Date of Award
MD (Medical Doctor)
Professor Kieran Murphy
Epilepsy, surgery, Cohort Studies, Ireland.
Epilepsy is a common disease with an incidence of 20-70 per 100 000 annually and prevalence of 0.5-1 % of the population. Data to date assessing psychopathology in refractory epilepsy patients is conflicting. In a subgroup of medically refractory epilepsy patients, surgical intervention is considered. Studies of outcome after neurosurgical resection of epileptogenic tissue or temporal lobectomy focus on frequency of seizures as their primary outcome measure. Neurosurgical intervention for epilepsy is associated with significant undesired psychiatric consequences including psychosis, major depression, obsessive compulsive disorder and suicide.
This study is prospective cohort study which examined a group of patients with medically refractory epilepsy, and also examined a cohort who proceeded to surgery before and after surgery. This study used the Hospital Anxiety and Depression Scale (HADS) and the Structured Clinical Interview for DSM IV (SCID I), to examine for an axis-1 psychiatric diagnosis. In addition, the study assessed the presence of personality disorder using the SCID-II. The Quality of life in Epilepsy (QOLIE-89) assessed social outcome. All patients admitted to the Epilepsy Monitoring Unit or who attended the Neurology OPD in Beaumont Hospital with treatment resistant epilepsy are considered a candidate for inclusion. All participants were assessed using the same instruments as those unwilling to participate. Those that proceeded to surgery were reassessed three to six-months after surgery using the same structured interview and standardised self rating questionnaires.
The findings of this study demonstrated the high prevalence of psychiatric comorbidity (49%) in patients with medically refractory epilepsy. In addition, the presence of a psychiatric disorder and the severity of the symptoms of psychiatric illness were correlated strongly with quality of life. Overall, this study has demonstrated that undergoing surgery for medically refractory epilepsy had an overall positive Impact on mental health with a significant reduction in the severity and prevalence of psychiatric symptoms and an improved quality of life.
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Barry, H. Psychiatric co morbidity in epilepsy, psychiatric and psychosocial morbidity before and after surgical treatment. [MD Thesis]. Dublin: Royal College of Surgeons in Ireland; 2013.