Do psychiatric comorbidities predict postoperative seizure outcome in temporal lobe epilepsy surgery?

Epilepsy Behav. 2009 Mar;14(3):529-34. doi: 10.1016/j.yebeh.2009.01.002. Epub 2009 Jan 30.


Clinical and demographic presurgical variables may be associated with unfavorable postsurgical neurological outcome in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). However, few reports include preoperative psychiatric disorders as a factor predictive of long-term postsurgical MTLE-HS neurological outcome. We used Engel's criteria to follow 186 postsurgical patients with MTLE-HS for an average of 6 years. DSM-IV criteria and psychiatric comorbidity criteria specific to epilepsy (interictal dysphoric disorder, postictal and interictal psychosis) were used to assess presurgical psychiatric disorders. Kaplan-Meier event-free survival and adjusted hazard ratios were estimated with unconditional logistic regression. Seventy-seven (41.4%) patients had a preoperative Axis I psychiatric diagnosis. Thirty-six patients had depression, 11 interictal dysphoric disorder, 14 interictal psychosis, 6 postictal psychosis, and 10 anxiety disorders. Twenty-three (12.4%) patients had Axis II personality disorders. Regarding seizure outcome, preoperative anxiety disorders (P=0.009) and personality disorders (P=0.003) were positively correlated with Engel class 1B (remaining auras) or higher. These findings emphasize the importance of presurgical psychiatric evaluation, counseling, and postsurgical follow-up of patients with epilepsy and psychiatric disorders.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Brain / pathology
  • Electroencephalography
  • Epilepsy, Temporal Lobe / psychology*
  • Epilepsy, Temporal Lobe / surgery*
  • Female
  • Follow-Up Studies
  • Forecasting
  • Humans
  • Interview, Psychological
  • Logistic Models
  • Magnetic Resonance Imaging
  • Male
  • Mental Disorders / complications*
  • Mental Disorders / psychology*
  • Middle Aged
  • Neurosurgical Procedures*
  • Postoperative Period
  • Psychiatric Status Rating Scales
  • Seizures / epidemiology*
  • Survival Analysis
  • Treatment Outcome
  • Young Adult