Abstracts

Psychiatric and behavioral co-morbidity are often reported in TLE. The authors conducted a prospective study to examine factors predictive of psychiatric morbidity in patients undergoing temporal lobectomy (TL) for relief of refractory TLE. 101 adults were evaluated for temporal lobectomy in the UMass Comprehensive Epilepsy Program from 1992-2000. 74 completed the pre-op evaluation, including neurology consultation, video-EEG telemetry monitoring, neuropsychological testing, neuropsychiatric consultation, SCL-90R and an interictal trait questionnaire. Surgical candidates underwent pre-op Wada testing and PET scanning; with repeat neuropsychological testing, neuropsychiatric consultation, and questionnaire completion 3 months post op. Of 74 patients evaluated, 35 underwent formal anterior TL with medial temporal resection (51% right/ 49% left), 10 lateral or extra-temporal resection, and 29 were not surgical candidates. 60% of 35 TL patients had positive psychiatric history. Average age was 37, average epilepsy duration 23.4 years, average education 12.7 years, average verbal IQ 90.5, average performance IQ 94.7. 71% had mesial temporal sclerosis (MTS). 94% had Engel class I or II outcomes.
23/35 patients (66%) had psychiatric disorders pre-op, 6 of these (26%) previously undiagnosed. 3 traits (vindictiveness, cohesiveness, and kindness) correlated inversely with education (p[lt]0.001, p[lt]0.006, p[lt]0.002 respectively). Age, epilepsy duration, gender, history of traumatic brain injury, and prior psychiatric treatment did not predict interictal traits. Temper and dysphoria correlated with use of psychiatric medication and mood disorder. Seriousness, vindictiveness, cohesiveness, religiosity, and cosmic interest correlated negatively with verbal IQ (p[lt]0.001- p[lt]0.01). Fluency and naming correlated negatively with seriousness, cosmic interest, cohesiveness, and wandering. Seriousness also correlated negatively with processing speed. Neither laterality nor presence of MTS predicted interictal traits or positive findings on the SCL-90R. 2 patients developed post-op suspiciousness without prior psychiatric problems.
17/35 patients completed post-op evaluations. 3 interictal traits decreased 40% or more with surgery (orderliness, amnesia, and misperception) (p[lt]0.01), a change not predicted by age, education, gender or laterality of focus. Psychiatric co-morbidity was found in 66% of unselected patients with refractory TLE, 26% of whom were undiagnosed prior to pre-op neuropsychiatric evaluation. Education and IQ were better predictors of interictal traits than were duration of epilepsy, traumatic brain injury, or psychiatric history. Interictal traits appeared more related to cognitive status than psychiatric history.