Date of Award

2015

Document type

Thesis

Degree Name

MD (Medical Doctor)

First Supervisor

Professor David Cotter

Second Supervisor

Professor Mary Cannon

Keywords

Epilepsy, Surgery, Psychiatry, Intellectual Disability, Comorbidity.

Abstract

Introduction

Epilepsy is a common disease with a prevalence of 0.5-1% of the population. The literature on psychopathology in refractory epilepsy is conflicting. In refractory epilepsy, surgical intervention is considered to reduce seizure frequency and in some cases prevent seizures. It has been reported that neurosurgical intervention for epilepsy is associated with significant undesirable psychiatric consequences. This study looked at psychiatric and psychosocial comorbidity in a sample of pre-operative epilepsy surgery candidates and also examined patients who proceeded to surgery at one year post-operatively to see whether surgery had positive or negative consequences on patients' mental health.

Methods

This study examined a sample of patients with medically refractory epilepsy and a prospective cohort study was conducted on a sub-group of this sample who underwent surgery and had psychiatric follow-up at one year postoperatively. This study used the Structured Clinical Interview for DSM IV (SCID I) to examine for an Axis I psychiatric diagnosis and the presence o f a personality disorder was assessed for using SCID II. The Hospital Anxiety and Depression Scale (HADS) and Quality of Life in Epilepsy 89 (QOLIE 89) were the subjective rating scales utilized.

Results

The findings of this study demonstrated the high prevalence of psychiatric comorbidity (54.4%) in patients with medically refractory epilepsy. A total of 48 patients had pre-operative and post-operative assessments at one year. There was a highly significant reduction post-operatively with the number of patients with a psychiatric diagnosis (p

Conclusions

Overall, this study demonstrated that undergoing surgery for medically refractory epilepsy had an overall positive impact on mental health with a significant reduction in the prevalence of psychiatric symptoms and an improved quality of life for patients.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.

File Size

17,321 KB

Comments

A thesis submitted for the degree of Doctor of Medicine from the Royal College of Surgeons in Ireland in 2015.

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