title: Do psychiatric comorbidities predict postoperative seizure outcome in temporal lobe epilepsy surgery?
abstract: 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.
authors.affiliation: Centro de Cirurgia de Epilepsia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil. ricardoguarnieri@uol.com.br
authors.forename: Ricardo
authors.initials: R
authors.lastname: Guarnieri
authors.forename: Roger
authors.initials: R
authors.lastname: Walz
authors.forename: Jaime E C
authors.initials: JE
authors.lastname: Hallak
authors.forename: Erica
authors.initials: E
authors.lastname: Coimbra
authors.forename: Edna
authors.initials: E
authors.lastname: de Almeida
authors.forename: Maria P
authors.initials: MP
authors.lastname: Cescato
authors.forename: Tonicarlo R
authors.initials: TR
authors.lastname: Velasco
authors.forename: Veriano
authors.initials: V
authors.lastname: Alexandre
authors.forename: Vera C
authors.initials: VC
authors.lastname: Terra
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Carlotti
authors.forename: João A
authors.initials: JA
authors.lastname: Assirati
authors.forename: Américo C
authors.initials: AC
authors.lastname: Sakamoto
mesh_terms: 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