Abstracts

Rationale: Beyond seizure freedom, psychiatric morbidity and functional status are core determinants of health related quality of life following anterior lobectomy. Anticipated cognitive changes are a primary consideration prior to surgery, yet actual and perceived deficits are not reliably correlated in this patient group. Relationships between pre- and post-surgical cognitive status, affective distress, and health satisfaction remain unclear. Methods: One hundred eleven (111) left (LTLE) and 82 right (RTLE) nonlesional temporal lobectomy patients underwent pre-surgical neuropsychological testing pre- and four (4) months post-surgery. Self-reported seizure control, health satisfaction, depression (Center for Epidemiological Studies Depression Scale; CESD), perceived cognitive change (memory items adapted with permission from Seidenberg et al. (J Clin Exp Neuropsychol 1994; 16:93-104), work and driving status, and functional adjustment were obtained 3-5 years post-operatively. Results: Results: Similar rates of seizure freedom (Engel class I; 79%, 72%) and high health satisfaction (62%, 69%) were observed in RTLE and LTLE patients, respectively. The mean CESD score in each group was 13. In RTLE patients: Linear regressions found seizure control (b=0.25, p=.0008) and depression (b=0.05, p=.002) to explain 63% of the variance in post-surgical health satisfaction (F(2,31) = 24.69, p=.0001). Seventy-one percent (71%) of post-surgical work satisfaction (F(4, 31) = 20.41, p=.0001) was explained by depression (b=0.06, p=.0002), seizure control (b=.31, p=.0004), and changes in verbal memory performance (b=0.08, p=.003) as assessed with the Wechsler Memory Scale-Revised Logical Memory (LM). Self-reported cognitive complaints were not significantly associated with health or work satisfaction, objective test performance, or depression. In LTLE patients: Self-reported cognitive complaints (b=0.39, p=.03) were more strongly associated with health satisfaction than seizure control (b=0.26, p=.002) or depression (b=0.04, p=.01). Depression (b=0.07, p=.0006) and changes in verbal memory performance (LM) (b=-0.08, p=.03) explained 28% of the variance in work satisfaction. Conclusions: Among all patients, incomplete seizure control and subclinical depression were significantly and negatively associated with health and work satisfaction. Lower verbal memory scores four months after surgery were negative predictors of long-term work satisfaction but were not associated with later depressive symptoms. Among LTLE patients only, subjective cognitive complaints were significantly associated with both depressed mood and objective cognitive impairment, and should warrant rigorous evaluation.