Objectives-Psychopathology has been reported to be prevalent both before and after surgical treatment for medically intractable temporal lobe epilepsy. Individual patients were evaluated prospectively to assess the eVect of anterior temporal lobectomy (ATL) on prevalence and severity of psychiatric disease. Methods-Psychiatric status was assessed in a consecutive series of epilepsy patients before and 6 months after ATL using a structured psychiatric interview, psychiatric rating scales, and self report mood measures. Results-A DSM-III-R axis I diagnosis was present in 65% of patients before and after surgery. The most common diagnoses were depression, anxiety, and organic mood/personality disorders. There was a trend for major psychiatric diagnoses to be more common in patients with right compared to left temporal lobe seizure focus, both before and after surgery. The apparent stability in the overall rate of psychiatric dysfunction concealed onset of new psychiatric problems in 31% of patients in the months shortly after surgery, and resolution of psychiatric diagnoses in 15% of patients. In the group as a whole, the severity of psychiatric symptoms was lower at 6 months postsurgery than before temporal lobectomy. Conclusions-The overall prevalence of psychiatric dysfunction was comparably high before and after ATL, but individual changes in psychiatric status and changes in severity of symptoms occurred in many patients in the 6 months after surgery. (J Neurol Neurosurg Psychiatry 2000;68:53-58)

Quality of Life in Epilepsy (QOLIE) scores, reflecting both general and specific aspects of quality of life, are strongly influenced by mood state, such as depression. Factors such as seizure control exert a more limited effect on the QOLIE. Health-related quality of life measures are needed in which mood does not play such a dominant role.

The perception that certain triggers precipitate seizures is related to anxiety, health locus of control, and seizure control. Hence, seizures might be misattributed to irrelevant precipitants because of an underlying psychological predisposition. Alternatively, there may be a physiological relationship between seizures and the triggers. Prospective studies are required to clarify the relationship between seizure precipitants and seizure occurrence.

Summary:Purpose: To identify factors that are associated with the emergence of nonepileptic seizures (NES) after resective epilepsy surgery.Methods: Twenty-two patients with medically refractory epilepsy in whom NESs were documented by EEG after resective surgery were compared with a larger series of epilepsy surgery patients on demographic, neurologic, and psychiatric variables.Results: NES tended to become apparent in the first few months after surgery. Patients who developed NESs did not differ from other epilepsy surgery patients in terms of age, IQ, or preoperative psychiatric diagnoses. However, surgical NES patients' neurologic problems and seizures began later in life, the NES group included a larger proportion of female subjects and patients with right hemisphere surgery, and NES patients were more likely to develop non-NES psychiatric problems after surgery.Conclusions: The heterogeneous collection of behaviors subsumed under the label NESs are determined by multiple factors.Several variables were found to be specifically associated with the development of NES after resective epilepsy surgery: A disproportionate number of postsurgical NES patients are female, they have primary neurologic dysfunction in the right hemisphere, and their epileptic seizures often began after adolescence. We propose that at least one group of patients with somatoform tendencies develop NESs as part of the psychiatric instability that occurs often in the few months after resective surgery. Key Words: Nonepileptic seizures-Temporal lobectomy.Nonepileptic seizures (NESs) may be defined as repeated paroxysmal behavioral events that are falsely interpreted to be epileptic seizures, either by the patient himself or herself or by others, but which are not accompanied by electrographic indicators of epilepsy on concurrent EEG. NESs are not infrequent among patients with well-documented chronic epilepsy (1-3). In several reported cases, NESs developed after resective surgery in patients with medically refractory epileptic seizures (4-7).It has been suggested that the prevalence of NES after epilepsy surgery is higher than generally recognized (3, although this problem has received relatively little attention and systematic study. This study examined a group of postsurgical epilepsy patients with EEG-documented NES to identify factors that might be associated with the development of NES after resective surgery. NES patients were compared with a larger group of unselected epilepsy surgery patients on various demographic, neurologic, and psychiatric variables.

SUMMARYPurpose: The degree to which depression interacts with the cognitive deficits of epilepsy to alter cognitive skill and general functioning is unknown. Depression has significant negative effects on adaptive functioning including cognitive skills. Temporal lobe epilepsy (TLE) patients are known to possess cognitive dysfunction. Thus, TLE patients who are depressed may suffer a double burden of cognitive deficits. Methods: We examined whether depressed patients show increased cognitive deficits relative to nondepressed TLE patients (n = 59). We then sought to determine if this effect varied for left versus right TLE patients utilizing preoperative depression and neuropsychological data. To accurately study the lateralization of any observed effects, we selected only patients with definitive evidence of unilateral pathology and seizure focus and utilized a two-year seizure-free postsurgical outcome to capture this.Results: The data suggested that cognitive performance was not related to depression, and that depression did not reliably mediate the cognitive presentation of either our left or right TL patients. The notion of a double burden on cognition did not receive support from our data. The data did produce the expected advantage on verbal memory measures for right TLE patients. Conclusions: The reasons for the limited statistical effects are discussed and issues in unraveling the causal relationships between depression, cognition, and TLE are considered. We discussed the potential role depression may play in the cognitive skills of TLE patients, but the major implication is that depression and neurocognitive performance appear to bear a limited relationship in the context of TLE. KEY WORDS: Temporal lobe epilepsyDepression-Neuropsychological deficits-Mood disorders-Cognition.Depression is a very common mood disturbance in epilepsy. The prevalence of depression in epilepsy ranges from 20% to 55% in patients with recurrent seizures and from 3% to 9% in patients with controlled epilepsy (Jacoby et al., 1996). Patients with temporal lobe epilepsy (TLE) tend to have a higher rate of affective disorders than other epilepsies (Kanner and Nieto, 1999) that are unrelated to seizure frequency or intractability of the seizures (Airaksinen et al., 2004). Some investigators have suggested that 20% of TLE patients become depressed