Abstracts

Rationale: Ictal fear (IF) has been associated with a variety of characteristics such as gender, lateralization of the epileptogenic zone, psychiatric disorders, amygdala atrophy and seizure free surgical outcome. This is a retrospective analysis of these factors after anteromesial temporal lobectomy in patients with and without IF. Methods: Surgical outcome was assessed in 65 patients with temporal lobe epilepsy (TLE) related to mesial temporal sclerosis (MTS). Assessment of the presence of IF included detailed review of available medical records, video-EEG recording and a standardized interview. It was only accepted if reported as being concomitant with an epileptic seizure; if it arose spontaneously, out of context; and if it could be clearly distinguished from the fear of a seizure. All patients underwent psychiatric evaluation via formal consultation with a psychiatrist, comorbidity identification was performed according to DSM IV criteria, and only axis I disorders were considered. MRI was performed in all patients. Results: Data from 15 patients with IF, 13 (87%) women and 50 patients without IF, 39 (78%) women were compared. Proportion analysis showed prevalence of IF of 25% in women and 15% in men. Laterality analysis showed no relation between side and presence of IF (χo2=1.936, df=1, p=0.164). Regarding amygdala atrophy, ANOVA was performed comparing groups right and left side separately from the IF, no IF and control group, showing statistical differences among them (F=5.54; DF=5, 86; p=0.000). Two sample T-test was performed comparing groups separately: IF and no IF left (To=3.02, p=0.007, DF=18); IF and normal control left (To=4.57, p=0.0001, DF=24); no IF and normal control left (To= 0.20, p=0.85, DF=18), IF and no IF right (To=1.71, p=0.10, DF=23), IF and normal control right (To= 3.06, p=0.006, DF=20), no IF and normal control right (To=1.26, p=0.22, DF=22). In patients with IF, the most frequent psychiatric disorder was depression, found in 7 (47%) followed by anxiety in 1 (6%). Considering patients without IF, depression was also the most frequent psychiatric disorder being found in 18 (35%), followed by psychosis 9 (17%), and anxiety in 3 (6%). No specific psychiatric comorbidity could be related to the IF group, neither when comparing depression (χo2=2.436, df=2, p= 0.296) nor psychiatric disorders as a group (χo2=2.394, df=1, p=0.122). Surgical follow up of patients with IF ranged from 61-1581 days (mean 652), and of those without IF from 89-1795 (mean 662). Regarding surgical outcome 11 patients (73%) in the IF group became seizure free (Engel IA) compared to 21 (42%) in the other group (T-Student test To= 2.28, p<0.027, DF=46). Conclusions: IF in TLE related to MTS was mainly seen in females independently of the side of the lesion. Atrophy of the amygdala, more intense on the left, was related to IF. Psychiatric comorbidity did not appear to be more prevalent in patients with IF. Favorable surgical outcome was strongly related to IF.