Predicting epilepsy surgery outcome in adult patients: May psychiatric diagnosis improve predictive models?

OBJECTIVE: With this study, we aimed to assess the importance of including psychiatric disorders in a comprehensive prediction model for epilepsy surgery. METHODS: Ambispective observational study with a sample of adults who underwent resective surgery. Participants were evaluated, before and one year after surgery, to collect data regarding their neurological and psychiatric history. The one-year post-surgical outcome was classified according to the Engel Outcome Scale. Previously identified predictors of post-surgical Engel Class were included in a logistic regression model. Then, the accuracy of alternative predictive models, including or excluding, past and current psychiatric diagnoses, were tried. RESULTS: One hundred and forty-six people participated in this study. The inclusion of psychiatric diagnosis resulted in a model with a higher AUC curve, however, the Delong method showed no significant statistical differences between the models. SIGNIFICANCE: Despite the fact that presurgical psychiatric diagnoses have shown to contribute to the prediction of epilepsy surgery outcome they do not contribute to a significant improvement of predictive models.

Psychiatric disorders as predictors of epilepsy surgery outcome.

OBJECTIVES: Our aim was to determine if a history of a mental disorder predicts a worst neurological outcome for patients undergoing epilepsy surgery. METHODS: We conducted an ambispective observational study including people with refractory epilepsy who underwent resective surgery. Demographic, psychiatric, and neurological data were collected, before and one year after surgery. Presurgical interviews included a psychiatric evaluation and the determination of prevalent and lifetime psychiatric diagnosis. The one-year postsurgical outcome was classified according to the Engel Outcome Scale. Predictors of postsurgical Engel class were determined using an ordered logistic regression model. RESULTS: A lifetime history of any mental disorder was a significant predictor of a higher Engel Class (p = 0.017). CONCLUSION: This study shows that psychiatric lifetime diagnoses are associated with worse surgical outcome and highlighted the importance of the inclusion of these diagnoses in the evaluation of the potential success of the surgery.

Clinical determinants of psychopathological outcomes after epilepsy surgery.

OBJECTIVES: People with refractory epilepsy submitted to surgery may improve or deteriorate their cognitive and emotional functions. The aim of this study was to determine the predictors of longitudinal changes in psychopathological symptomatology, one year after epilepsy surgery, considering clinical and demographic characteristics. METHODS: People with refractory epilepsy referred to epilepsy surgery were included in this ambispective study. Psychiatric evaluations were made before surgery and one year after the procedure. Demographic, psychiatric, and neurological data were recorded. Linear regression was used to analyze longitudinal data regarding the Global Severity Index and 9 symptom dimensions of Symptom Checklist-90 (SCL-90). RESULTS: Seventy-six people were included. Bilateral epileptogenic zone, lack of remission of disabling seizures, and deep brain stimulation, targeting the anterior nucleus of the thalamus (ANT-DBS), were the most important predictors of an increase in SCL-90 scores, after surgery. CONCLUSION: Some individual factors may have an impact on the development or worsening of the previous psychopathology. This study identifies clinical aspects associated with greater psychological distress, after surgery. These patients may benefit from more frequent psychiatric routine assessments for early detection.

Personality patterns of people with medically refractory epilepsy - Does the epileptogenic zone matter?

OBJECTIVES: The aims of this study were to determine the rate of dysfunctional personality patterns before and after epilepsy surgery, their types, and the importance of the epileptogenic zone in a sample of people with refractory epilepsy. METHODS: We conducted an ambispective observational study, including refractory epilepsy surgery candidates. Demographic, psychiatric, and neurological data were recorded. Evaluation of personality was made using the Millon Clinical Multiaxial Inventory-II (MCMI-II). Presurgical predictors of personality patterns were determined using a linear regression model. The proportion of patients with dysfunctional personality patterns, before and after surgery, was compared using the Mcnemar's test. Then a generalized estimating equation model was performed to include predictors of changes in this rate. RESULTS: One hundred and ninety-nine participants were included. Seventy percent had a dysfunctional personality pattern before surgery. After surgery, this percentage dropped to 58%. The difference was statistically significant after adjusting for potential confounders (p = 0.013). The most common types were Cluster C personality patterns. Temporal epileptogenic zone was a significant predictor of higher scores of the Avoidant (Coef. 11.8; Confidence Interval (CI) -0.59 23.7; p = 0.051) and Compulsive (Coef. 9.55; CI 2.48 16.6; p = 0.008) personality patterns and lower scores of Histrionic (Coef. -11.4; CI -21.2 -1.55; p = 0.024) and Antisocial (Coef. -8.4; CI -15.6 -1.25; p = 0.022) personality patterns, compared to extratemporal epileptogenic zone. CONCLUSION: People with refractory epilepsy have high rates of dysfunctional personality patterns. These patterns differ according to the epileptogenic zone.

Predicting de novo psychopathology after epilepsy surgery: A 3-year cohort study.

OBJECTIVE: The aim of this study was to determine the potential risk factors for de novo psychiatric syndromes after epilepsy surgery. METHODS: Refractory epilepsy surgery candidates were recruited from our Refractory Epilepsy Reference Centre. Psychiatric evaluations were made before surgery and every year, during a 3-year follow-up period. Demographic, psychiatric, and neurological data were recorded. The types of surgeries considered were resective surgery (resection of the epileptogenic zone) and palliative surgery (deep brain stimulation of the anterior nuclei of the thalamus (ANT-DBS)). A survival analysis model was used to determine pre- and postsurgical predictors of de novo psychiatric events after surgery. RESULTS: One hundred and six people with refractory epilepsy submitted to epilepsy surgery were included. Sixteen people (15%) developed psychiatric disorders that were never identified before surgery. Multilobar epileptogenic zone (p = 0.001) and DBS of the ANT-DBS (p = 0.003) were found to be significant predictors of these events. CONCLUSION: People with more generalized epileptogenic activity and those who undergo ANT-DBS seem to present an increased susceptibility for the development of mental disorders, after neurosurgical interventions, for the treatment of refractory epilepsy. People considered to be at higher risk should be submitted to more frequent routine psychiatric assessments.