Psychiatric Care in Epilepsy Surgery

Expectation of surgery:

  • Desire beyond seizure
  • Various expectation of social and psychological nature
  • Self confidence
  • Driving
  • Employment
  • Getting married

Affective Disorder - Depression

Pre-operative depression Post-operative despression
Refractory epilepsy Most common
Atypical presentation, dysphoric mood Transient
Temporal lobe epilepsy: risk or not Risk factors: older patients,  males, poor preoperative adjustment, neurological deficit, family history, poor post operative seizure control, psychosocial adjustment of not having seizures
Role of lateralisation is unclear (Rt more than Lt) Lateralisation (Right)
Frontal lobe dysfunction Prefrontal dysfunction
Role of gender unclear De nova depression ranges from 5-25% after TLE
Role of AED Reported cases of suicide
Suicide: greater than general population, TLE more so  

Affective Disorder - Anxiety

Pre-Operative Post-Operative
GAD (13.2%), panic attacks and disorder (3.4%), phobias (11-15%), OCD 17-54% anxiety disorder, 1 mpnth after surgery, reduces by 3 months
More common in TLE (Lt), frontal, atypical aura Left temporal resection
Chronic refractory seizure disorder  
Stigmas and poor quality of life  
Structural abnormalities in the amygdala; ictal fear  
AED  

Psychosis

Pre-Operative Post-Operative
Ictal psychosis expression of seizure activity Mostly become free of psychosis
Postictal psychosis (Clusters) 6%-10% Forced normalisation
Chronic Interictal psychosis 4%-10% De novo: rare can occur even after 2 years after surgery
Neurodevelopmental abnormalities  
Focal/generalised structural lesion