Abstracts

Rationale: Mesial Temporal Lobe Epilepsy (mTLE) is refractory to treatment in approximately over 60% of cases. Although resective epilepsy surgery can be a suitable treatment for seizure control, depression is very common in patients with mTLE, which may increase risk of worsening depression after resective surgery. Additional serial follow-up data are needed to investigate pre- and post-surgical psychiatric outcomes and treatment factors associated with potential improvements in the psychosocial status of surgical patients across the stages of the surgical process (i.e., prior, subacutely, long-term follow-up). Methods: We evaluated the rates of preoperative psychiatric diagnoses and treatment along with post-surgical outcome of psychiatric disorders in a patient cohort of patients with medically refractory mTLE (N = 12) who underwent neurosurgical intervention at a regional epilepsy center. The presence of psychiatric disorders was determined by a structured psychiatric diagnostic interview (Mini International Neuropsychiatric Interview). Outcome variables included presence of post-surgical psychiatric disorders, seizures, use of psychotropics at 1, 6, and 12 months after surgery. Results: This study primarily included patients undergoing resections of right hemispheric lesions (67%). Depression were diagnosed preoperatively in six (50%), General Anxiety Disorder (GAD) in one (8%), and Schizophrenia in one (8%) patients. Patients with psychiatric disorders (n = 8, 66%) were treated with psychotropics before surgery. One month after resection, nine (75%) patients were seizure-free. All of the patients (n = 6) treated for depression preoperatively continued on their regimen, three remained symptomatic; one patient was newly diagnosed for MDD and one additional patient was diagnosed with GAD. At 6 months, 58% were seizure free, depressive symptoms increased in six (50%) patients; two were noncompliant. Of the seven (58%) patients taking psychotropics, two were asymptomatic. At 1 year, seven (58%) were still seizure free, only two (17%) continued to meet criteria for major depression, and five (42%) continued taking medications. Conclusions: Results indicated that there may be an increased risk of depressive symptoms by 6 months after temporal lobectomy. However, the pattern of longitudinal outcome in patients from the present patient cohort also revealed a pattern of declining prevalence of psychiatric diagnoses post-surgery, which is a more favorable outcome than research reporting worsening postoperative psychiatric outcomes. Thus, the current findings highlight the relevance of preoperative diagnoses and subsequent psychiatric treatment in the comprehensive care of surgical patients with medically refractory TLE in order to maximize long-term psychosocial outcome after surgery.