Abstracts

Assess risk factors influencing the development and prognosis of mania following anterior temporal lobectomy. The University of Colorado Epilepsy Surgery Database was used to identify patients who developed mania or hypomania after anterior temporal lobectomy requiring treatment within the last fifteen years. A comparable group of controls was selected based on age, sex, epilepsy severity and antiepileptic drug burden. Ten patients were found that had mania following anterior temporal lobectomy (mean followup 7.7 years). There was no correlation with the likelood of developing post-operative mania with age, sex, post-operative seizure freedom, laterality of surgery, or evidence of bitemporal disease. Six of the ten manic patients had a pre-operative history of mania or hypomania, compared to none of the control patients. Four of the six patients with pre- and post-operative mania required hospitalization for their symptoms, compared to only one of the four patients who developed mania de novo following temporal lobectomy. Five out of six with pre-operative mania or hypomania had mania persisting for more than a year after surgery. In contrast three out of four without pre-operative mania or hypomania, had their mania resolve within the first post-operative year. A pre-operative history of mania was correlated with a longer duration of manic symptoms following surgery and greater likelihood of hospitalization for manic symptoms. There was no obvious correlation between mania duration or severity with age, sex, post-operative seizure freedom, laterality of surgery, or evidence of bilateral disease. Mania often emerged after reduction of antiepileptic drugs. This data suggests that preoperative mania or hypomania are risk factors in the development of mania following temporal lobectomy, and, if present, its duration and severity. Mania often emerged after reduction of antiepileptic drugs. Additional prospective studies, with larger numbers of patients, are clearly needed to further delineate the effect of presurgical psychiatric morbidity on long-term epilepsy surgery outcomes.