. Findings may differ depending on the duration of postsurgical follow-up, with the immediate postoperative period-4 to 8 weeks-possibly being the period of highest risk of psychiatric morbidity (24,25). Scale 2 administered 1 year after surgery, therefore, may underestimate the peak morbidity of depression.…”