Abstracts

Rationale: Over 2 million Americans have epilepsy (www.efa.org) and more than one-third of people with epilepsy have medically refractory epilepsy [1]. While 50% of patients seen in a tertiary epilepsy center have depression and anxiety [2], psychotic symptoms and somatoform disorders are less commonly seen. Some behaviors, particularly irritability and aggressiveness, tend to improve with epilepsy surgery [3], but somatoform disorders or psychosis may worsen or emerge after surgery [4, 5]. So far, few studies have looked at the prevalence of somatoform disorders in patients with medically refractory epilepsy before or after epilepsy surgery. Methods: This retrospective cohort analysis assessed 21 patients who underwent neurosurgical intervention for intractable epilepsy at the South Texas Comprehensive Epilepsy Center (STCEC), between 2007 and 2008. Participants were primarily female (67%), right-handed (81%) and single (43%). They had epilepsy for an average of 13.24 (sd 8.6) years. Clinical variables including age at surgery, hippocampus sclerosis, psychiatric disorders, psychotropic medications, neuropsychological testing, side of resection, and outcome variables such as frequency of seizures and psychiatric disorders at 6-months post-surgical follow-up were reviewed. Results: The majority of patients had complex partial seizures (91%); half (52%) had generalized tonic-clonic seizures. Forty-eight percent had hippocampal sclerosis on MRI. The majority of the resections were in the right hemisphere (52%). Mean age at time of resection was 36.7 (sd 12.9) years and mean Full Scale IQ was 84.6 (sd 25). Six months after resection, 52.4% (n=11) of the patients were seizure-free and 33% had a reduction in anti-epileptic medications. See Table 1 for psychiatric diagnosis of patients prior to and following resection. At the 6-month follow-up, four patients were newly diagnosed with OCD and Somatoform disorder. Conclusions: Psychiatric complications after TLE are frequent and independent of seizure outcome. Somatoform and OCD disorders presented de novo post surgery; all the patients with these disorders underwent right hemisphere surgery. It will be important to correlate the emergence of somatoform disorders with depressive and anxiety-related symptoms, and evaluate how somatic complaints respond to antidepressant therapies initiated pre- or post-operatively.