Anterior hippocampectomy in patients with drug-resistant TLE was associated with significant early improvements in BDI-II and WHOQOL scores, and routine psychiatric screening and postoperative psychological support remain essential.
Abstract
Background
Temporal lobe epilepsy (TLE), frequently associated with mesial temporal sclerosis (MTS), is the most common form of focal epilepsy in adults and is often accompanied by depressive symptoms that impair quality of life. While anterior hippocampectomy is an established surgical approach for drug-resistant TLE, its postoperative psychiatric and psychosocial impact remains insufficiently studied, particularly in non-Western populations. This study assessed changes in depressive symptoms and quality of life following anterior hippocampectomy in a Middle Eastern cohort.
Methods
Depression was assessed preoperatively and at 1- and 3-month follow-up using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Beck Depression Inventory (BDI). Quality of life was measured using the World Health Organization Quality-of-Life (WHOQOL) scale.
Results
Forty patients were included, of whom 18/40 (45.0%) screened positive for depression at baseline. BDI scores decreased significantly over time (p = 0.011) and WHOQOL scores improved significantly across follow-up (p = 0.016). PNDDI-E scores showed a non-significant reduction over time (p = 0.055). 9/18 (50.0%) of patients who screened positive for depression preoperatively converted to screen-negative status at 3 months, while 4/22 (18.2%) of preoperatively screen-negative patients developed new screen-positive status. Improvements in BDI and WHOQOL scores were not significantly influenced by age, sex, education, or surgical laterality.
Conclusions
Anterior hippocampectomy in patients with drug-resistant TLE was associated with significant early improvements in BDI-II and WHOQOL scores. These findings should be regarded as preliminary given the small sample size, short follow-up, and absence of postoperative seizure outcome data. Given that a subset of patients may develop new or worsened depressive symptoms postoperatively, routine psychiatric screening and postoperative psychological support remain essential.
Depression is one of the most frequent psychiatric comorbidities in drug-resistant patients with epilepsy, reaching up to 60% of them. Studies indicate that the pathophysiology of depression and epilepsy have a lot in common, especially the temporal lobe epilepsy (TLE). Since hippocampal sclerosis (HS) is a frequent histopathology finding in patients with TLE, the purpose of this study was to investigate if there is a frequency relation between depression and the different types of HS. 119 patients with TLE, with and without HS, were selected (HS1 = 40, HS2 = 40, NHS = 39) and their medical records were analyzed. Depression was seen in 44 of them, without difference between HS types nor NHS (HS1 = 20, HS2 = 12, NHS = 12, p = 0.1). However, women were 3 times more likely to have depression (p = 0.004). Patients without HS were younger at seizure onset than those with HS2 (p = 0.02). The HS2 group had more cases of initial precipitating injury than NHS (p < 0.001) but were similar to HS1 patients. Our study shows that presence of depression in drug-resistant patients with mesial temporal lobe epilepsy is linked to hippocampal disfunction rather than neuronal density in the hippocampus.
Thais Forner Batelli, Nathália Stela Visoná de Figueiredo, R. S. Centeno et al.· Epilepsy & Behavior· 0 citations
OBJECTIVE
To investigate changes in quality of life (QoL) dimensions and their relationship with seizure outcome, depression, and suicidality after the addition or substitution of an anti-seizure medication (ASM) in adults with drug-resistant focal epilepsy.
METHODS
A total of 665 consecutively enrolled patients were followed prospectively and assessed with Quality of Life in Epilepsy Inventory 31 (QOLIE-31) and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). QoL changes over time for the overall population and seizure outcome categories were analyzed with analysis of variance (ANOVA), whereas factors affecting QoL changes were assessed by using a linear regression model.
RESULTS
Seizure freedom was associated with a marked improvement across all QoL domains, ranging from 11 points for Seizure worry to 4 points for Emotional well-being. The presence of depression before starting medication and its persistence during the observation period was associated with a global worsening of QoL across all domains, ranging from 10 points worse for Social functioning, almost 8 points for Energy and fatigue, 6 points for Cognitive functioning, and to nearly 5 points for Seizure worry. The new development of depression during treatment was associated with worsening in specific QoL domains such as Cognitive functioning, Social functioning, and Overall QoL subscales. Persistent positive suicidality screening was associated with progressive worsening in the domain Emotional well-being.
SIGNIFICANCE
Seizure freedom can improve all domains of QoL, but mainly Seizure worry, although this can be negatively affected by depressed mood. Improvement in the domain of Social functioning requires a period of sustained seizure freedom longer than 6 months to improve, and it is negatively influenced by persistent depressed mood. In contrast, changes in Emotional well-being are negatively influenced by suicidality. Clinical and demographic variables, including duration of epilepsy and number of comorbidities or concomitant medical problems, showed no correlation with changes in QoL.
Marco Mula, S. Borghs, Bruno Ferrò et al.· Epilepsia· 0 citations
OBJECTIVE
To identify the role of the lateralization of the epileptic focus in the manifestation of comorbid psychopathological symptoms in patients with temporal lobe epilepsy (TLE).
MATERIAL AND METHODS
A total of 104 patients diagnosed with epilepsy were included in the study, comprising 40 males and 64 females, with a mean age of 35.65±8.45 years. Participants were categorized into three groups based on electroencephalographic findings: left-sided epileptic focus (n=28), right-sided focus (n=25), and bilateral foci (n=51). The psychometric assessment utilized the Symptom Checklist-90 (SCL-90), which consists of nine distinct subscales. Statistical analyses were conducted using Student's t-test, correlation analysis, and regression methods.
RESULTS
The mean scores for the SCL-90 subscales did not reveal any statistically significant differences among the groups (p>0.05). Notably, in patients with right-sided localization, the correlation between depression and anxiety (r=0.84) was stronger than that observed in the left-sided focus group (r=0.62). Similarly, correlations with other SCL-90 indicators, such as somatization (right-sided r=0.77; left-sided r=0.34) and paranoid ideation (right-sided r=0.81; left-sided r=0.53), showed stronger associations in the right-sided focus group. Regression analysis confirmed the correlation between depression and anxiety as significant exclusively within the right focus group (beta coefficient 0.83).
CONCLUSIONS
The findings highlight the significance of the lateralization of the epileptic focus in the development of affective psychopathological symptoms, as well as the interplay between depressive and anxiety syndromes in patients with TLE. These insights may inform the personalization of diagnostic and therapeutic strategies.
V. Kalinin, A. Zemlyanaya, E. A. Fedorenko et al.· Zhurnal Nevrologii i Psikhia...· 0 citations
Abstract Objective This study aimed to assess long‐term memory outcomes in patients with temporal lobe epilepsy (TLE) who underwent anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SAH), compared to nonoperated TLE over a 10‐year follow‐up period. Methods A total of 48 participants were studied: 10 ATL, 26 SAH, and 12 patients with nonoperated mesial temporal lobe epilepsy (MTLE). Verbal memory was assessed using the Sözel Bellek Süreçleri Testi (SBST—a test of verbal memory processes), and nonverbal memory was evaluated with the Wechsler memory scale—visual reproduction (WMS) (Turkish adaptation). Given the small and unbalanced groups, linear mixed‐effects models (LMMs) were used as the primary inferential analyses to test group × time interactions. Statistically reliable individual changes were identified using the reliable change index (RCI). Neuropsychological outcomes were analyzed longitudinally over a 10‐year follow‐up period. Results A significant group × time interaction was observed for verbal total learning (p = 0.001). The nonoperated TLE group showed a significant decline over time, whereas both surgical groups differed significantly from it. The ATL group demonstrated significant improvement. For delayed verbal recall, a significant main effect of group was observed; however, the group × time interaction was not statistically significant. Visual immediate recall showed a significant group × time interaction (p = 0.004), with a significant interaction effect in the ATL group. Visual delayed recall demonstrated a significant group × time interaction (p < 0.001), with significant interaction effects in both surgical groups. Seizure freedom was achieved in 90% of ATL and 80% of SAH cases; however, seizure outcome was not significantly associated with memory outcomes. Reliable change index analyses indicated lateralization‐dependent patterns of change. Significance ATL, particularly left‐sided ATL, was associated with statistically significant long‐term improvements in verbal memory and significant longitudinal changes in visual memory. SAH demonstrated significant longitudinal effects in selected memory domains. In contrast, nonoperated TLE patients showed significant cognitive decline over time. These findings highlight differential long‐term cognitive trajectories across treatment approaches and the role of lateralization in memory outcomes following epilepsy surgery. Plain Language Summary We examined memory changes over 10 years in people with temporal lobe epilepsy who underwent different surgical treatments or received medical management alone. Patients who underwent anterior temporal lobectomy (ATL), particularly on the left side, showed improvement in certain memory measures over time. Those who had selective amygdalohippocampectomy (SAH) demonstrated more domain‐specific cognitive changes despite good seizure control. In contrast, patients who did not undergo surgery experienced a decline in verbal learning. These findings suggest that surgical approach and brain lateralization play important roles in long‐term memory outcomes.
Tehran Aliyeva, Fadime Çadırcı Tungaç, Beyza Tağraf et al.· Epilepsia Open· 0 citations
BACKGROUND
In the U.S., about one million people with active epilepsy are adults aged 55+. Older adults with epilepsy (OAWE) experience complex health conditions that compromise quality of life (QOL). The contribution of depressive symptom dimensions to health-related QOL remains underexplored in OAWE.
METHODS
We analyzed baseline data from 13 epilepsy self-management studies in the CDC-sponsored MEW-DB (Managing Epilepsy Well Database), including adults ages 55 and older (N = 198). The primary outcome was health-related QOL, assessed via the 10-item Quality of Life in Epilepsy scale (QOLIE-10), which was inverse rank normalized (mean = 0, SD = 1). Primary predictors included the Patient Health Questionnaire (PHQ-9) total score, cognitive and somatic symptom sub scores, and suicide ideation. Multivariable mixed-effects linear regression was used to assess associations. Models included a random intercept for originating study.
RESULTS
Participants were x̄ = 60.8 years (range: 55-79); 60.6% female and 68.7% White. On average, participants had mild depressive symptoms (mean PHQ-9 = 8.3). Depressive symptom severity was significantly associated with worse QOL. Cognitive (β = 0.17 SD, 95% CI: 0.12-0.21, p = 5.6 × 10-13), somatic (β = 0.19 SD, 95% CI: 0.14-0.23, p = 3.3 × 10-17), and total depressive (PHQ-9 total) symptoms (β = 0.10 SD, 95% CI: 0.08-0.12, p = 3.8 × 10-21) were associated with worse QOLIE-10 total scores when adjusting for likely confounders. Suicide ideation was not associated with QOLIE-10 (β = 0.07 SD, 95% CI: -0.15 to 0.29, p = 0.51). Past 30-day seizure occurrence was associated with worse total QOLIE-10 only when depressive terms were excluded from the multivariable model (β = 0.38 SD, 95% CI: 0.05-0.72, p = 0.024).
CONCLUSIONS
Among OAWE, depressive symptoms are strongly linked to reduced QOL. These findings underscore the importance of integrated mental health screening and intervention for OAWE.
Elaine T. Kiriakopoulos, Farren Briggs, Nicole Fiorelli et al.· Epilepsy & Behavior· 0 citations
OBJECTIVE
The postictal state is a major yet underrecognized component of the epilepsy burden. We aimed to develop a structured patient-reported instrument to quantify postictal recovery, characterize its multidimensional burden, and identify demographic, clinical, psychiatric, and treatment-related factors associated with postictal severity and duration.
METHODS
We conducted a prospective, single-center observational cohort study (Timone Hospital, Marseille, February 2025-March 2026). Consecutive patients aged ≥15 years admitted for scalp or stereo-EEG video-monitoring were included. Patients completed the Postictal Recovery Scale (PRS), an 11-domain questionnaire assessing fatigue, mood, sensory, motor, language, orientation, time perception, and postictal amnesia. Items were rated from 0 (severe impairment) to 3 (no symptoms), yielding a total score of 0-33. Internal consistency was assessed using Cronbach's alpha. Associations between PRS scores, subjective postictal duration and covariates were analyzed using group comparisons, correlations, and regression models.
RESULTS
Of 107 enrolled patients, 96 were included. PRS showed good internal consistency (Cronbach's α = 0.79). 96% of patients reported experiencing postictal symptoms, with fatigue (80%) and postictal amnesia (79%) being the most frequent and severe manifestations. Recovery exceeded 1 h in 21% of patients. Greater postictal impairment was associated with higher interictal anxiety (Spearman ρ = -0.32, p = 0.0018) and depressive symptoms (Spearman ρ = -0.40, p = 0.0001), whereas demographic, epilepsy-related, and treatment variables showed no significant associations. Altered postictal time perception was reported by 40% of patients and was associated with disorientation, but not postictal psychiatric symptoms. Subjective postictal duration was longer than subjective ictal duration (Wilcoxon test, p < 0.0001).
SIGNIFICANCE
The postictal state is a frequent and multidimensional patient-reported experience. Greater postictal severity, particularly concerning anxiety and depression, is associated with interictal psychiatric comorbidity, while altered temporal experience emerges as a distinct dimension of postictal dysfunction. These findings support integrating postictal measures into clinical practice and trials.
Ionuț-Flavius Bratu, A. Trébuchon, F. Bartolomei· Epileptic disorders· 0 citations
