Neuropsychiatric Symptoms of Epilepsy

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G. Rayner and S.J. Wilson
Postsurgery Follow-up. In the context of seizure freedom, by 1 month post
surgery S.P. had developed some insight into her persistently low mood and the
impact that it was having on her recovery and the dynamics of the family unit.
Following liaison between our multidisciplinary Seizure Surgery Follow-Up
and Rehabilitation Program and her local GP, she was prescribed citalopram
and commenced cognitive behavioral therapy with a clinical psychologist.
At 3 months post surgery, S.P. described a significant improvement in her
mood. In particular, she described feeling “re-invigorated” with a very positive
outlook and a sense that she was back to being the person she was prior
to seizure onset. She described having a renewed sense of freedom, personal
control, and autonomy with a related reduction in her dependence on others.
She expressed resentment at well-intentioned comments from others that she
required ongoing care and supervision. She stated that seizure freedom had
“given me my life back” and was eager to maximize all future opportunities.
Her libido also suddenly significantly increased beyond what she had ever
previously experienced but her sexual satisfaction was diminished, leading to
frustration and more frequent demands for sex from her partner.
One year after resective surgery, S.P. remained completely seizure-free and
considered herself “cured” of epilepsy. Her mood was now stable; she successfully
weaned antidepressant medication after 6 months and was no longer
attending psychological therapy. Her hypersexuality had now settled considerably.
She described herself as a happier, more confident, easy going, “in control”
individual no longer plagued with the self-doubt that characterized her
preoperative disposition. She denied ruminating about the possibility of seizures.
Psychosocially, the dynamics of the marital relationship underwent some
adjustment in the context of changed roles stemming from seizure freedom, but
eventually settled. She enjoyed the support of a close network of friends. S.P.
made a successful, graded return to her former work position, has regained her
driver’s license, and remained very happy with her decision to have surgery.
Summary: The Trajectory of Psychological Recovery After Epilepsy
Surgery
• Seizure-free patients must adjust from being chronically sick to suddenly
well, often invoking the burden of normality.
• Patients with seizure recurrence report a different adjustment process
where significant disappointment and psychological concerns are paramount.
Patients describe using benefit-finding and cognitive reframing as
a way of adaptively coping with their suboptimal outcome.
• Regardless of seizure outcome, successful adjustment after epilepsy surgery
depends on the intrinsic coping capabilities of patients and their families
as well as the support of their treating team.
• Failure to adjust to seizure freedom or seizure recurrence may lead to
ongoing neuropsychiatric symptoms and reduced quality of life.