De Novo Psychosis After Epilepsy Surgery: A 12-Year Single Institution Case-Control Study
Abstract number :
3.447
Submission category :
9. Surgery / 9C. All Ages
Year :
2022
Submission ID :
2233008
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:29 AM
Authors :
Sarah Thomas, MD, MS – University of Kentucky; Timothy Ainger, PhD – Clinical neuropsychologist, Assistant Professor, Department of Neurology, University of Kentucky; Sally Mathias, MD – Assistant Professor, Department of Neurology, University of Kentucky; Meriem Bensalem-Owen, MD, FACNS, FANA – Director of Epilepsy Program, Department of Neurology, University of Kentucky; Farhan Mirza, MD – Director of Epilepsy Surgery, Department of Neurosurgery, University of Kentucky
This is a Late Breaking abstract
Rationale: The intersection of psychiatric disorders and epilepsy has been of interest since the late 1800s. Multiple observational studies characterizing psychiatric outcomes of epilepsy surgery have revealed the alarming possibility of post-operative psychiatric deterioration with cases of de novo psychosis being especially bewildering.1 Effort has gone into elucidating and determining risk factors associated with this phenomenon. This study is the first to analyze neuropsychological data in these patients in the interest of identifying risk factors in the pre-operative setting.
Methods: Under IRB approval, we retrospectively reviewed our refractory epilepsy surgery database (2010 - 2021) for patients with post-operative psychotic events. Controls were age matched within 7 years. Standardized scores for neuropsychological tests were compared using the Wilcoxon rank sum test. Categorical variables were reported using percentages and continuous data was reported using medians and interquartile ranges [median (IQR)].
Results: Post-operative psychosis was identified in 5 patients (3 F, 2 M, age 41 (25.5) yrs, epilepsy duration (ED) 15 (22.3) yrs, 60% with anxiety/depression, 60% Engel I, follow-up (FU) 3.1 (4.1) yrs). Age matching allowed for a 4:1 ratio totaling 20 controls (14 F, 6 M, age 43 (29.5) yrs, ED 9.5 (33.5) yrs, 30% with anxiety/depression, 40% Engel I, FU 2.7 (1.5) yrs). There was a significant difference between groups when it came to estimated premorbid intellectual ability [78.0 (8.5), controls 92.0 (12.0), p< 0.01], general verbal learning [70.0 (14.6), controls 88.0 (21.0), p< 0.01], verbal long delay recall [55.0 (3.8), controls 81.5 (22.5), p< 0.01], verbal recognition [71.5 (13.0), controls 93.0 (28.5), p=0.02], general visual learning [55.0 (6.0), controls 81.5 (36.0), p=0.04], visual long delay recall [55.0 (6.0), controls 84.0 (41.5), p=0.03], language comprehension [70.0 (9.4), controls 92.0 (17.0), p=0.02], and visuospatial judgement/reasoning [67.0 (4.5), controls 96.0 (29.5), p=0.04]. No significant difference between groups for age at surgery, epilepsy duration, or post-operative follow-up duration.
Surgery