Changes in psychiatric comorbidity during early postsurgical period in patients operated for medically refractory epilepsy--a MINI-based follow-up study.
OBJECTIVE
The purpose of this study was to assess axis-I DSM-IV psychiatric disorders in patients at baseline and 3 months after surgery for medically refractory temporal lobe epilepsy.


METHODS
The Mini International Neuropsychiatric Interview (MINI) and Quality of Life in Epilepsy Inventory-10 (QOLIE-10) were evaluated before and 3 months after surgery in 50 consecutive patients (21 females, 29 males) with medically refractory temporal lobe epilepsy (persistent seizures>2/month, despite treatment with ≥2 appropriate drugs in adequate doses for ≥2 years) who underwent surgery [anterior temporal lobectomy with amygdalo-hippocampectomy (for mesial temporal sclerosis in 40), electrocorticography-guided lesionectomy (for other lesions in 10)].


RESULTS
Twenty-six patients (52%) had an axis-I psychiatric disorder [26% depressive disorder, 28% anxiety disorder] at baseline, while 30 (60%) patients had an axis-I psychiatric disorder [28% depressive disorder, 28% anxiety disorder] at 3 months after surgery. Twenty percent developed a new psychiatric disorder, while 12% showed improvement postsurgery. Mean QOLIE-10 scores improved from 23.78 to 17.80 [24 (48%) patients showed ≥5-point improvement]. Thirty-four (68%) patients had no seizure, 6 (12%) had non-disabling seizures, while 2 (4%) had disabling seizures after surgery. High frequency of seizures prior to surgery (p<0.038) and seizure occurrence after surgery (p<0.055) predicted the presence of psychiatric disorders after surgery. No clinical characteristic could predict development of new psychiatric disorder after surgery.


CONCLUSIONS
Psychiatric dysfunction in the early postsurgery period is seen in nearly half of patients undergoing surgery for temporal lobe epilepsy, is mild in nature, and does not adversely affect quality of life but may cause significant clinical problems when it arises de novo postsurgery.
Shree Krishna Hospital, Karamsad, Anand, Gujarat, India; Dept. of Neuro-Medicine, Pramukhswami Medical College, Karamsad, Anand, Gujarat 388325, India.
Soaham
S
Desai
Dept. of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: garimashukla@hotmail.com.
Garima
G
Shukla
Dept. of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.
Vinay
V
Goyal
Dept. of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.
Achal
A
Srivastava
Dept. of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.
M V Padma
MV
Srivastava
Dept. of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.
Manjari
M
Tripathi
Dept. of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.
Mamta
M
Singh
Dept. of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India.
K
K
Shivanand
Dept. of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India.
Rajesh
R
Sagar
Dept. of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110029, India.
Aditya
A
Gupta
Dept. of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110029, India.
P
P
Saratchandra
Dept. of Neuro-radiology, All India Institute of Medical Sciences, New Delhi 110029, India.
Ajay
A
Garg
Dept. of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.
C S
CS
Bal
Dept. of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.
Madhuri
M
Behari
D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000379:methods*; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004569:Electroencephalography; D004827:Epilepsy / Q000453:epidemiology / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D011788:Quality of Life; D012640:Seizures / Q000453:epidemiology; D018434:Sickness Impact Profile; D016896:Treatment Outcome; D055815:Young Adult
Epilepsy surgery; Outcome; Psychiatric comorbidity