Authors :
Presenting Author: Karanbir Padda, MD – New York-Presbyterian/Weill Cornell Medicine
Rebecca Matthews, MD – Emory University School of Medicine; ioannis Karakis, MD – Emory University School of Medicine; kelsey Hewitt, PsyD – Emory University School of Medicine; edward Valentin, PhD – Emory University School of Medicine; cady Block, PhD – Emory University School of Medicine; taylor Shade, BS – Emory University School of Medicine; Adam Dickey, MD – Emory University School of Medicine; scott Millis, PhD – Wayne State University; jon Willie, MD, PhD – Washington University St. Louis; Robert Gross, MD, PhD – Emory University School of Medicine; Daniel Drane, PHD – Emory University School of Medicine
Rationale:
Stereotactic laser amygdalohippocampotomy (SLAH) is a minimally invasive surgical treatment for medically refractory temporal lobe epilepsy (TLE) that has comparable rates of seizure freedom to traditional open resective (OR) TLE surgery. The objective of this study was to determine psychiatric outcome (i.e., depression and anxiety changes, psychosis) after SLAH, to explore possible contributory factors to these changes, and to determine the prevalence of de novo psychopathology.
Methods:
We explored mood and anxiety in 37 adult TLE patients undergoing SLAH using the Beck psychiatric symptoms scales (i.e., Beck Depression Inventory-II [BDI-II] and Beck Anxiety Inventory [BAI]) preoperatively and 6 months following surgery. Multivariable regression analysis was conducted to identify predictors of worse depression or anxiety symptoms following SLAH. The prevalence of de novo psychopathology following SLAH was also determined.
Results:
We found a significant decrease in BDI-II (mean decline from 16.3 to 10.9,
p = 0.004) and BAI (mean decline from 13.3 to 9.0,
p = 0.045) scores following SLAH at the group level.
While the rate of resolution of depression (from 62% to 49%) did not achieve statistical significance (p=0.13, McNemar’s), the rate of resolution of anxiety (from 57% to 35%) was statistically significant (p=0.03, McNemar’s). The de novo rate of psychopathology (i.e., new onset depression or anxiety) following SLAH was 14% (1/7). Using a metric of meaningful change rather than complete symptom resolution, 16 of 37 (43%) patients experienced improvement in depression and 6/37 (16%) experienced worsening. For anxiety, 14 of 37 (38%) experienced meaningful improvement and 8/37 (22%) experienced worsening. Baseline performance on the Beck Scales was the only factor contributing to outcome status. While not a primary focus of the study, two patients with preexisting histories of psychosis experienced recurrent symptoms after undergoing SLAH procedures, both of which were right-sided. Both required brief hospitalization and resumption of antipsychotic medications to get their psychiatric symptoms under control.
Conclusions:
In one of the first studies to evaluate psychiatric outcomes after SLAH, we found promising overall trends towards stability or significant improvement in symptom burden at the group level for both depression and anxiety. There was a significant decrease in clinical anxiety, though the decrease in clinical depression was not significant, likely owing to the limitations of sample size. SLAH may improve overall psychiatric symptoms, similarly to traditional resective TLE surgery, but de novo psychopathology and postoperative psychiatric morbidity remain significant issues, and larger samples are necessary to determine causal contributory factors.
Funding:
NIH/NINDS (R01 NS088748)