anxiety and depression

Altalib HH, et al. Epilepsy & Behavior, 83(2018):7-12

Testing for epilepsy surgery includes EEG (electroencephalogram) testing (to assess electrical activity in the brain), imaging (to look at the structure of the brain), and knowledge of the seizure type. Cognitive testing is also important to see if a person could benefit from epilepsy surgery. Anxiety and depression have been associated with poor seizure control after surgery. Yet, the role of psychiatric assessment before surgery is not well established.

Purpose

  • The goal of this study was to examine the effect of pre-surgical depression and anxiety on seizure control after surgery.
  • Researchers looked at data to see if depression and anxiety were associated with surgical outcome at two and five years after surgery.

Description of Study

  • 379 adults with drug resistant epilepsy were followed between 1996 and 2001 at seven epilepsy centers.
  • Before surgery, people had testing, including cognitive testing, neuroimaging, EEG, and a psychiatric evaluation.
  • After surgery, people were called on the phone by a trained research assistant every 3 months and asked for information about seizures and medicines.
  • People were considered either “seizure free” or “non-seizure free” after surgery.
    • Only people who were completely seizure free (not including auras) between surgery and the follow ups at 2 and 5 years after surgery were placed in the “seizure free” group.
  • Mood and anxiety disorders were evaluated using a standardized assessment (the World Mental Health Composite International Diagnostic Interview (CIDI)).

Summary of Study Findings

  • 75 people had a current or lifetime depressive disorder before surgery.
  • 59 people had an anxiety disorder before surgery.
  • There was no evidence that presurgical depression or anxiety predicted seizure outcomes after surgery.
    • Gender, age, ethnicity, length of epilepsy, or presence of mesial temporal sclerosis did not affect these findings.
    • This was true at both the 2- and 5-year post-surgical time points.
  • One exception was found - people with an anxiety disorder before surgery had a modest decrease in seizure freedom 2 years after surgery.

What does this mean?

  • This study suggests that a pre-surgical history of depression or anxiety does not affect long-term seizure outcome after surgery.
  • A psychiatric evaluation is important to look for mood changes before and after surgery.
  • Clinicians and researchers should be cautious about overstating the risk of depression and anxiety in predicting poor epilepsy surgery outcomes.

Summary

Mood disorders and anxiety should be assessed both before and after surgery. This study found that these psychiatric problems may have little or no influence on whether a person is seizure free after surgery. The effect of anxiety and depression on a person’s quality of life was not looked at in this study.

Article published in Epilepsy & Behavior, June 2018.

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Authored By: 
Elaine Kiriakopoulos MD, MSc
Authored Date: 
07/2018
Reviewed By: 
Patricia O. Shafer RN, MN and Joe Sirven MD
on: 
Sunday, July 29, 2018