Psychiatric disorders before and after surgery for epilepsy

Abstract

Purpose: To examine the frequency of psychiatric disorders before and after surgery for epilepsy and the postoperative changes. Methods: We examined the psychiatric status of 226 patients aged 18 years or older and with IQ >50 who underwent focal resection surgery after age 15 years at our center and were followed up for >2 years after surgery. Results: Seventy-eight (34.5%) patients had psychiatric disorders before and/or after surgery, comprising 36 patients with psychosis, 15 with affective disorders, and 27 with neurotic/behavioral disorders. All but four of these patients had temporal lobe epilepsy. Of the 61 patients who had psychiatric disorders before surgery, 22 patients were free of psychiatric symptoms after surgery (eight with psychosis, 13 with neurotic/behavior disorders, one with affective disorders), and 39 patients continued having psychiatric symptoms after surgery (22 with psychosis, 12 with neurotic/behavior disorders, five with affective disorders). Nine patients had a transient affective disorder that appeared 1-2 months after surgery and disappeared within 1-2 months. In eight patients, chronic psychiatric symptoms manifested after surgery (psychosis in six cases, neurotic/behavior disorders in two), one of whom exhibited postictal psychosis after drug noncompliance. Psychosis that disappeared after surgery was often seizure related. The patients with aggravated psychiatric conditions after surgery had a lower age at epilepsy onset and at surgery, and exhibited deviated personality, traits even before surgery. Conclusions: One third of the surgical patients had psychiatric disorders before and/or after surgery. Preexisting psychiatric problems disappeared after surgery in one third of the patients, but persisted after surgery in the remaining patients, with aggravation in a few. Transient affective disorders appeared in some patients immediately after surgery, and chronic psychiatric disorders appeared after surgery in a minority of patients. The patients having aggravated psychiatric conditions after surgery tended to be young and to have deviated personality traits. The social situation of the patients having psychiatric disorders after surgery was not good.