Abstracts

Anterior temporal lobectomy (ATL) is an effective intervention for treating medically refractory temporal lobe epilepsy (TLE). However, research findings have conflicted about how ATL impacts emotional functioning. Previous studies have found a propensity for comorbid depression in patients with TLE, but research investigating the possible lateral effects of ATL on post-operative depression have shown mixed results. Some research has found that left ATL results in increased depression, whereas other studies have failed to document lateralized effects. The goal of the current study was to clarify potential emotional benefits or risks associated with ATL in patients with right versus left TLE and to examine variables that may influence emotional outcome after surgery.
This IRB-approved study involved a retrospective analysis of data archived as part of the standard clinical care of 56 left and 55 right ATL patients. Patients were administered the Beck Depression Inventory-Second Edition (BDI-II) and the Personality Assessment Inventory (PAI) before and approximately six months after surgery. Changes in self-reported emotions were examined at both a group (repeated-measures analysis of variance) and an individual (Chi-square analysis) level. A series of follow-up Chi-square analyses were conducted to determine whether right- vs. left-sided surgery, age of seizure onset, duration of epilepsy, seizure outcome, or memory outcome impacted changes in depression over time.
Depression scores were significantly higher pre- than post-operatively, indicating post-operative improvements in mood. Similar improvements in depression were apparent when the data were analyzed at an individual level. Changes in depression were not mediated by side of surgery, age of seizure onset, seizure outcome, or memory outcome. However, patients who had suffered from epilepsy for 11 years or longer were more likely to develop depression after surgery than those with seizure disorders of shorter duration. For the PAI, a significant main effect of Scale was found, but this main effect was mediated by a significant Scale X Time interaction. Pre- to post-operative improvements were apparent in anxiety and emotional lability on this measure, but this effect was not impacted by side of surgery.
Patients with temporal lobe epilepsy evidenced significant improvements in several aspects of their emotional functioning after anterior temporal lobectomy, highlighting the emotional benefit of surgical intervention in this population. Consistent with other studies in the literature, findings suggest that emotional outcome is similar in right and left TLE patients. Among several factors examined, only duration of epilepsy impacted changes in emotions across time, with patients who have suffered from seizures longer having more difficulty with emotional adjustment during the immediate post-operative period.