Mania and Depression after Temporal Lobectomy
Abstract number :
3.217
Submission category :
Year :
2001
Submission ID :
2979
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
M.A. Carran, MD, Neurology, UMDNJ, Camden, NJ; C.G. Kohler, MD, Neuropsychiatry, University of Pennsylvania, Philadelphia, PA; M.J. O[ssquote]Connor, MD, Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA; M.R. Sperling, MD, Neurology, T
RATIONALE: New onset transient mania and depression after temporal lobectomy (ATL) bring together cases that are similar with respect to clinical variables, brain dysfunction, and surgical interventions.
METHODS: Of 461 consecutive temporal lobectomies at TJUH, we identified 16 patients with onset of mania within 1 year of ATL. 16 patients with no psychiatric problems within 1 year of surgery were matched for age, side of surgery, and gender. In addition we identified a group of 30 patients with depression within 1 year following ATL, half of which were hospitalized for depression. Preoperative data from scalp and intracranial EEG, neuropsychological tests, MRI, PET or SPECT, and Wada were compared across the three groups. Data were scored as incongruent when lateralized to the non-surgical side. Patients were also compared for seizure onset and type, frequency, aura type, early risk, laterality of surgery, pathology findings, seizure outcome, preoperative psychiatric diagnosis and psychotropic drug treatment.
RESULTS: Incongruence of all preoperative tests were more common in mania (31/76=41%) than depression (25/134=19%) or control subjects (9/72=13%, p[lt].001). Examining preoperative tests separately, we found a higher incidence of bilateral EEG findings (sharp waves or seizure onset) in the mania group (11/16=69%) than in depressed (8/30=27%) or control patients (1/16=6%; p[lt].001). Preoperative tonic-clonic seizures were more common in patients with mania (10/16=63%) and depression (26/30=87%) than control patients (4/16=25%; p[lt].001). More patients with mania (12/16=75%) underwent right ATL when compared to the remaining population in the surgical database (195/399=49%; p=.04). Patients with mania (7/16=44%) and depression (9/30=30%) were more likely to experience postoperative seizures than controls (1/16=6%; p=.05).
CONCLUSIONS: Significant bihemispheric limbic and diencephalic dysfunction appear to be risk factors for mania after ATL. Abnormalites of the non-operated hemisphere were more prominent in mania; however, both groups had more preoperative GTC seizures, and were more likely to have postoperative seizures than controls.