Abstracts

Rationale: Epilepsy and psychosocial factors of mental health and quality of life are known to be closely correlated, but remain poorly understood, especially in surgical epilepsy patients. This study investigates self-reported longitudinal depressive and anxiety symptoms, and quality of life measures in temporal lobe epilepsy (TLE) surgery patients.Methods: This retrospective study included 141 adults who underwent resective TLE surgery in Cleveland Clinic Epilepsy Center from 2008 to 2013. Patients completed health status measures, including the Patient Health Questionnaire (PHQ-9) for depression, Generalized Anxiety Disorder (GAD-7) for anxiety, and Quality of Life in Epilepsy (QOLIE-10). Self-reported measures were compared from pre-surgical baseline, follow-up visit at least six months after surgery, and most recent follow-up visit.Results: -The mean age was 40 years (range 18 to 71). Females were 56% (79) of group. Majority were white 89% (125) along with 9% (12) black and 2% (3) other ethnicity. Marital status indicated 48% single, 40% married, 6% divorced, and 6% other. MRI was abnormal in 85% (119), and surgery was on the left in 53% of patients. At the time of surgery, 10% were taking one antiepileptic drug (AED), 50% were taking two, 34% were taking three, and 5.1% were taking 4-5 AEDs. Early follow-up was on average 10.4 months after surgery, and last follow-up 43 months post-surgery. Sixty-six percent were seizure-free since surgery at the early post-operative visit, and 41% at last visit. -PHQ-9 scores showed some improvement between pre-surgical to early post-operative visit (p=0.07), however there was no significant difference at last visit when compared to baseline (p=0.22), or early follow-up (0.57). -GAD-7 anxiety measure showed improvement from baseline to early post-surgical follow-up (p=0.04) and to last follow-up (p=0.02), however no significant improvement between early and late follow-up evaluations (p=0.59). -QOLIE measure was similarly improved from pre-operative to early post-surgical follow-up (p<0.0001) and last follow-up (p<0.001), however no significant improvement between early and late follow-up (p=0.98). -A similar number of patients were taking a psychiatric medication (antidepressant or antipsychotic) prior to surgery 34% compared to early follow-up 37% and last follow-up 38%. -The proportion driving improved from 15% at baseline to 35% at early follow-up and 42% at last follow-up. Employment/school status remained stable from 48% baseline to 48% at early and 42% at most recent visit.Conclusions: All three self-reported measures of depressive symptoms, anxiety symptoms, and quality of life improved on early follow-up compared to pre-surgical status, but this improvement was least noticeable and least sustained with depression. During this same period, antidepressant dosing showed minimal change indicating a potential continued underserved need for psychiatric care in these patients. Similarly, although more patients were driving, the work status didn’t improve, indicating an ongoing need for vocational/social attention to this patient population.