Authors :
Presenting Author: Carol Schramke, PhD – Allegheny General Hospital / Allegheny Health Network
Shahzaib Tariq, MD – Resident, neurology, Allegheny Health Network; Laxmi Shah, DO – Allegheny Health Network; James Valeriano, MD – Allegheny Health Network; Andrea Synowiec, DO – Allegheny Health Network; Kevin Kelly, MD – Allegheny Health Network
Rationale:
Psychiatric disorders, including depression, are common in patients with epilepsy. Psychopathology prior to epilepsy surgery has been found to be associated with an increased risk of psychiatric problems post-surgery and psychiatric and behavioral problems prior to an epilepsy diagnosis have been found to be associated with intractable epilepsy. Altalib et al. (2018) identified five studies that found an association between depression and surgical outcome and five that did not. They did not find that a diagnosis of depression or anxiety, based on standardized clinical interviews for past or current depression and anxiety (n=379), was associated with lower surgical success. This study updates our data presented in 2015 that examined whether patient reports of depression, taking antidepressant medication at the time of evaluation, or the Minnesota Multiphasic Personality Inventory (MMPI) Depression Scale was associated with surgical success.
Methods:
Records from January 1, 1989 through June 1, 2022 at Allegheny General Hospital Epilepsy Center identified patients being evaluated for epilepsy surgery. Engel Classifications were determined through outpatient chart review. “Good outcome” was defined as Engel class 1 (i.e., seizure free or rare disabling seizures). Included patients had psychological interviews, completed the MMPI-2, and were followed for at least one year post-surgery. Patient reports of taking antidepressant medication, depression prior to first seizure, since first seizure, and at time of the pre-surgical evaluation were recorded. MMPI scale 2 (Depression) was considered elevated when t-scores were greater than 65. Results:
Of the 56 patients meeting inclusion criteria, 29 were female (52%), 43/56 had a lobectomy (76.7%), 7/56 had lesionectomy (12.5%), 6/56 had both lesionectomy and lobectomy (10.7%), 53/56 had either a temporal lobectomy or lesionectomy (93%), and 31/56 had a lobectomy or lesionectomy on the right side (55%). 33/56 patients had multiple seizure types (54%), 21/56 had only complex partial seizures (38%), 2/56 of patient had only GTC (4%), 2/56 of patients had only simple partial seizure (4%). Depression prior to first seizure, since first seizure, or at time of neuropsychiatric evaluation was not associated with a lower probability of a good outcome (see table 1, p=.95). However, patients with scale two elevations were significantly less likely to have good outcomes compared to patients without scale two elevations (see table 2, p< .01).