Authors :
Presenting Author: Edward Valentin, PhD – Emory University
Adam Dickey, MD, PhD – Emory University; Taylor Shade, BS – Emory University; Evan Brady, BA – Emory University; Kelsey Hewitt, PsyD – Emory University; Daniel Drane, PhD – Emory University
Rationale:
Stereotactic laser amygdalohippocampotomy (SLAH) is a minimally invasive surgical treatment for medically refractory temporal lobe epilepsy (TLE). The hypothesis of this study was that patients who are seizure free after SLAH will have reduced depression or anxiety symptomatology relative to patients who are not seizure free. This extends prior work (Padda et al., 2023) by including a larger cohort and longer follow-up.
Methods:
Beck Depression Inventory-II (BDI) and Beck Anxiety Inventory (BAI) were assessed pre and post operatively in 77 TLE patients who underwent SLAH. We used a univariate unpaired t-test to assess whether change in BDI or BAI differed by seizure free status. We performed multivariate regression with independent variables of pre-operative BDI or BAI and seizure free status and dependent variable of change in BDI or BAI.
Results:
We had complete data in 67 patients for BDI and in 65 patients for BAI. The mean change in BDI in seizure free patients was -5.1, compared to -1.0 in patients not seizure free, which was not significantly different (p=0.08). In multivariate analysis, both the pre-operative BDI (p< 0.001) and seizure free status (p=0.006) were significant predictors of change in BDI. Seizure freedom was associated with an additional 5.1 point drop in BDI.
The mean change in BAI in seizure free patients was -3.0, compared to -2.0 in patients not seizure free, which was not significantly different (p=0.87). Seizure free status was not a significant predictor of change in BAI in multi-variate analysis (p=0.28).
Conclusions:
In multivariate analysis, we showed a statistically significant and clinically relevant reduction in depression symptoms in patients who were seizure free after SLAH, compared to those we are not seizure free. There was also a significant effect of baseline BDI score, suggesting regression to the median – scores less than the median of thirteen tended to increase, while scores above median tended to decrease. In contrast, anxiety symptoms did not differ based on seizure free status. These findings can help us counsel patients about expected psychiatric changes following minimally invasive epilepsy surgery.
Funding:
A.S.D. was supported by the National Center for Advancing Translational Sciences of the NIH under award number UL1 TR002378 and KL2 TR002381. D.L.D was in part supported by a research grant from NIH National Institute of Neurological Disorders and Stroke (R01NS088748).