Neuropsychiatric Symptoms of Epilepsy

17 The Role of Epilepsy Surgery
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Table 17.3 Features of the burden of normality to canvass in rehabilitation after epilepsy surgery
[ 19 , 59 ]
Life domain Features Common issues for rehabilitation
Psychological Changes in self-concept (“well
self”)
Sense of “cure” or “difference”
Need to “prove” normality
Increased expectations (from self or
others)
Lack of “excuse” of chronic illness
Grieving the loss of epilepsy
Sense of missed opportunities (“lost
years”)
Need to make up for lost time
Behavioral Changes in activities “Overdoing it” (physical, vocational,
social)
“Underdoing it” (physical, vocational,
social)
Other somatic complaints
Change in sex drive (typically
increased)
Nonadherence to anticonvulsants
Affective Changes in mood Euphoria, joy of “cure”
Anxiety, increased “pressure”
Depression, shame, guilt
Frustration, regret
Sociological
Changes in family dynamics and
social function
Changed role of the primary carer
Attitudes of family members and
friends
Increased family conflict
New vocational horizons
Educational and vocational programs
Employment opportunities, promotion
New social horizons
Driving
Intimate and other friendships
New social activities and networks
Neurobiologically, neuroimaging research shows that postoperative anxiety is
associated with resection of an amygdala with normal volume [ 73 ] or a smaller ipsilateral
hippocampal remnant following a left temporal lobe resection [ 64 ]. Together,
these two studies suggest that significant disease in mesial temporal structures, or
the resection of relatively healthy tissue, plays some role in the development of postsurgical
anxiety. This is broadly consistent with functional imaging data in TLE
patients showing that greater preoperative ipsilateral amygdala activation, presumably
from a healthy structure, is associated with significantly increased anxiety
symptoms after surgery [ 77 ]. The amygdala plays a central role in the limbic circuit
responsible for threat reactivity. This circuit is thought to be modulated by the
Affective Appraisal Network, which has nodes in the ventromedial prefrontal cortex,
the posterior cingulate cortex and the hippocampus, and is involved in emotion
generation and regulation, self-related cognition, long-term memory retrieval, and