Occurrence of Psychiatric disorders in temporal epilepsy patients that underwent surgery in a developing country

D`ALESSIO L, ODDO S, GIAGANTE B, SILVA W, SOLIS P, CONSALVO D, KOCHEN

Seattle

Congreso; Annual Meeting of the American Epilepsy Society; 2004

American Epilepsy Society

Propose: The aim of this study is to determine the current and past history of psychiatric disorders, in patients with refractory temporal lobe epilepsy included in the epilepsy surgical program, and determine the psychiatric outcome after surgery. Methods: Twenty nine patients with standardized presurgical psychiatric assessment underwent temporal lobectomy for refractory epileptic seizures, and followed up for 6 month to four years after surgery. Psychiatric assessment included: Structural Interview, SCID I and II of DSM IV for past and current psychiatric disorders, psychopharmacological history, suicide attempts, and psychiatric institutionalization. Results: Three different groups of patients were presurgical determined: nine patients (31%) without psychiatric disorders, nine patients (31%) with not severe psychiatric compromise and eleven patients (38%) with severe psychiatric compromise: current psychiatric disorders at the moment of presurgical assessment, psychiatric history, Axis I and Axis II co morbidity. This last group had a higher range of other psychiatric variables like suicide attempts (63%), psychiatric institutionalization (54,5%) and psychopharmacological history(45,5%). After surgery 31 % developed a psychiatric disorder codified in Axis I of DSM IV, while most of them were total relief of seizures: Engel class I was observed in 89% of patients.  Most patients without psychiatric co morbidity  (89%), and patient with not severe psychiatric co morbidity (77%) did not have psychiatric complications after surgery. The third group showed controversial results; while some patients developed other and de novo psychiatric disorders (55%), like conversion, mania, psychoses and depression, other patients with both co morbid disorders in Axis I and II, were completely relief of symptoms in Axis I, and secondary get better in Axis II (45%). Conclusion: Psychiatric disorders after epileptic surgery seem to be more common in patients with more severe presurgical psychiatric compromise, but some patients with both Axis I and Axis II co morbidity and severe psychiatric compromise, get better in both Axis symptoms after surgery.