Psychiatric comorbidity and temporal lobe epilepsy surgery outcome

Abstract

Pharmacoresistance in PWE is frequently associated with psychiatric comorbidity. The effectiveness of epilepsy surgery is well established, established; however, the impact of surgery on depression and anxiety remains controversial. To study possible association between psychiatric comorbidity in patients with temporal lobe epilepsy (PTLE) and epilepsy surgery outcome. PTLE who underwent anterior temporal lobectomy with amygdalohippocampectomy were examinined before surgery and 6 months after. The diagnosis of psychiatric disorder was verified by a structured diagnostic interview for DSM-IV (SCID-I). Epilepsy-specific interictal dysphoric disorder (IDD) was also assessed. Seizure outcome was determined according to Engel’s classification. 18 PTLE aged 35 ± 9.16 years with the age of the onset of epilepsy 13.67 ± 10.75 years, duration 21.39 ± 12.24 years and frequency 11.72 ± 7.23 seizures per month were examined. 11 of them suffered from major depression, 6 had anxiety and 2 - obsessive-compulsive disorders. IDD was detected in 16 patients. 10 patients were treated with psychopharmacotherapy. 10 PTLE achieved Engel Class I with significant (P < 0.05) reduction of IDD in 7 of them. In 8 PTLE with Engel II and III outcomes no appreciable changes in IDD were observed. Only 4 from 18 PTLE with different surgery outcomes had no signs of any psychiatric disorder 6 months after. All of them were treated with psychopharmacotherapy before and after the surgery. In PTLE and comorbid psychiatric disorders who underwent anterior temporal lobectomy with amygdalohippocampectomy Engel Class I outcome was associated with the significant reduction of epilepsy-specific IDD.