PSYCHIATRIC OUTCOMES AFTER EPILEPSY SURGERY: A SYSTEMATIC REVIEW
Abstract number :
2.176
Submission category :
6. Cormorbidity (Somatic and Psychiatric)
Year :
2009
Submission ID :
9885
Source :
www.aesnet.org
Presentation date :
12/4/2009 12:00:00 AM
Published date :
Aug 26, 2009, 08:12 AM
Authors :
Sophie Macrodimitris, E. Sherman, J. Tellez-Zenteno, S. Wiebe, A. Metcalf, L. Hernandez-Ronquillo and N. Jette
Rationale: There is a significant amount of literature exploring psychiatric outcomes following epilepsy surgery, although these outcomes have not been studied systematically. Our goal was to conduct a systematic review to identify: 1) prevalence and severity of psychiatric conditions before and after resective surgery, 2) incidence of post-surgical psychiatric conditions, and 3) predictors of psychiatric status after resective surgery. Methods: A literature search was conducted as part of a larger project on the development of an appropriateness and necessity rating tool to identify patients with potentially resectable focal epilepsy. This was an extensive search using PubMed, EmBase and the Cochrane database, yielding 5061 articles related to epilepsy surgery. Abstracts were reviewed to ensure they met the following inclusion criteria: partial epilepsy, focal resections (e.g. lesionectomy, lobectomy, corticectomy), English only, n ≥ 20, all ages except neonates. We excluded: hypothalamic hamartoma, hemispherectomies, non-resective surgery, electrical stimulation, and abstracts not published as full papers. Of 763 articles meeting inclusion criteria and reviewed in full text, 68 reported psychiatric outcomes. Studies were included in the present analysis if they: reported pre and post surgery data; provided prevalence estimates of psychiatric problems or information about predictors of psychiatric outcomes; used DSM or ICD criteria for psychiatric diagnoses or used a psychometrically-sound self-report symptom scale; used a systematic method for obtaining information (e.g., review by psychiatrist, structured interview, rating scale). Thirteen articles met all eligibility criteria. Results: The studies demonstrated either improvements in psychiatric problems post-surgery or no changes in psychiatric issues. Only one study demonstrated deterioration in psychiatric status after surgery, with higher anxiety in the context of continued seizures post-surgery. One study reported a significantly high rate of post-surgical psychosis. The two main predictors of psychiatric outcome were seizure freedom (predicted better psychiatric outcome) and pre-surgical psychiatric history (predicted worse psychiatric outcome). Factors such as laterality, age at epilepsy onset, gender and age have minimal predictive value in psychiatric outcomes after epilepsy surgery. De novo psychiatric conditions occur post-surgery at a rate of 1.1 - 18.2%, with the increased likelihood being related to the severity of the psychiatric issue (i.e., 1.1% de novo psychosis vs. 18.2% Interictal Dysphoric Disorder or less severe conditions being more likely). The studies did not provide insight into the possible predictors of de novo psychiatric issues other than continued seizures. Conclusions: Overall, studies demonstrate either improvement in psychiatric outcomes post-surgery or no change. However, there is a need for more prospective, well-controlled studies to better delineate the prevalence and severity of psychiatric conditions occurring in the context of epilepsy surgery, and to identify specific predictors of psychiatric outcomes after epilepsy surgery.
Cormorbidity