Neuropsychiatric Symptoms of Epilepsy

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G. Rayner and S.J. Wilson
delineate the prevalence and severity of psychiatric conditions occurring in the context
of epilepsy surgery, and to identify specific predictors of psychiatric outcome
after epilepsy surgery. In particular, despite the prevalence and day-to-day impact of
anxiety in people with epilepsy [ 121 ], the current literature review illustrates that
anxiety attracts relatively scant research attention (Table 17.1 ) and further research
into the course of anxiety both before and after epilepsy surgery is warranted.
The provision of personalized medicine in epilepsy would greatly benefit from
predictive modeling of postsurgery outcomes, including psychiatric risk for different
disorders and their clinical subtypes , rather than for heterogeneous cohorts of broadly
similar patients [ 9 , 59 ]. This could improve precision in how patients are grouped in
behavioral, genetic, or neuroimaging studies and should help prevent the effects of
smaller subgroups from being “washed out” in larger heterogeneous samples.
The neurobiological aspects of postsurgery rehabilitation also warrant more
careful delineation. First, behavioral and neuroimaging studies could throw more
light onto the neurocognitive and affective networks underscoring psychiatric disturbance
after epilepsy surgery. Longitudinal studies could relate patterns of cortical
activation before and after surgery to out-of-scanner measures of cognition and
mood to assess the neurobiological basis of any changes in the patient’s neuropsychiatric
status, and how this might vary in differing subtypes of patients. Such
approaches provide a mean of identifying biomarkers of neuropsychiatric outcome,
which, in turn, would enhance prognostic counseling and the provision of optimal
treatment for patients undergoing epilepsy surgery. Although challenging to achieve,
improved treatment of neuropsychiatric symptoms would increase the likelihood of
seizure freedom and maximize the considerable psychosocial benefits afforded by
epilepsy surgery.
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