Expectation of surgery:
- Desire beyond seizure.
- Various expectation of social and psychological nature.
- Self confidence.
- Driving.
- Employment.
- Getting married.
Affective Disorder - Depression
|
Pre-operative depression |
Post-operative depression |
|---|---|
|
Refractory epilepsy |
Most common |
|
Atypical presentation, dysphoric mood |
Transient |
|
Temporal lobe epilepsy: risk or not |
Risk factors: older patients, males, poor preoperative adjustment, neurological deficit, family history, poor post operative seizure control, psychosocial adjustment of not having seizures |
|
Role of lateralisation is unclear (Rt more than Lt) |
Lateralisation (Right) |
|
Frontal lobe dysfunction |
Prefrontal dysfunction |
|
Role of gender unclear |
De nova depression ranges from 5-25% after TLE |
|
Role of AED |
Reported cases of suicide |
|
Suicide: greater than general population, TLE more so
|
|
Affective Disorder – Anxiety
|
Pre-Operative |
Post-Operative |
|---|---|
|
GAD (13.2%), panic attacks and disorder (3.4%), phobias (11-15%), OCD |
17-54% anxiety disorder, 1 mpnth after surgery, reduces by 3 months |
|
More common in TLE (Lt), frontal, atypical aura |
Left temporal resection |
|
Chronic refractory seizure disorder |
|
|
Stigmas and poor quality of life |
|
|
Structural abnormalities in the amygdala; ictal fear |
|
|
AED
|
|
Psychosis
|
Pre-Operative |
Post-Operative |
|---|---|
|
Ictal psychosis expression of seizure activity |
Mostly become free of psychosis |
|
Postictal psychosis (Clusters) 6%-10% |
Forced normalisation |
|
Chronic Interictal psychosis 4%-10% |
De novo: rare can occur even after 2 years after surgery |
|
Neurodevelopmental abnormalities |
|
|
Focal/generalised structural lesion |
|
Non epileptic attacks post epilepsy surgery
|
Pre-Operative |
Post-Operative |
|---|---|
|
Usually excluded |
50% become free of both seixures |
|
|
De novo? 6-12 months after opertation |
|
|
Right hemispheric dysfucntion: misperception or misinterpretation of emotional |
|
|
Low intelligence |
|
|
Female younger, history of psychiatric problems |