Abstracts

Mood disorders are frequent co-morbidities in epilepsy and may be accompanied by polysomatic complaints. Studies of temporal lobectomy patients have reported post-surgical mood changes with right vs left laterality differences. Among non-epilepsy patients, right hemisphere lesions have been associated with diminished awareness of physical impairments. A sample of right (R) vs left (L) temporal lobectomy S[apos]s with pre and 1-yr. post surgical measures was compared to evaluate the effect of surgery and laterality on Anxiety (anx.), Depression (dep.), and Somatization (somat.). We prospectively studied 20 (L) and 12 (R) side sequentially admitted temporal lobectomy patients, 16 male, and compared Personality Assessment Inventory (PAI) Anxiety, Depression, Somatization subtest scores pre and 1-yr. post surgery. Pre-surgical duration of epilepsy, age at surgery, gender, and IQ were assessed. The PAI is a reliable [amp] valid standardized, multi-dimensional, self-report presonality trait test administered pre and post surgery. L side patients had mean pre-surgical sz duration of 25 yr, vs 18.3 yr. for R side patients. Mean age at L surgery = 43.3 yr, and R side = 36.5 yr. Age difference L vs R equalled the difference in pre-surg. sz duration (7 yr.). Mean IQ[apos]s were L = 93; R = 98. L vs R sample equivalency was challenged by a significantly lower number of R side cases returning for 1 yr. post testing.
Females and males, L [amp] R side, had equal pre-surgical scores on all variables (dep., anx., somat.). While R side S[apos]s post-scores improved on all variables (p[underline][lt][/underline] .014), L side patients post-scores did not improve on anx. or dep. but did improve on somat. (p[underline][lt][/underline] .008). Post-surgically, L were more depressed than R side S[apos]s (p[underline][lt][/underline].04). Seizure improvement outcome grades at 1 yr. were equivalent, L and R. Principal findings are of equal pre-surgical L vs R anx., dep., and somat.. However, anx., dep, [amp] somat. scores improved 1 year post-surgery for R side S[apos]s; while L S[apos]s improved only on somat. scores and had no improvement in anxiety or depression. This is consistent with reports that L hemisphere lesions more likely produce mood deterioration; while R damage is associated with decreased appreciation of physical impairment and, occasionally, denial of illness/injury. Alternatively, the combination of L focus and post-surg sz reduction may deprive patients of anti-depressant effects of seizures. Hence, while L side patients[apos] depression and anxiety did not improve, the reduction in seizures produced reduced somat. scores. Though higher post-surgical somatic complaints might have been expected in dominant hemisphere surgery, due to increased threat to language, this did not occur. The greater pre-surgical sz duration of the L patients may reflect reluctance to operate on the dominant hemisphere. Although higher depression, anxiety, and somatization has often been reported among females, this was not seen.