Abstract Details

To evaluate the changes in neurocognitive and psychiatric profile in patients with intractable epilepsy who had undergone epilepsy surgery.

Epilepsy surgery can be a successful treatment option for medically refractory epilepsy; however, there remains concern regarding neuropsychological decline following surgical interventions. 

We performed a retrospective analysis of neuropsychological evaluations of patients who underwent temporal lobectomy with emphasis on verbal memory, visuospatial abilities, learning, attention/concentration, depression, and anxiety. Post-surgical evaluations were compared to pre-surgical scores using 2-tailed T-test. Pearson correlation was used to assess for association between change in neuropsychiatric scores with seizure control and change in AED. 

Nineteen patients were included in this study. Ten patients had undergone left temporal lobectomy, 7 with right temporal lobectomy, and 2 with right frontal lobectomy. Full seizure cessation was achieved in 52% of patients, while 37% showed partial reduction in seizure frequency, and 11% showed no change. After surgery, patients showed improvement in symptoms of depression (BDI 16.9 ± 11.8 vs 8.4 ± 8.1; p=0.008) and anxiety (BAI 15.7 ± 11.7 vs 8.5 ± 9.9; p=0.05). There was no difference between patients who had undergone left versus right temporal lobectomy. There was a trend towards correlation between improvement in anxiety and seizure control (R=-0.49; p=0.06). 

Mean IQ was 88.0±13.2. In domain of verbal learning, 21% showed improvement, 32% showed worsening, and 47% showed unchanged function. Visuospatial abilities were improved in 16%, worsened in 21%, and unchanged in 63%. Language ability was improved in 21%, worsened in 16%, and unchanged in 63%. Attention/concentration improved in 21%, worsened in 21%, and remained unchanged in 58%.

Epilepsy surgery is an effective treatment for patients with intractable epilepsy. Patients show improvement in symptoms of depression and anxiety, which correlate with the degree of seizure control post-operatively. Patients show considerable changes in all neuropsychological domains post-operatively.