Abstracts

Depression and anxiety are the most common psychiatric disorders found in patients with temporal lobe epilepsy (TLE) before and after anterior temporal lobectomy (ATL). Severity of depression is associated with neuropsychological impairment in TLE patients. No previous study has characterized the relationship between the presence of depression/anxiety and changes in memory function after ATL. We studied 56 patients (ages 17-56 years) who underwent ATL for refractory epilepsy. Patient data were divided into four groups: left-ATL with (N=10) and without (N=13) psychiatric disturbance and right-ATL with (N=17) and without (N=16) psychiatric disturbance. There were no significant differences between groups in age, education, age at seizure onset, duration of illness, pre-ATL seizure frequency and post-ATL seizure outcome. Retrospective chart review was used to determine the presence of psychiatric disturbance (mood and anxiety disorders), which was based on recommendations for psychiatric treatment after ATL made by the attending neuropsychologist. Patients were included if they had an IQ [gt]84 to ensure that memory deficit was not attributable to generalized cognitive impairment. Memory abilities were assessed an average of 5 months before surgery and an average of 11 months after surgery using the Verbal and Nonverbal Selective Reminding Tests. Twenty-seven patients (48% of the sample) received recommendations for psychiatric treatment after surgery: 13 for mood disorders, 2 for anxiety disorders, and 12 for comorbid mood and anxiety disorders. Repeated measures ANOVA indicated that left-ATL patients with psychiatric disturbance had the largest verbal memory reductions from before to after surgery compared to all other groups (Tukey post-hoc p values [lt] .01). There was also a drop in the number of words recalled by left-ATL patients without psychiatric disturbance, but the reduction was significantly greater for left-ATL patients with psychiatric disturbance. On the other hand, there was slight improvement in verbal recall ability for right-ATL patients after surgery regardless of psychiatric status. There were no significant interactions or main effects for nonverbal memory. Our results suggest that besides side of excision, the presence of depression and anxiety should be taken into account when evaluating verbal memory deficits after ATL. Questions remain regarding whether or not verbal memory deficits will improve after ATL if psychiatric symptoms are remediated with psychotherapeutic or psychopharmaceutic interventions.