Supplementary Tables Chapter 17
Table S17.1 Results of the systematic literature review: depressive disorders after epilepsy
surgery
Devinski et al (2005)
USA [32]
Derry et al (2000)
CANADA [122]
De Araujo Filho et al
(2012) [87]
BRAZIL
Carran et
al (2003)
[53]
USA
Buschmann
et al
(2009)[70]
GERMANY
Baird et al (2003) [31]
AUSTRALIA
Study
Sample
Design &
follow-up
period
Age at
surgery
58 patients
undergoing
temporal
lobectomy
(TLE);
16 patients
undergoing
extratemporal
resections
(eTLE)
21 patients
undergoing
extratemporal
resections
Retrospective;
24mo
TLE: 35.3 ± 9.2
eTLE: 32.8 ±
11.6
Semi-structured
interview; Expert
evaluation
according to DSM
criteria
Pre-op prevalence depression: 9
Prospective;
12mo
32.3 ± 10.6
Beck Depression
inventory
No change in depression scores p
Pre-op: 8.94 ± 6.12 (minimal depr
Post-op: 8.90 ± 11.16 (minimal de
Surgical cohort
of 415 patients
with TLE
Retrospective;
12mo
33.2 ± 8.6
Expert diagnosis
according to DSM
criteria
Post-op prevalence depression: 9
clinically significant depression fo
Psychiatric correlates of seizure o
patients with depression after AT
115 TLE patients
who underwent
corticoamygdalohippocampectomy
Retrospective;
Not stated
36.9 ± 10.8
Expert analysis
according to DSM
criteria
Pre-op prevalence depression: 47
diagnosis
Post-op remission: n=27 (54%)
De novo prevalence depression: n
Risk factors poor psychiatric outc
contralateral EEG abnormalities
Psychiatric correlates of seizure o
a risk factor for poor seizure outco
39 patients who
underwent ATL
Prospective;
24mo
31.2 ± 1.0
Psychiatric correlates of seizure o
symptoms limited to patients with
associated with good preoperativ
Correlates of high depression sco
preoperative adjustment, older ag
preoperative neurologic deficits, f
360 patients
undergoing
epilepsy surgery
(89% TLE)
Prospective;
24mo
37.6 ± 11.1
Centre for
Epidemiological
Studies
Depression Scale;
Washington
Psychosocial
Seizure Inventory
Beck Depression
Inventory; Beck
Anxiety
Inventory;
Composite
International
Diagnostic
Interview
1
Measure
Psychiatri
Post-op prevalence depression: 1
Pre-op prevalence depression: M
depression were reported in 22.1
a depressive disorder
Postop prevalence depression: D
declined; 9% met criteria for a de
Psychiatric correlates of seizure o
levels of depression symptoms we
patients who continued to have p
only 8.2% of those who were seiz
Hamid et al (2011a & b) [55]; Hamid et al
(2014) [35]
USA
Hellwig et al (2012) [33]
GERMANY
Hermann et al
(1989) [52]
USA
Lackmeyer
et al (2013)
[51]
AUSTRIA
Maixner et al (2010)
USA [123]
Malmgren et al (2002)
[48]
SWEDEN
373 surgical
patients with
refractory
epilepsy
(87% TLE)
Prospective;
60mo
37.7 ± 10.4
Beck Depression
Inventory;
Beck Anxiety
Inventory
Pre-op prevalence depression: 34
(22.7%) had moderate to severe d
Post-op prevalence depression: 2
(14.8%) were moderately to sever
Psychiatric correlates of seizure o
excellent seizure outcome saw re
surgery
Postop depression scores strongly
after surgery
Suicide: 4 of 27 deaths after surge
suicide (13.3 times higher than in
patient of which endorsed moder
on the BDI. Two of the patients re
anxiety symptoms.
Pre-op prevalence depression: 60
[42% suffered from a mood disord
criteria for epilepsy-associated DD
Disorder, 22% Post-ictal Dysphori
seizure frequency and ictal fear
Symptom remission after surgery
De novo prevalence depression: 1
Psychiatric correlates of seizure o
linked to good seizure outcome
Pre-op depression & locus of con
external locus of control
Post-op depression & locus of co
Symptom remission after surgery
depressive symptoms postop
Seizure outcome & depression: d
rendered completely seizure-free
84 patients
proceeding to
epilepsy surgery
Prospective;
3-12mo
36.9
Expert diagnosis
according to ICD
and ILAE criteria
37 patients with
TLE undergoing
ATL
Prospective;
6mo
32.8 ± 10.7
45 consecutive
patients with
mTLE
undergoing
surgery
Retrospective;
36mo
40.83 ± 10.15
Center for
Epidemiological
Studies of
Depression Scale;
Internal-external
control of
reinforcement
scale
Beck Depression
Inventory
Case study of a
38 year old
woman who
underwent left
amygdalohippocampectomy for
medically
refractory
seizures
70 consecutive
epilepsy
patients
undergoing
surgery (54 TLE)
Retrospective;
48mo
38
Expert psychiatric
evaluation
Emergence of catatonia 3 days po
verbal output; waxy flexibility; stu
negativism; grimacing
Successfully treated with 3 week c
therapy
Seizure free
Prospective;
24mo
35.1
(SD not
reported)
Expert psychiatric
evaluation
according to DSM
and Lindqvist–
Malmgren
diagnostic
systems
Pre-op prevalence: 44.3% had a p
commonly major depression or a
cognitive problems, irritability & e
Emotional disorder”)
Post-op prevalence: 68.1 % of pa
diagnosis, most commonly anxiet
and “Astheno-Emotional disorder
Risk of post-op depression is prepreoperative history of depressive
2
Pre-op prevalence: 20 (44.4%) ha
symptoms
Post-op prevalence: 10 (25%) had
symptoms
Seizure outcome & pre-op depre
Ring et al
(1998) [38]
UK
Quigg et al (2003) [67]
USA
Quigg et al
(2011)
USA [124]
Pauli et al (2009)
[40] GERMANY
Moss et al (2009)
[37]
UK
Metternich et al
(2009) [70]
GERMANY
Meldolesi
et al (2007)
[39]
ITALY
higher risk of postoperative depre
52 consecutive
TLE patients
undergoing
surgery
Prospective;
24mo
33.0 ± 9.4
115 patients
undergoing
epilepsy surgery
(84% TLE; 16%
FLE)
Retrospective;
12mo
38.5 ± 13.2
27 TLE patients
undergoing
epilepsy surgery
Prospective;
3mo
Not stated
(range= 19-49)
120 TLE patients
undergoing
epilepsy surgery
Not reported
Not reported
26 mTLE
patients
undergoing
epilepsy surgery
Prospective;
24mo
34.1 ± 7.9
Beck Depression
Inventory
107 focal
epilepsy
patients
undergoing
epilepsy surgery
(84% TLE)
Prospective;
12mo
Left-sided:
31.9 ± 1.2;
Right sided:
33.1 ± 1.5
60 TLE patients
undergoing
epilepsy surgery
Prospective;
6 wks & 3mo
27 ± 7.4
Scale 2 of the
MMPI-2; A clinical
depression index
(CDI) scoring the
occurrence of
depressive
symptoms,
psychiatric
referral, or
attempted/compl
eted suicide
Expert interview
3
Beck Depression
Inventory;
Spielberger StateTrait Anxiety
Inventory
Beck Depression
Inventory
Formal
psychiatric
diagnosis
according to ICD
criteria; Hospital
Anxiety and
Depression Scale
Beck Depression
Inventory;
Speilberger StateTrait Anxiety
Inventory
Post-op depression scores: gradu
Pre-op depression & post-op sz o
significantly lower BDI scores preo
significant predictor of postopera
freedom
Post-op depression & post-op sz
had significantly lower BDI scores
Results comparable for TLE+FLE a
Post-op depression/anxiety prev
anxiety & emotional lability within
Risk factors for post-op depressio
pre-op anxiety scores; right tempo
Elevated pre-op levels of depress
significantly more symptoms of de
normative levels
Decreased post-op depression/an
Correlates of decreased post-op d
op anxiety linked to seizure freed
depression linked to seizure freed
No change in depression scores a
Predictors of post-op depression
morbidity & right-sided surgery p
Similarly, higher pre-op depressiv
worse post-op Scale 2 scores
No effect of TLE versus eTLE focus
De novo psychopathology: 50% o
pre-op had developed symptoms
Post-op course: Depressive states
Prospective;
12mo
41 (SD not
given; range:
21–68)
Expert diagnosis;
FDG-PET
355 epilepsy
patients who
underwent
surgery
Prospective;
12mo
36.6 ± 11.3
Beck Depression
Inventory; Beck
Anxiety Inventory
60 patients who
underwent
epilepsy surgery
(50% TLE; 50%
FLE – matched
on BDI scores)
13 patients who
underwent
epilepsy surgery
(77% TLE)
Retrospective;
M=7.3mo
29.6 ± 9.6
Beck Depression
Inventory
Mood improved post-op: Men sh
women
FLE patients showed more extrem
post-op mood than TLE, related t
Prospective;
6mo
31
Mini International
Neuropsychiatric
Interview
Prospective;
12mo
37.1 ± 12
Witt et al
(2008) [49]
GERMANY
151 consecutive
patients
undergoing
epilepsy surgery
(83% TLE)
Beck Depression
Inventory
Wrench et
al (2004)
[17]
AUSTRALIA
60 seizure
surgery patients
(72% TLE,
28% eTLE)
Prospective;
3mo
TLE: 35 ± 10
eTLE: 37 ±11
Semi-structured
interview
60 seizure
surgery patients
(63% mTLE, 37%
nmTLE)
Prospective;
12mo
35 ± 10.9
Expert diagnosis
according to DSM
criteria
Prevalence pre-op depression: 46
All patients with pre-op psychop
medications
No exacerbation of pre-op psych
patients with pre-op psychopatho
maintained on psychotropic medi
suffered an exacerbation of the m
Pre-op prevalence of elevated m
Correlates of pre-op mood sympt
Seizure freedom associated with
symptoms; differential changes w
(enhanced emotional stabilization
patients (decreased anxiety, less v
Pre-op prevalence of depression:
Post-op prevalence of depression
levels than eTLE at 1mo
Correlates of post-op mood distu
not related to seizure outcome
Pre-op prevalence depression: 43
depression [40% of mTLE & 50% n
groups]
Predictors of pre-op depression:
illness, financial dependence
Post-op prevalence depression:
patients experienced depression,
between groups
Prevalence de novo depression: 1
patients (significant difference)
Course of post-op depression: Th
(70%) were diagnosed in the first
cases, the depression persisted fo
Predictors of post-op depression
depression, poor postoperative fa
Wrench et al (2011) [20]
AUSTRALIA
Velez et al (2013)
[34]
USA
Suchy et al
(2001)
USA [126]
Spencer et
al (2003)
[36]
USA
Salzberg et al
(2006)
AUSTRALIA
[125]
23 TLE patients
who underwent
ATL
Pre-operative prevalence history
Post-op prevalence depression: 5
Neurobiological correlates of dep
hypometabolism in ipsilateral orb
Neurobiological correlates of pos
in ipsilateral orbitofrontal region
Reduced depression & anxiety po
scores improved dramatically with
No impact of seizure outcome on
ATL=anterior temporal lobectomy; BDI=Beck Depression Inventory; DSM=Diagnostic and Statistical
Manual for Mental Disorders; eTLE=extratemporal lobe epilepsy; FDG-PET=fludeoxyglucose Positron
Emission Tomography; FLE=frontal lobe epilepsy; ICD=International Classification of Diseases; mo=months;
mTLE=mesial temporal lobe epilepsy; nmTLE=nonmesial temporal lobe epilepsy; pre-op=pre-operative;
post-op=post-operative; SGTCS=secondarily generalized tonic-clonic seizures; TLE=temporal lobe epilepsy;
wks=weeks
4
5
Table S17.2 Results of the systematic literature review: anxiety disorders surrounding epilepsy
surgery
Meldolesi et al
(2007) [39]
ITALY
Mattsson et al
(2005) [74]
SWEDEN
Hamid et al
(2014) [35]
USA
Halley et al
(2010) [73]
AUSTRALIA
Devinsky et al (2005)
[32]
USA
Baird et al (2003) [31]
AUSTRALIA
Study
Sample
58 patients
undergoing
temporal
lobectomy
(TLE);
16 patients
undergoing
extratemporal
resections
(eTLE)
360 patients
undergoing
epilepsy
surgery
(89% TLE)
Design &
follow-up
period
Retrospective;
24mo +
Age at
surgery
TLE: 35.3 ± 9.2
eTLE: 32.8 ±11.6
Measure
Psychiatri
Semi-structured
interview;
Expert
evaluation
according to
DSM criteria
Pre-op: 2 (3%) TLE with clinically signif
Beck Depression
Inventory; Beck
Anxiety
Inventory;
Composite
International
Diagnostic
Interview
Expert diagnosis
according to
DSM criteria;
T1-weighted
MRI
Pre-op prevalence: Moderate and seve
24.7% of patients; 18% met diagnostic
Postop prevalence: anxiety symptoms
met criteria for an anxiety disorder
Seizure outcome & psychiatry: Mode
symptoms were reported in 14.7% of t
postoperative seizures compared to on
Post-op: 2 (3%) TLE with clinically signi
Prospective;
24mo
37.6 ± 11.1
mTLE (n= 26);
nmTLE (n=16);
41 healthy
controls
Prospective;
12mo
mTLE: 36 ± 12
nmTLE: 33 ± 10
Controls: 35 ± 13
373 surgical
patients with
refractory
epilepsy
(87% TLE)
57 patients
undergoing
epilepsy
surgery
(82% TLE)
52
consecutive
TLE patients
undergoing
surgery
Prospective;
60mo
37.7 ± 10.4
Beck Depression
Inventory;
Beck Anxiety
Inventory
Prospective;
2-8 years
39 ± 10
Karolinska
Scales of
Personality
Anxiety scores decreased after surgery
Anxiety)
No relationship between pre- or post-o
Prospective;
24mo
33.0 ± 9.4
Beck Depression
Inventory;
Spielberger
State-Trait
Anxiety
Inventory
Post-op anxiety scores decreased signi
6
Pre-op prevalence: 27% MTR; 25% NM
Post-op anxiety remission: 29% MTR;
De novo anxiety: 27% MTR; 19% NMTR
Neurobiological correlate of postop an
amygdala of normal volume in patient
regardless of seizure outcome
Anxiety scores strongly linked to lower
Moss et al (2009) [37]
UK
Pauli et al (2009)
[40]
GERMANY
Ring et al (1998)
[38]
UK
Spencer et
al (2003)
[36]
USA
Velez et al (2013)
[34]
USA
Wrench et al
(2004) [17]
AUSTRALIA
27 TLE
patients
undergoing
epilepsy
surgery
Prospective;
3mo
Not stated
(range= 19-49)
120 TLE
patients
undergoing
epilepsy
surgery
Not reported
Not reported
60 TLE
patients
undergoing
epilepsy
surgery
Prospective;
6 wks & 3mo
27 ± 7.4
355 epilepsy
patients who
underwent
surgery
13 patients
who
underwent
epilepsy
surgery
(77% TLE)
60 seizure
surgery
patients
(72% TLE,
28% eTLE)
Prospective;
12mo
36.6 ± 11.3
Prospective;
6mo
31 (SD not
reported)
Prospective;
3mo
TLE: 35 ± 10
eTLE: 37 ±11
Formal
psychiatric
diagnosis
according to ICD
criteria;
Hospital Anxiety
and Depression
Scale
Beck Depression
Inventory;
Speilberger
State-Trait
Anxiety
Inventory
Expert interview
Beck Depression
Inventory; Beck
Anxiety
Inventory
Mini
International
Neuropsychiatri
c Interview
Semi-structured
interview
Post-op depression/anxiety prevalenc
emotional lability within 3mo of surger
Risk factors for post-op depression/an
anxiety scores; right temporal lobectom
Elevated pre-op levels of depression/a
more symptoms of depression & anxie
Decreased post-op depression/anxiet
Correlates of decreased post-op depre
linked to seizure freedom after surgery
seizure freedom only in left TLE patien
De novo psychopathology: 50% of tho
developed symptoms of anxiety or dep
noted to have increased emotional lab
Post-op course: Emotional lability & an
3mo post-op
Correlates of persistent anxiety: Left h
Reduced depression & anxiety post-o
improved dramatically within 3mo afte
No impact of seizure outcome on post
Pre-op prevalence of anxiety: 31%
All patients with pre-op psychopathol
No exacerbation of pre-op psychopath
pre-op psychopathology were seizure
medications, none of the patients suffe
symptoms after surgery
Pre-op prevalence of anxiety: 23% of T
Post-op prevalence of anxiety: 42% of
eTLE at 1mo
Correlates of post-op mood disturban
to seizure outcome
ATL=anterior temporal lobectomy; BDI=Beck Depression Inventory; DSM=Diagnostic and Statistical
Manual for Mental Disorders; eTLE=extratemporal lobe epilepsy; ICD=International Classification of
Diseases; mo=months; mTLE=mesial temporal lobe epilepsy; nmTLE=nonmesial temporal lobe epilepsy;
pre-op=pre-operative; post-op=post-operative; TLE=temporal lobe epilepsy; wks=weeks
7
Table S17.3 Results of the systematic literature review: psychosis surrounding epilepsy surgery
D'Alessio et al
(2014) [128]
ARGENTINA
Da Conceiao et
al (2012)
BRAZIL [87]
De Conceicao
et al (2012)
BRAZIL [127]
Cleary et al
(2013) [63]
UK
Calvet et al
(2011) [92]
ARGENTINA
Barbieri et al (2011)
[86]
ITALY
Baird et al (2003)
[31]
AUSTRALIA
Study
Sample
58 patients undergoing
temporal lobectomy
(TLE);
16 patients undergoing
extratemporal
resections (eTLE)
12 patients with
chronic inter-ictal
psychosis
(surgical cohort of 504)
Design &
follow-up
period
Retrospective;
24mo +
Age at
surgery
TLE: 35.3 ± 9.2
eTLE: 32.8 ±11.6
Measure
Psychiatric Outcomes
Semi-structured
interview; Expert
evaluation
according to DSM
criteria
Pre-op: 2 (3%) TLE with psycho
Worse post-op psychosis: n=6
Four patients (33%) worsened
patients (16%) worsened and d
Compliance with preoperative
follow-up was satisfactory
Good seizure outcome: Seven
one showed no worthwhile im
Pre-op psychopathology: 1 x a
Cluster A personality disorder
Post-op psychosis: 1 x acute p
schizoaffective disorder; 1x br
disorder
All seizure free
Pre-op correlates of PIP: posit
psychopathology; less lateraliz
Recurrent PIP linked to de nov
PIP not related to seizure outc
Improved psychiatric outcome
remission of psychotic sympto
Good seizure outcome: 7/8 pa
freedom and improved quality
Post-op: 1 (2%) TLE with psych
Retrospective;
12mo
36.3 ± 8.2
Expert evaluation
according to DSM
criteria; Self-report
questionnaire
Case series of 3 TLE
patients who
underwent ATL
Unclear;
1-5 yrs
46, 41, 29 yo
Expert evaluation
according to DSM
criteria
20 patients with
TLE+PIP
60 patients with TLE
only
8 patients with TLE +
psychosis underwent
surgery
Retrospective;
4 yrs
Not reported
Expert evaluation
according to DSM &
ILAE criteria
Retrospective;
Not reported
Not reported
Expert evaluation
according to DSM &
ILAE criteria
18 patients with TLE
and psychosis of
epilepsy, 10 of whom
went to on have
surgery
Retrospective;
24m+
40.4 ± 8.9
(N=18)
Expert diagnosis
according to DSM &
ILAE criteria
Reduced psychotic symptoms
pre-op psychiatric status
Good seizure freedom: 6 (60%
Of 89 with TLE,
14 (15.7%) diagnosed
with psychosis
Prospective;
24mo
Not reported
Structured clinical
interview according
to DSM and ILAE
criteria
Reduced psychotic symptoms
No change in psychosis after s
Transient exacerbation of psyc
De novo depression after surge
Seizure outcome after surgery
8
Hellwig et al (2012)
[33]
GERMANY
Louis et al
(2013)
USA [129]
Prospective;
3-12mo
36.9
Expert diagnosis
according to ICD
and ILAE criteria
90 patients proceeding
to epilepsy surgery
(68% TLE; 3 with PIP
Retrospective;
not reported
Not reported
Expert diagnosis
6 mesial TLE patients
with inter-ictal
psychosis
Unclear;
36mo
Not reported
Expert diagnosis
according to DSM
criteria
Post-op symptom remission: 5
improvement in mental state,
patient
Good seizure outcome (Engel
100 patients who
underwent epilepsy
surgery (70% TLE)
Retrospective;
2-22yrs
Not stated
Expert diagnosis
Post-op prevalence of psycho
medically refractory)
Characterization of post-op ps
delusions, anxiety, irritability,
5 patients with dual
diagnosis of intractable
TLE and chronic
psychosis who
underwent ATL
Retrospective;
2-8 yrs
Range: 30-42
Expert diagnosis
according to DSM
criteria
Nil issues with informed conse
No worsening of psychotic sym
Seizure outcome good
Improved function in everyday
seizure freedom)
Reutens et al
(1997) [84]
CANADA
Mayanagi
et al (2001)
[90]
JAPAN
Marchetti
et al (2003)
[85]
BRAZIL
84 patients proceeding
to epilepsy surgery
(5 with psychosis)
Pre-op prevalence: 60% receiv
psychotic syndromes]. Correla
mesial temporal focus
Post-op remission: Psychotic s
PIP remitted after surgery
Sz outcome and psychosis: sym
seizure outcome
Pre-op prevalence of PIP: Thre
Post-op symptom remission: A
symptoms after surgery
Sz outcome and psychosis: all
ATL=anterior temporal lobectomy; DSM=Diagnostic and Statistical Manual for Mental Disorders;
eTLE=extratemporal lobe epilepsy; ICD=International Classification of Diseases; ILAE=International League
Against Epilepsy; mo=months; MTS=mesial temporal sclerosis; PIP=post-ictal psychosis; pre-op=preoperative; post-op=post=operative; TLE=temporal lobe epilepsy; yrs=years
9
Table S17.4 Results of the systematic literature review: somatic symptom disorders surrounding
epilepsy surgery
Reuber et al (2002) [99]
GERMANY
Markoula et al (2013)
[103]
UK
Baird et al (2003)
[31]
AUSTRALIA
Study
Sample
58 patients
undergoing temporal
lobectomy (TLE);
16 patients
undergoing
extratemporal
resections (eTLE)
Cohort of 790
epilepsy surgery
patients; 29 had
post-operative PNES
Cohort of 1342
epilepsy surgery
patients; 13 (1%) had
both epileptogenic &
psychogenic seizures
Design &
follow-up
period
Retrospective;
24mo +
Age at
surgery
TLE: 35.3 ± 9.2
eTLE: 32.8 ±11.6
Retrospective;
Unclear
PNES: 35
No PNES: 32
(SD not
reported)
Retrospective;
M=56mo
29 (SD not
reported)
Measure
Semistructured
interview;
Expert
evaluation
according to
DSM criteria
Expert
diagnosis ±
video-EEG
monitoring
Expert
diagnosis ±
video-EEG
evidence
Psychiatric
Pre-op PNES: 2 (3%) TLE had pre-existing
Post-op PNES: nil diagnoses of PNES afte
cases
De novo post-operative prevalence: 29
PNES within 2 weeks-10 years post-surge
De novo PNES independent of seizure o
Prevalence post-op psychiatric comorbi
PNES; 49% of patients with no post-op P
Pre-op psychiatric prevalence: 65% of p
depression; 10% psychosis; 38% other); 3
(24% depression; 5% psychosis; 22% oth
Epilepsy surgery led to clinically relevan
7 became free of epileptogenic & psycho
of epileptogenic seizures but continued t
seizures, 1 patient reported more than a
seizure frequency and abolishment of ps
nondisabling epileptogenic seizures pers
psychogenic seizures stopped. In 2 of 13
produce notable improvements.
ATL=anterior temporal lobectomy; DSM=Diagnostic and Statistical Manual for Mental Disorders;
eTLE=extratemporal lobe epilepsy; mo=months; PNES=Psychogenic Nonepileptic Seizures; pre-op=preoperative; post-op=post=operative; TLE=temporal lobe epilepsy
10