Pre-surgical predictors for psychiatric disorders following epilepsy surgery in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis.
Psychiatric outcomes of patients submitted to epilepsy surgery have gained particular interest given the high prevalence of pre-surgical psychiatric disorders (PD) in this population. The present study aimed to verify the possible pre-surgical predictors for psychiatric disorders following epilepsy surgery in a homogeneous series of patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS). Data from 115 TLE-MTS patients (65 females; 56.5%) who underwent cortico-amygdalohippocampectomy were included. Pre- and post-surgical psychiatric evaluations were performed using DSM-IV criteria. Pre-surgical PD - particularly mood, anxiety and psychotic disorders - were diagnosed in 47 patients (40.8%). Twenty-seven patients (54% of those with pre-surgical PD) demonstrated a remission of psychiatric symptoms on post-surgical psychiatric evaluation. Eleven patients (9.6%) developed de novo PD. The presence of pre-surgical depression (OR=3.32; p=0.008), pre-surgical interictal psychosis (OR=4.39; p=0.009) and epileptiform discharges contralateral to the epileptogenic zone (OR=2.73; p=0.01) were risk factors associated with post-surgical PD. Although epilepsy surgery is considered to be the best treatment option for patients with refractory TLE-MTS, the relatively high psychiatric comorbidities observed in surgical candidates and their possible negative impact on post-surgical outcomes require a careful pre-surgical evaluation of clinical, sociodemographic and psychiatric factors.
Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. filho.gerardo@gmail.com
Gerardo Maria de Araújo
GM
Filho
Lenon
L
Mazetto
Francinaldo Lobato
FL
Gomes
Murilo Martinez
MM
Marinho
Igor Melo
IM
Tavares
Luís Otávio Sales Ferreira
LO
Caboclo
Ricardo Silva
RS
Centeno
Elza Márcia Targas
EM
Yacubian
D000328:Adult; D000679:Amygdala / Q000601:surgery; D038481:Anterior Temporal Lobectomy / Q000009:adverse effects; D015897:Comorbidity; D004833:Epilepsy, Temporal Lobe / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000601:surgery; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D012598:Sclerosis / Q000453:epidemiology / Q000601:surgery; D013702:Temporal Lobe / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult