Major depressive disorder as a predictor of a worse seizure outcome one year after surgery in patients with temporal lobe epilepsy and mesial temporal sclerosis
Seizure - European Journal of Epilepsy, 07/31/2012
de Araujo Filho GM et al. – Although epilepsy surgery may be the best treatment option for patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE–MTS), the findings emphasize the importance of performing a detailed psychiatric examination as part of the pre–surgical evaluation protocol.Methods
- Data from 115 TLE-MTS patients (65 females; 56.5%) who underwent cortico-amygdalohippocampectomy (CAH) were analyzed.
- Pre- and post-surgical psychiatric evaluations were performed using DSM-IV and ILAE criteria.
- The outcome subcategory Engel IA was considered as corresponding to a favorable prognosis.
- A multivariate logistic regression model was applied to identify possible risk factors associated with a worse seizure outcome.
- Pre-surgical PDs, particularly major depressive disorder (MDD), anxiety and psychotic disorders, were common, being found in 47 patients (40.8%).
- Fifty-six patients (48.7%) were classified as having achieved an Engel IA one year after CAH.
- According to the logistic regression model, the presence of pre-surgical MDD (OR=5.23; p=0.003) appeared as the most important risk factor associated with a non-favorable seizure outcome.