Abstracts

Rationale: Post-surgical depression and anxiety disorders have been identified in approximnately 30% of patients during the first 6 months after an antero-temporal lobectomy, with a presurgical psychiatric history being a risk factor of post-surgical psychiatric complications. MRI-Guided Laser Alation (MRI-GLA) of mesial temporal structures is a new minimally invasive surgical technique that has been used over the last two years in the management of patients with treatment-resistant TLE. The post-surgical complications of this procedure have yet to be investigated. The purpose of this prospective study is to identify the prevalence of psychiatric complications following this procedure, defined as 1) de-novo development of a mood, anxiety or psychotic disorder; 2) Exacerbation in severity and / or recurrence of of a presurgical psychiatric disorder, which requires a pharmacologic intervention.Methods: Sixteen patients, underwent a MRI-GLA at the Comprehensive Epilepsy Center of the University of Miami; nine were performed in left and seven in right mesial temporal structures. Lifetime psychiatric history was established as part of the presurgical evaluation in every patient. They were seen in follow-up visit at one, 4, 12 and 18, 40 and 52 weeks after the surgical procedure. The occurrence of any psychiatric symptom was investigated at each visit, but patients were urged to contact us if they were to experience any psychiatric symptom after surgery.Results: Among the 16 patients, 10 (62.5%) experienced a post-ablation psychiatric complication consisting of a recurrence of a presurgical depressive disorder in eight, a de-novo depressive episode in one and a de-novo hypomanic episode in one. Among the nine patients who had a left sided ablation, seven (78%) had a psychiatric complication, while this occurred in three (43%) of the patients who underwent an ablation in the right side. Two patients with a presurgical mood disorder continued to display symptoms of depression, but did not exacerbate in severity. Both patients had undergone a right sided ablation. In all patients, symptoms presented within the first six months after surgery. One patient had to be admitted to a psychiatric unit. Pharmacologic treatment resulted in symptom remission of the other patients.Conclusions: Post-surgical psychiatric complications are relatively frequent following MRI-GLA, particularly among patients with presurgiocal psychiatric history. Accordingly, careful presurgical psychiatric evaluation and post-surgical psychiatric monitoring are of the essence. Of note, psychiatric complications following MRI-GLA appear to be more frequent than those reported with antero-temporal lobectomies.