Comprehensive analysis of presurgical factors predicting psychiatric disorders in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis underwent cortico-amygdalohippocampectomy.

Wei Yang,Chongyi Chen,Bo Wu,Qiaoyu Yang,Dongdong Tong

doi:10.1002/jcla.22724

Abstract

BackgroundThis study aimed to evaluate the predictive value of presurgical factors for psychiatric disorders (PD) in refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE‐MTS) patients underwent cortico‐amygdalohippocampectomy (CAH).MethodsA total of 98 refractory TLE‐MTS patients underwent CAH were consecutively enrolled in this cohort study. Several presurgical factors were recorded, such as married status, employment status, highest education, disease duration, family history of epilepsy, and disorganized VEEG background activity.ResultsThere were 17 (17.3%) refractory TLE‐MTS patients occurring PD after CAH, including 8 (8.2%) mood disorders, 7 (7.1%) anxiety disorders, 8 (8.2%) psychoses, and 1 (1.0%) interictal dysphoric disorder. Employed status correlated with low PD occurrence, while disease duration and asymmetric VEEG background activity positively correlated with PD occurrence. Multivariate logistic analysis revealed employed status (P = 0.009) could independently predict lower PD occurrence, while highest education (P = 0.027), disease duration (P = 0.028), seizure frequencies (P = 0.015), and asymmetric VEEG background activity (P = 0.034) could independently predict higher PD occurrence. Receiver operating characteristic curve showed combination of these five factors (area under curve (AUC) = 0.871, 95%CI: 0.783‐0.960) disclosed a great predictive value of PD occurrence. The sensitivity and specificity were 70.6% and 92.6% at the best cutoff point. In addition, the percentage of PD was increased with higher Engel classification (P = 0.003).ConclusionEmployed status, highest education, disease duration, seizure frequencies, and asymmetric VEEG background activity correlate with PD occurrence independently in epileptic patients.

Highlights

Epilepsy, a transient occurrence of signs and/or symptoms owning to abnormal excessive or synchronous neuronal activity in the brain, is a kind of chronic disorder that frequently causes long‐term medical, psychological, and social sequelae.[1,2] According to the report of World Health Organization (WHO), there are estimated more than 50 mil‐ lion epilepsy patients and 2.4 million new cases occurring worldwide per year.[3]
Approximately 60% patients are diagnosed as partial‐onset epilepsy, whose most common subtype is temporal lobe epilepsy (TLE), and mesial temporal sclerosis (MTS) is considered as the most common pathological substrate of TLE.[4,5]
For these TLS‐MTS patients, most of them have been reported to be re‐ fractory to antiepileptic drugs (AEDs), but have favorable responses to surgery, including cortico‐amygdalohippocampectomy (CAH), which is a type of anterior and mesial temporal lobectomy (ATL) and one of optimal choices in patients with refractory epilepsy.[5,6]

Summary

Introduction

A transient occurrence of signs and/or symptoms owning to abnormal excessive or synchronous neuronal activity in the brain, is a kind of chronic disorder that frequently causes long‐term medical, psychological, and social sequelae.[1,2] According to the report of World Health Organization (WHO), there are estimated more than 50 mil‐ lion epilepsy patients and 2.4 million new cases occurring worldwide per year.[3]. This study aimed to evaluate the predictive value of presurgical factors for psychiatric disorders (PD) in refractory temporal lobe epilepsy and mesial tempo‐ ral sclerosis (TLE‐MTS) patients underwent cortico‐amygdalohippocampectomy (CAH). Multivariate logistic analysis revealed em‐ ployed status (P = 0.009) could independently predict lower PD occurrence, while highest education (P = 0.027), disease duration (P = 0.028), seizure frequencies (P = 0.015), and asymmetric VEEG background activity (P = 0.034) could indepen‐ dently predict higher PD occurrence. Conclusion: Employed status, highest education, disease duration, seizure frequen‐ cies, and asymmetric VEEG background activity correlate with PD occurrence inde‐ pendently in epileptic patients

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