The Role of Epilepsy Surgery

Abstract

(from the chapter) While seizure control is an obvious goal of epilepsy surgery, the postsurgical period can have the paradoxical effect of worsening an individual's psychiatric function. This chapter systematically reviews the literature relating to neuropsychiatric outcomes of epilepsy surgery, revealing that there is a heightened risk for psychopathology both before and after surgery. This commonly takes the form of depression, anxiety, and psychosocial adjustment difficulties, and can emerge in patients with no prior psychiatric history. From this review a compelling case arises for the routine provision of presurgical psychiatric and psychosocial evaluation, in addition to postsurgical follow-up and rehabilitation. Pre-surgery, this evaluation can shape the team's understanding of surgical candidacy and the patient's capacity for informed consent. Moreover, it provides a prime opportunity for managing the sometimes-unrealistic expectations that patients and their families harbor for postsurgery life. While preexisting psychopathology is a risk factor for poor seizure and psychosocial outcomes, it is not a contraindication to surgery when the treating team has the capacity to treat it proactively. Post surgery, efficacious treatment of psychiatric comorbidity increases the likelihood of seizure freedom, as well as optimizing psychosocial functioning and quality of life. By contrast, failure to treat can allow psychiatric comorbidity to persist or escalate, and psychological difficulties to develop as the patient adjusts to life after surgery. (PsycINFO Database Record (c) 2016 APA, all rights reserved)