Psychiatric outcomes of epilepsy surgery: A systematic review

Abstract

SUMMARYPurpose: The objective of this systematic review was to identify: (1) prevalence and severity of psychiatric conditions before and after resective epilepsy surgery, (2) incidence of postsurgical psychiatric conditions, and (3) predictors of psychiatric status after surgery. Methods: A literature search was conducted using PubMed, EmBase, and the Cochrane database as part of a larger project on the development of an appropriateness and necessity rating tool to identify patients of all ages with potentially resectable focal epilepsy. The search yielded 5,061 articles related to epilepsy surgery and of the 763 articles meeting the inclusion criteria and reviewed in full text, 68 reported psychiatric outcomes. Thirteen articles met the final eligibility criteria. Key Findings: The studies demonstrated either improvements in psychiatric outcome postsurgery or no changes in psychiatric outcome. Only one study demonstrated deterioration in psychiatric status after surgery, with higher anxiety in the context of continued seizures postsurgery. One study reported a significantly increased rate of psychosis after surgery. The two main predictors of psychiatric outcome were seizure freedom and presurgical psychiatric history. De novo psychiatric conditions occurred postsurgery at a rate of 1.1-18.2%, with milder psychiatric issues (e.g., adjustment disorder) being more common than more severe psychiatric issues (e.g., psychosis). Significance: Overall, studies demonstrated either improvement in psychiatric outcomes postsurgery or no change. However, there is a need for more prospective, well-controlled studies to better delineate the prevalence and severity of psychiatric conditions occurring in the context of epilepsy surgery, and to identify specific predictors of psychiatric outcomes after epilepsy surgery.

Surgical Effects of Focus Resection for Patients With Intractable Epilepsy

“…15) The present and previous findings have implicated TLE and presurgical psychiatric history as important risk factors for postoperative psychiatric problems. 1,5,9,14) In contrast to the present results, some earlier studies identified poor seizure outcome and surgical side as strong predictive factors. 1,2,15) The findings of the types of postoperative disorders have also varied: earlier papers more commonly report milder psychiatric issues 9) and transient mood disorders such emotional lability and depression, 5) whereas we predominately observed conditions requiring treatment with antipsychotic drugs.…”

“…1,5,9,14) In contrast to the present results, some earlier studies identified poor seizure outcome and surgical side as strong predictive factors. 1,2,15) The findings of the types of postoperative disorders have also varied: earlier papers more commonly report milder psychiatric issues 9) and transient mood disorders such emotional lability and depression, 5) whereas we predominately observed conditions requiring treatment with antipsychotic drugs. The follow-up period and patient selection criteria might partly explain these discrepancies, as our subgroup of patients with postoperative psychiatric disorders was limited to patients who received psychotropic drugs 2 or more years after the surgery.…”

“…Postoperative psychiatric problems were found in 21% of patients with TLE, similar to those rates reported in previous reviews. 5,9) In one study, 1) 18% of patients developed de novo psychopathology following TLE surgery. However, the surgical effect on psychiatric impairment is still under discussion.…”

“…[1][2][3][4][5][6]9,11,[13][14][15]17,19) These problems have recently become a focus of interest, as intractable epilepsy is recognized as a chronic encephalopathy in which one seizure induces other seizures. 7) Therefore, we need to analyze the overall effects on the quality of life to demonstrate the benefits of surgery.…”

Epilepsikirurgi - utredning og pasientseleksjon

“…Psykiatrisk komorbiditet, inkludert angst, depresjon, atferdsforstyrrelser og psykoser, ble tidligere ansett som en relativ kontraindikasjon til kirurgi. I de senere år har man imidlertid endret holdning, idet man har sett at psykiatriske symptomer som regel ikke blir verre etter inngrepene, i mange tilfeller tvert imot (14,15). Pasienter med betydelig psykiatrisk komorbiditet har allikevel mindre sjanse for å bli anfallsfrie etter resektiv kirurgi enn pasienter uten slike problemer (14,15).…”