Psychiatric outcome of temporal lobe epilepsy surgery: A prospective, 2-year follow-up study.

OBJECTIVE: We performed a prospective, longitudinal, 2-year follow-up study to clarify psychiatric courses and outcomes after temporal lobe epilepsy surgery.

METHODS: We assessed 141 patients (68 men, 73 women) aged 16 or older with structured interviews and psychiatric rating scales before surgery and 3 months, 1 year, and 2 years afterward.

RESULTS: Fifty-two patients (36.9%) had a psychiatric condition before surgery or during the follow-up period or both. The number of patients with a psychiatric condition decreased from 31 (22.0%) before surgery to 14 (9.9%) at 2 years. On the basis of our results, we defined 5 courses of psychiatric conditions: course 0, no psychopathology (n = 89, 63.1%); course 1, remission or resolution of a presurgical psychiatric condition after surgery (n = 19, 13.5%); course 2, new onset, transient psychiatric condition after surgery (n = 19, 13.5%); course 3, new onset, persistent psychiatric condition after surgery (n = 2, 1.4%); and course 4, chronic psychiatric condition before and after surgery (n = 12, 8.5%). In 14/25 (56.0%) patients with a mood or anxiety disorder before surgery, the condition remitted or resolved after surgery (course 1). Eighteen of 110 patients (16.4%) without any psychopathology before surgery developed mood or anxiety disorders afterward, including major depressive disorder in 13 patients (courses 2 and 3); in more than half of these patients, the disorder manifested within 1 year. More patients with a past history of psychiatric conditions were found in course 2 than in course 0. The duration of epilepsy was longer in course 4 than in course 0, and age at epilepsy onset was lower in course 4 than in course 0.

SIGNIFICANCE: Most patients with a psychiatric condition show a favorable outcome 2 years after surgery; however, some show a transient worsening or new onset of psychiatric conditions, in particular depression.