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A lifetime psychiatric history predicts a worse seizure outcome following temporal lobectomy

From the Departments of Neurological Sciences (A.M.K., A.C., J.W., M.F.) and Neurosurgery (R.B.), Rush Medical College and Rush University Medical Center, Chicago, IL.

Address correspondence and reprint requests to Dr. Andres M. Kanner, Department of Neurological Sciences, Rush University Medical Center, 1653 W. Congress Pkwy., Chicago, IL 60612 akanner{at}rush.edu

Purpose: To identify the psychiatric and epilepsy variables predictive of postsurgical seizure outcome after anterotemporal lobectomy (ATL).

Methods: Retrospective study of 100 consecutive patients with temporal lobe epilepsy (TLE) who underwent ATL. The mean (± SD) follow-up period was 8.3 (± 3.1) years. Three types of surgical outcomes were examined at 2 years after surgery and at last contact: class IA (no disabling seizures no auras), class IA + IB (no disabling seizures), and class IA + IB + IC (no or rare disabling seizures in the first postsurgical year). Logistic regression analyses were performed separately for the three types of surgical outcomes. The epilepsy-related independent variables included age at onset, cause of TLE (mesial temporal sclerosis, lesional and cryptogenic TLE), extent of resection of mesial structures, neuropathologic abnormalities, having only complex partial seizures, and duration of the seizure disorder. The psychiatric independent variables included a postsurgical and presurgical lifetime history of mood, anxiety, attention deficit hyperactivity, and psychotic disorders.

Results: The absence of a psychiatric history was an independent predictor of all three types of surgical outcomes. In addition, a larger resection of mesial structures was a predictor for class IA outcome, and having only complex partial seizures (vs generalized tonic–clonic seizures) was a predictor for class IA + IB and IA + IB + IC. Having mesial temporal sclerosis (vs other causes of TLE) was a predictor for class IA + IB + IC as well.

Conclusions: These data indicate that a lifetime psychiatric history may be predictive of a worse postsurgical seizure outcome after an anterotemporal lobectomy.

Abbreviations: ADHD = attention-deficit hyperactivity disorder; AED = antiepileptic drug; ATL = anterotemporal lobectomy; BPD = bipolar disorder; CI = confidence interval; CPS = complex partial seizures; CTLE = cryptogenic temporal lobe epilepsy; DD = dysthymic (or interictal dysphoric) disorder; GAD = generalized anxiety disorder; GTC = generalized tonic–clonic seizures; IECoG = intraoperative electrocorticography; LTLE = lesional temporal lobe epilepsy; MDD = major depressive disorder; MTS = mesial temporal sclerosis; OR = odds ratio; ref = reference group; sz = seizure; PIP = postictal psychotic episode; PNES = postsurgical nonepileptic seizures; TLE = temporal lobe epilepsy; V-EEG = video-EEG.

Disclosure: While A.M.K. does not have any conflict of interest with the content of the article, he has the following financial disclosures: Research: A.M.K. has received research grants from Novartis and GlaxoSmithKline; Advisory Board: In the last 12 months, A.M.K. has served in advisory boards of Ortho-McNeill, GlaxoSmithKline, Valeant Laboratories, Ovation Laboratories, and Abbott; Speakers’ Bureaus: GlaxoSmithKline, UCB, Pfizer, and Ortho McNeill. The other authors report no disclosures.

Received June 17, 2008. Accepted in final form December 3, 2008.

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