Suicide outcomes after resective epilepsy surgery

Hamid, Hamada; Devinsky, Orrin; Vickrey, Barbara G.; Berg, Anne T.; Bazil, Carl W.; Pacia, J.T.

doi:10.1016/j.yebeh.2011.04.037

Cited by 6 publications

(9 citation statements)

References 12 publications

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“…Neurosurgery treatment for medication-refractory epilepsy in infants and children remains an area of active research, and PET and SPECT imaging provides useful information in planning surgery for children [51,52]. Consistent with previous data, psychosocial outcome is improved among patients whom were seizure free [53,54].…”

Section: Epilepsy Surgerysupporting

confidence: 52%

An update on epilepsy

Schoenberg

Frontera

Bozorg

et al. 2011

Expert Review of Neurotherapeutics

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Section: Epilepsy Surgerysupporting

confidence: 52%

An update on epilepsy

Schoenberg

Frontera

Bozorg

et al. 2011

Expert Review of Neurotherapeutics

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“…The subgroups in our study were small, so definite conclusions cannot be made. We conclude that preoperative depression should not exclude patients from surgery, but the complex relationship between preoperative and postoperative depression in epilepsy surgery warrants further standardized investigation (Witt et al., 2008; Hamid et al., 2011; Wrench et al., 2011; Jobst, 2012).…”

Section: Discussionmentioning

confidence: 90%

Outcome of frontal lobe epilepsy surgery

et al. 2012

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Summary Purpose: There is still controversy in deciding which patients with frontal lobe epilepsy (FLE) should undergo resective surgery, even though it is a well‐established therapy. The aim of this study is to define multiple outcome measures and determine whether there are certain subpopulations of preferred surgical candidates that have a more favorable seizure prognosis. Methods: Fifty‐eight patients underwent resective FLE surgery with a mean follow‐up period of 79.3 months (range 12–208 months). Patient demographics, clinical seizure characteristics, seizure‐onset zone within the frontal lobes, and diagnostic tests were tabulated. Engel class, International League Against Epilepsy (ILAE) class, postoperative seizure patterns, time to first recurrent seizure, and seizures and employment during the last year of follow‐up were used as outcome measures. Neuropsychological performance and Beck Depression Inventory (BDI) scores were used to define neuropsychological outcome and examined as predictors of seizure outcome. Key Findings: Thirty‐three (57%) patients with resective surgery had an Engel class I outcome and 29 (50%) had an ILAE class I outcome. Mean time to first seizure after surgery was 33.3 months (range 0–208). Only 14 patients (24%) were completely seizure‐free without auras (Engel IA) throughout the entire follow‐up period. The most common pattern of seizure recurrence was mixed, with prolonged periods of seizure freedom intermixed with recurrences. In addition, 32% of patients made gains in employment and 52% were able to reduce use of antiepileptic drugs (AEDs), although only 9% discontinued AEDs. No significant association was found between class I or class IA outcome and the presence of a focal magnetic resonance imaging (MRI) abnormality, any specific localization of seizure focus within the frontal lobe, or neuropsychological change. Significance: Findings indicate that that long‐term outcome is generally favorable in FLE resective surgery, and support the need for considering multiple outcome measures to more fully characterize clinically relevant postsurgical changes. Outcome can be favorable even in MRI‐negative patients.

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“…Furthermore, three other patients (6.3%) developed suicidal ideation that required hospitalization in a psychiatric unit. Postsurgical suicidality following ATL has also been recognized in previous studies 37 . To identify patients at risk of developing these psychiatric complications, a current and lifetime psychiatric history needs to be identified at the time of the presurgical evaluation of every surgical candidate.…”

Section: Discussionmentioning

confidence: 99%

Long‐term seizure and psychiatric outcomes following laser ablation of mesial temporal structures

et al. 2022

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Objective: Postsurgical seizure outcome following laser interstitial thermal therapy (LiTT) for the management of drug-resistant mesial temporal lobe epilepsy (MTLE) has been limited to 2 years. Furthermore, its impact on presurgical mood and anxiety disorders has not been investigated. The objectives of this study were (1) to identify seizure outcome changes over a period ranging from 18 to 81 months; (2) to investigate the seizure-free rate in the last follow-up year; (3) to identify the variables associated with seizure freedom; and (4) to identify the impact of LiTT on presurgical mood and anxiety disorders. Methods: Medical records of all patients who underwent LiTT for MTLE from 2013 to 2019 at the University of Miami Comprehensive Epilepsy Center were retrospectively reviewed. Demographic, epilepsy-related, cognitive, psychiatric, and LiTT-related data were compared between seizure-free (Engel Class I) and non-seizure-free (Engel Class II + III + IV) patients. Statistical analyses included univariate and multivariate stepwise logistic regression analyses.Results: Forty-eight patients (mean age = 43 ± 14.2 years, range = 21-78) were followed for a mean period of 50 ± 20.7 months (range = 18-81); 29 (60.4%) achieved an Engel Class I outcome, whereas 11 (22.9%) had one to three seizures/ year. Seizure-freedom rate decreased from 77.8% to 50% among patients with 24and >61-month follow-up periods, respectively. In the last follow-up year, 83% of all patients were seizure-free. Seizure freedom was associated with having mesial temporal sclerosis (MTS), no presurgical focal to bilateral tonic-clonic seizures, and no psychopathology in the last follow-up year. Presurgical mood and/or anxiety disorder were identified in 30 patients (62.5%) and remitted after LiTT in 19 (62%).Significance: LiTT appears to be a safe and effective surgical option for treatmentresistant MTLE, particularly among patients with MTS. Remission of presurgical mood and anxiety disorders can also result from LiTT.

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Suicide outcomes after resective epilepsy surgery

Cited by 6 publications

References 12 publications

An update on epilepsy

An update on epilepsy

Outcome of frontal lobe epilepsy surgery

Long‐term seizure and psychiatric outcomes following laser ablation of mesial temporal structures

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