Neuropsychiatric Symptoms of Epilepsy

17 The Role of Epilepsy Surgery
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approximate face-to-face reviews with the treating team. Ideally, the postsurgery
follow-up program should be of sufficient length (i.e., ≥24 months) to allow problems
to appear, with work by Wilson and colleagues [ 59 ] illustrating how the adjustment
process continually evolves over this period.
Patients with a history of psychiatric disorder are especially vulnerable to the
challenges of postoperative life. Moreover, the strong link between seizure recurrence
and the emergence or persistence of psychopathology after surgery indicates
that regular management and review is particularly relevant in patients who experience
seizure recurrence [ 119 ]. A patient displaying signs of comorbid psychopathology
will often warrant pharmacological and/or psychological interventions,
with symptom remission achievable in up 60 % of patients treated with either pharmacotherapy
or cognitive behavior therapy (see [ 120 ] for a review). While some
clinicians may be concerned that psychotropic drugs can lower the seizure threshold,
Blumer et al. [ 22 ] and others [ 92 ] illustrate that postoperative neuropsychiatric
symptoms can be successfully treated with medication without risking seizure
relapse. On the contrary, the evidence described above suggests that failure to treat
psychopathology after epilepsy surgery may heighten the chance of seizure recurrence
and undermine the patient’s psychosocial functioning and quality of life (see
Text Box).
Summary: Clinical Considerations
• Ideally, all patients considered for epilepsy surgery should have access to
formal pre- and postsurgery psychosocial counseling.
• Before surgery, patient and family expectations of surgery should be canvassed
and psychoeducation provided to reframe unrealistic hopes for surgery;
patients should also be prepared for the postsurgical adjustment
process.
• Preexisting psychiatric conditions should be stabilized with medical or
psychological treatment before proceeding to surgery.
• After surgery, patient rehabilitation should be provided by specialized clinicians,
such as (neuro)psychologists, psychiatrists, and epilepsy nurse
clinicians.
• Ideally, all patients should be regularly monitored for at least 2 years for
the emergence of de novo or dormant psychopathology, and prompt treatment
provided.
Implications for Future Research
Despite the impact of psychiatric comorbidity described by patients and caregivers
surrounding epilepsy surgery, Cleary et al. [ 63 ] estimate that less than 3 % of outcome
studies have investigated the psychiatric comorbidity of surgery. Urgently
warranted are more prospective, experimentally controlled studies to better