Do psychiatric comorbidities predict postoperative seizure outcome in temporal lobe epilepsy surgery?
Clinical and demographic presurgical variables may be associated with unfavorable postsurgical neurological outcome in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). However, few reports include preoperative psychiatric disorders as a factor predictive of long-term postsurgical MTLE-HS neurological outcome. We used Engel's criteria to follow 186 postsurgical patients with MTLE-HS for an average of 6 years. DSM-IV criteria and psychiatric comorbidity criteria specific to epilepsy (interictal dysphoric disorder, postictal and interictal psychosis) were used to assess presurgical psychiatric disorders. Kaplan-Meier event-free survival and adjusted hazard ratios were estimated with unconditional logistic regression. Seventy-seven (41.4%) patients had a preoperative Axis I psychiatric diagnosis. Thirty-six patients had depression, 11 interictal dysphoric disorder, 14 interictal psychosis, 6 postictal psychosis, and 10 anxiety disorders. Twenty-three (12.4%) patients had Axis II personality disorders. Regarding seizure outcome, preoperative anxiety disorders (P=0.009) and personality disorders (P=0.003) were positively correlated with Engel class 1B (remaining auras) or higher. These findings emphasize the importance of presurgical psychiatric evaluation, counseling, and postsurgical follow-up of patients with epilepsy and psychiatric disorders.
Guarnieri
Ricardo
R
Centro de Cirurgia de Epilepsia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil. ricardoguarnieri@uol.com.br
Walz
Roger
R
Hallak
Jaime E C
JE
Coimbra
Erica
E
de Almeida
Edna
E
Cescato
Maria P
MP
Velasco
Tonicarlo R
TR
Alexandre
Veriano
V
Terra
Vera C
VC
Carlotti
Carlos G
CG
Assirati
João A
JA
Sakamoto
Américo C
AC
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000523:psychology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007406:Interview, Psychological; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000523:psychology*; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011184:Postoperative Period; D011569:Psychiatric Status Rating Scales; D012640:Seizures / Q000453:epidemiology*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult