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 depression

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

 

Non epileptic attacks post epilepsy surgery

Pre-Operative

Post-Operative

Usually excluded

50% become free of both seixures

 

De novo? 6-12 months after opertation

 

Right hemispheric dysfucntion: misperception or misinterpretation of emotional

 

Low intelligence

 

Female younger, history of psychiatric problems