Neuropsychiatric Symptoms of Epilepsy

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G. Rayner and S.J. Wilson
comply with treatment and to provide fully informed consent for an elective procedure
by weighing the risks of surgery against its potential therapeutic benefits [ 84 ,
117 ]. Psychosocial and neuropsychiatric issues identified in the presurgical evaluation
require discussion by the treating team to determine the patient’s suitability for
epilepsy surgery, and what, if any treatment or support needs to be put into place
before surgery.
Does Treating Neurobehavioral Disorder Improve Seizure Outcome
After Surgery?
The impact of epilepsy surgery on psychopathology is tied to the recurrence
of seizures after surgery. Namely, patients who are most likely to enjoy good
seizure control after surgery are those with lower levels of psychopathology
before and after the operation. This appears to be a bidirectional relationship.
Preexisting neuropsychiatric symptoms such as anxiety, depression, and
mania may significantly lower a patients’ chance of achieving seizure freedom
or improvement after surgery ([ 26 , 29 , 53 , 62 , 70 , 109 ]; but see [ 44 ] for
a null finding). Conversely, recurrent seizures after surgery are linked to the
emergence, persistence, and exacerbation of psychopathology in the postoperative
period [ 62 , 70 , 118 ]. The remission of psychiatric symptoms and disorders
after surgery is associated with the complete absence of seizures
following the procedure ([ 22 , 33 , 47 , 49 ]; although see [ 17 ] for a null finding).
Together, these findings make a compelling case for the prompt identification
and treatment of neuropsychiatric symptoms both before and after epilepsy
surgery, to maximize an individual’s chances of achieving good seizure control
and improved quality of life.
After Surgery
After surgery, even psychologically resilient patients may find the rehabilitation
process challenging, and thus ideally, professional support should be offered to all
candidates during the postoperative period [ 113 ]. Where possible, follow-up monitoring
should include regular (i.e., 3–6 monthly) multidisciplinary reviews with
both patients and their family members. The focus throughout the rehabilitation
period is to canvass patient adjustment to life after surgery in the context of seizure
outcome, including identification of adjustment difficulties, such as features of the
burden of normality. This provides patients and their families with tailored counseling
and where indicated, formal treatment. Wilson et al. [ 59 ] noted that liaison with
members of the patient’s broader social community is also useful, particularly
employers and vocational services to ensure that a carefully graded return to work
is enabled. For geographically isolated patients, a dedicated epilepsy nurse clinician
or other such specialist is essential for providing regular telephone monitoring and
support, with the advent of telemedicine providing a novel opportunity to