Evaluating depression, anxiety and quality of life before and after surgical treatment for temporal lobe epilepsy

72 7. SUMMARY The incidence of psychiatric disorders is higher in epileptic patients when compared to the general population and other chronic neurological diseases. This rate is much higher in patients with drug resistant temporal lobe epilepsy. Epilepsy causes various difficulties in all areas of life for the individual. Clinical seizure characteristics and especially seizure type, disease duration, seizure frequency and severity have a negative influence on quality of life in addition to the effects of antiepileptic medication. This study evaluated depression, anxiety and quality of life in patients with temporal lobe epilepsy before and after ATL. This may help determining the relation between depression and anxiety in resistant TLE and its association with clinical seizure variables. We felt it may be possible to prevent the negative influence on the quality of life of epileptic patients by using this information. We found a rate of 43.5% for depression and anxiety before surgical treatment. There was no difference for age, sex, age seizures started, presence of risk factors, anti-epileptic drug usage, MRG, EEG, pathology, surgery undertaken, right or left temporal lobe localization, educational status or socioeconomic status between the group with and without depression. The rate of depression and anxiety increased with increased frequency of seizures (pO.OOl and p=0.012 respectively). Depression and anxiety improved markedly following ATL in our cases. This improvement is directly associated with attaining a seizure-free state following surgical treatment (p<0.001). We found a correlation between a decrease in findings of depression and anxiety following surgical treatment (r=0.48 p=0.02).73 We found a marked improvement in all eight subscales of SF36, consisting of physical function, role difficulty (physical and emotional), pain, general health, vitality, social functioning and mental health following surgical treatment when compared with the period before surgery. There was no positive correlation between depression following surgical treatment and any quality of life subscale but there was a negative correlation with the general health and social functioning subscales (r=0.045 p=0.029 and r=0.301 p=0.101 respectively). We determined that the association between BAE and the Social Functioning subscale of SF 36 was due to depression. These results indicate that psychiatric symptoms influence quality of life more than most other epileptic seizure variables. We found in this series that ATL can benefit carefully-chosen drug resistant TLE cases both with an improvement in epileptic seizures and also in the psychopathology. A seizure-free state following surgical treatment is the most powerful predictor of decreased findings of depression and anxiety. It has been shown that quality of life improvement in epileptic patients may be possible with depression and anxiety treatment and that this may be attained by efficient treatment methods such as ATL.