Abstracts

Rationale:
In our institution, epilepsy surgery patients can receive presurgical depression and anxiety inventories twice: once during a clinical neuropsychological evaluation and again in a research neuropsychological evaluation occurring a mere 1 to 2 weeks before surgery. We repeated these self-report inventories, as we felt they are likely capturing “state” rather than “trait” mood levels, and that it was best to capture emotional state closest to the date of surgery. However, we observed that these emotional ratings appeared to improve for many patients just before surgery, and decided to formally evaluate these trends. This is an important observation because tracking cognitive and psychological functioning has been critical for establishing the efficacy of treatment and surgical outcome. It may be that assessing mood just prior to actual surgery date is capitalizing on the procedure itself, perhaps spuriously masking actual emotional disturbance.
Method:
All patients underwent a presurgical protocol, which included video-EEG monitoring, neuropsychological testing, and imaging to include MRI and PET scans. We compared presurgical clinical and research self-reported psychological symptoms in a series of stereotactic laser amygdalohippocampotomy (SLAH) patients (n=37). All patients received reliable and valid self-report psychological inventories for depression (Beck Depression Inventory-II; BDI-II) and anxiety (Beck Anxiety Inventory; BAI). We used a repeated measures univariate ANOVA to compare our outcomes of individual self-reported experiences.
Results:
Patients had a mean age of 42.62±15.10 years and 70.3% were women. The majority (73%) had seizure semiology of focal plus secondary generalization. Roughly half (54.1%) of the sample was right seizure lateralization. The average age of epilepsy diagnosis was 18.62±2.32 years (range 1-58) while epilepsy duration was 24.00±2.98 years (range 1-64). Sixteen patients (43.2%) self-reported a diagnosis of depression and nine patients (24.3%) a diagnosis of anxiety. A repeated measures univariate ANOVA revealed a significant main effect for time: F(1, 27) = 5.02, p = 0.03, partial η2 = 0.16. Scores on the BDI-II at the clinical neuropsychological evaluation were higher than scores obtained in the subsequent research neuropsychological evaluation (15.54±2.40 vs. 11.57±1.77, respectively). In addition to statistical significance, there was clinical significance such that 28% of patients self-reported depression decreased convention levels by one or more categories (e.g., severe to mild). In contrast, scores on the BAI were non-statistically significant. Although clinically, 32% of patients decreased convention levels by one or more categories for self-reported anxiety, yet the magnitude of change in total scores was insufficient to achieve significance.
Conclusion:
Epilepsy surgery patients showed significant improvement in mood as assessed closer to their actual surgery date, suggesting that they may have experienced altered self-perception of clinical mood disturbance in anticipation of possible surgical benefits. This may obscure meaningful change if artificially elevating scores just prior to the procedure, and is deserving of further exploration of potential intervening causes.
Funding:
:None to disclose.