Neuropsychiatric Symptoms of Epilepsy

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G. Rayner and S.J. Wilson
context-based modulation of conditioned fear [ 78 ]. Although speculative, neuroimaging
of postoperative anxiety suggests that surgical disruption to anxiety- related
brain networks may exacerbate or give rise to anxiety symptoms after surgery.
Anxiety and Seizure Outcome
The relationship between anxiety and seizure recurrence after epilepsy surgery
remains ambiguous. This literature review identified one study showing that seizure
freedom after surgery was related to lower postsurgery anxiety [ 40 ], and another
suggesting that heightened anxiety was more likely to persist long-term in patients
with ongoing seizures [ 32 ]. Three studies, however, did not find a relationship
between seizure outcome and pre- or postsurgery anxiety [ 17 , 36 , 74 ]. Since all five
of these studies were methodologically robust, employing prospective designs with
sample sizes of 57–360 patients, further investigation is needed to clarify the issue.
Summary: Anxiety
• 20–30 % of surgical patients have a lifetime history of significant anxiety.
– This is a predictor of postsurgery anxiety and depression.
• Around ~30 % of patients meet criteria for an anxiety disorder early
postsurgery.
– A significant proportion represent de novo anxiety symptoms.
• Neurobiological risk factors for postsurgery anxiety implicate dysregulation
of the mesial temporal node of the Affective Appraisal Network.
• Other risk factors for postsurgery anxiety include previous episodes of
depression/anxiety and poor coping skills.
• Links between perisurgical anxiety and seizure recurrence remain
equivocal.
Psychotic Symptoms and Disorder
Pre-surgery Prevalence
The psychoses of epilepsy are also a heterogeneous group of disorders that differ
according to the temporal relationship they have with seizures. Postictal psychosis
(PIP) is a well-established psychiatric complication of focal epilepsy, occurring in
around 7 % of patients with drug-resistant TLE [ 79 , 80 ]. Symptoms such as thought
disorder, hallucinations, and delusions typically emerge 12–72 h after a cluster of
seizures and last from a few days to a few weeks [ 79 , 81 , 82 ]. A diagnosis of PIP can
be made on the basis of a single psychotic episode. Clinical risk factors include a