title: Major depressive disorder as a predictor of a worse seizure outcome one year after surgery in patients with temporal lobe epilepsy and mesial temporal sclerosis.
abstract: OBJECTIVE
  The association between pre-surgical psychiatric disorders (PDs) and worse seizure outcome in patients with refractory epilepsy submitted to surgery has been increasingly recognized in the literature. The present study aimed to verify the impact of pre- and post-surgical PD on seizure outcome in a series of patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS).
  
  
  METHODS
  Data from 115 TLE-MTS patients (65 females; 56.5%) who underwent cortico-amygdalohippocampectomy (CAH) were analyzed. Pre- and post-surgical psychiatric evaluations were performed using DSM-IV and ILAE criteria. The outcome subcategory Engel IA was considered as corresponding to a favorable prognosis. A multivariate logistic regression model was applied to identify possible risk factors associated with a worse seizure outcome.
  
  
  RESULTS
  Pre-surgical PDs, particularly major depressive disorder (MDD), anxiety and psychotic disorders, were common, being found in 47 patients (40.8%). Fifty-six patients (48.7%) were classified as having achieved an Engel IA one year after CAH. According to the logistic regression model, the presence of pre-surgical MDD (OR=5.23; p=0.003) appeared as the most important risk factor associated with a non-favorable seizure outcome.
  
  
  CONCLUSIONS
  Although epilepsy surgery may be the best treatment option for patients with refractory TLE-MTS, our findings emphasize the importance of performing a detailed psychiatric examination as part of the pre-surgical evaluation protocol.
authors: Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil. filho.gerardo@gmail.com
authors: Gerardo Maria
authors: GM
authors: de Araújo Filho
authors: Francinaldo Lobato
authors: FL
authors: Gomes
authors: Lenon
authors: L
authors: Mazetto
authors: Murilo Martinez
authors: MM
authors: Marinho
authors: Igor Melo
authors: IM
authors: Tavares
authors: Luís Otávio Sales Ferreira
authors: LO
authors: Caboclo
authors: Elza Márcia Targas
authors: EM
authors: Yacubian
authors: Ricardo Silva
authors: RS
authors: Centeno
mesh_terms: D000328:Adult; D038481:Anterior Temporal Lobectomy; D003865:Major Depressive Disorder / Q000150:complications*; D004833:Epilepsy, Temporal Lobe / Q000523:psychology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D012598:Sclerosis / Q000473:pathology; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome