Abstracts

Rationale: The prevalence of comorbid psychiatric disturbs (PD) in patients with temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) reaches 20-40%, rising to 70% in patients with refractory forms of epilepsy. Mood disorders are the most common (24-74%). The association between pre-surgical PD and a worse post-surgical seizure outcome in patients with refractory epilepsy submitted to epilepsy surgery has been also increasingly recognized. This study aims at verifying the impact of pre-surgical mood disorder, specially depression, on seizure outcome in surgically treated patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS). Methods: After previous consent, retrospective data from 115 surgically treated (corticoamygdalohyppocampectomy) TLE-MTS patients (65 females; 56.5%) were reviewed. Clinical, socio-demographic, and electrophysiological variables were analyzed. Psychiatric evaluations were performed by the same psychiatrist and through DSM-IV or ILAE criteria. The mean follow-up interval after surgery was of 4.7±1.66 (one to eight) years. Engel IA was established as a favorable post-surgical outcome. Univariate statistical analyses was performed firstly, followed by multivariate statistical analysis (logistic regression model) to identify predictors of a non-favorable seizure outcome, and the odds-ratio (OR) was calculated for significant risk factors. P value of <0.05 was considered significant. Results: Forty-five patients (41.6%) were classified as Engel IA; 47 patients (40.8%) presented pre-surgical PD. Depression (OR=5.11; p=0.004) appeared as a risk factor associated to a non-favorable seizure outcome. Conclusions: In patients with refractory TLE-MTS, the presence of depression predicts an unfavorable surgical outcome. The findings of the present paper are of great value and reinforce the importance of performing a detailed psychiatric pre-surgical evaluation in all epilepsy patients candidates for surgical treatment.