Psychiatric Symptoms in Refractory Epilepsy During the First Year After Surgery

Abstract

Psychiatric morbidity in drug-resistant epilepsy is frequent. Surgery is the best therapeutic alternative for treating seizures, but the current evidence concerning the effects of surgery on psychiatric disorders (PDs) is inconclusive. We aim to clarify surgery's role in long-term PDs. Using a prospective controlled study, we analyzed the psychopathologic outcomes of patients with drug-resistant epilepsy, comparing those who underwent surgery to those who did not due to not being suitable. Surgical candidates were paired (n = 84) with the immediately following nonsurgical candidates (n = 68). Both groups continued their usual medical treatment. We studied psychiatric changes for each group and analyzed de novo and remission cases. The assessments were made during the presurgical evaluation, and at 6 months (6-M) and 12 months (12-M) after surgery. Finally, we determined associated factors for postsurgical PDs. At 12 months, using the Hospital Anxiety and Depression Scale (HADS), anxiety improved in both groups (p = 0.000), while depression improved only in the surgical group (p = 0.016). Moreover, all symptom dimensions on the Symptom Checklist-90-R (SCL-90), as well as severity, distress, and total symptoms, decreased only in the surgical group. These ameliorations reached not only statistical significance but also clinical significance for depression (HADS) (p = 0.014) and the interictal dysphoric disorder (p = 0.013). The main predictors for PDs after surgery were as follows: the presurgical and 6-month psychiatric symptoms, the absence of surgery, seizure outcomes, and some antiepileptic and psychiatric drugs. This study provides evidence that surgery for epilepsy could have a role in improving some symptoms of psychiatric disorders 12-M after the surgery.

Transtornos psiquiátricos “de novo” na cirurgia de epilepsia

“…Apesar dos casos de remissão, foi observado que em todos os estudos incluídos a porcentagem de casos de transtornos psiquiátricos no pós-operatórios continuou significante (Quadro 2). Inclusive, alguns estudos 11, [13][14][15] relataram um número maior de casos no pós-operatório quando comparado ao pré-operatório.…”

An Overview of Anxiety Disorders and Depression in Children with Epilepsy: A Literature Review

“…69 Recently, a prospective study regarding cases with refractory epilepsy revealed that epilepsy surgery has beneficial outcomes on depression symptoms compared with control group after 12 months of postoperative followup. 70 Another confounding condition in diagnosis and treatment may be interictal symptoms. Preictal and postictal behavior changes may develop in some patients with epilepsy, temporal lobe, and other forms.…”

<p>Monitoring And Managing Depression In Adolescents With Epilepsy: Current Perspectives</p>

“…On the other hand, epilepsy surgery is often the best therapeutic alternative for treating seizures, but the current evidence concerning its effects on mood is inconclusive: surgery could improve presurgical depressive symptoms or cause a relapse or de novo episodes of depression 42. A recent prospective controlled study on patients with refractory epilepsy showed that epilepsy surgery resulted in an improvement in depressive symptoms after 12 months follow-up compared to a control group 48Table 2Psychotropic Proprieties Of Antiepileptic DrugsAntiepileptic DrugMechanism Of ActionPsychotropic ActionMood EffectBarbituratesGABAergicNegative psychotropic action–BenzodiazepinesGABAergicNegative psychotropic action–VigabatrinGABAergicNegative psychotropic action–TiagabineGABAergicNegative psychotropic action–TopiramateVoltage-sensitive sodium channelGABAergic↓GlutammateNegative psychotropic action–LevetiracetamSynaptic vesicle SV2APresynaptic Calcium ChannelsNegative psychotropic action–ZonisamideVoltage sensitive sodium channelsT-type Calcium channelsNegative psychotropic action–Felbamate+ GABAA receptors− NMDA receptorsNegative psychotropic action–PerampanelNon-competitive antagonist AMPA receptorisNegative psychotropic action–Valproic acidVoltage dipendent sodium channelGABAergic effectMood-stabilizing+CarbamazepineVoltage sensitive sodium channels blockerSerotonin release/reuptake inhibitorMood-stabilizing+OxcarbazepineVoltage sensitive sodium channels blockerMood-stabilizing+LamotrigineVoltage sensitive sodium chann...…”