Psychiatric morbidity in refractory mesial temporal lobe epilepsy before and after epilepsy surgery

Background & Objective: Psychiatric disorders constitute a large part of illness burden in patients with refractory epilepsy. A careful presurgical psychiatric assessment is now an integral part of evaluation in most centers performing surgeries for refractory epilepsy. This study was undertaken to determine the prevalence of psychiatric disorders and outcome of the psychopathology in patients of refractory mesial temporal lobe epilepsy (mTLE) before and after epilepsy surgery. Method: Forty eight patients diagnosed as having refractory mTLE by the Neurologists were included in the study. The patients were assessed using the Brief Psychiatric Rating Scale (BPRS), Beck’s Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) before surgery as well as in the second and sixth month of postoperative period. Results: More than half of the patients (54%) had psychopathology. Depressive disorders were more common. Lateralisation of focus in MTS and psychopathology in the patient revealed equal right and left preponderance. No significant difference was found on BPRS, BDI and HDRS scales at 2 and 6 months follow up post epilepsy surgery in patients having psychopathology. Conclusions: Patients had a favourable outcome after surgery as regards to their psychopathology as well as the seizures. Neurology Asia 2015; 20(2) : 129 – 138 Address correspondence to: Dr. Sawant Neena S, 10,Vijay Residency, NP road, Wadala, Mumbai-400031,India. Tel: +91 022 24107492, Fax: +91 022 22702503, E-mail: [email protected] INTRODUCTION Temporal lobe epilepsy (TLE) is the most frequent type of focal refractory epilepsy, accounting for two thirds of localisation-related epilepsy. Surgical treatment of medically refractory epilepsy aims at reducing the number and intensity of seizures, minimising neurological morbidity and antiepileptic drug (AED) toxicity and improving the patient’s quality of life.A significant proportion of patients with mesial temporal lobe epilepsy (mTLE) is resistant to medications, surgical therapy is the best option for some of these individuals. Psychiatric disorders have been recognized in patients with both generalized and partial epilepsies. Interictal psychiatric symptoms are those that occur when patients are not experiencing any seizures and present as depressive, anxiety, psychotic or behavioural disorders.There has been increased focus on psychiatric morbidity in patients with TLE and seizure control alone does not determine the success of the treatment. The last two decades has seen research on en-bloc anterior temporal lobectomyresection with the development of de novo postoperative psychiatric conditions like psychosis, anxiety, depression and obsessive-compulsive disorders or the role of temporal resective surgery in the exacerbation of preoperative psychiatric conditions.This study was purposed to study the prevalence and type of psychiatric morbidity in patients of refractory mTLE before and after epilepsy surgery and relation between symptoms of psychopathology with localisation and lateralisation of epileptogenic focus with effectiveness of treatment with psychopharmacology and the outcome on 6 months follow up.