Abstracts

Rationale: Patients with epilepsy from lower socioeconomic status (SES) have higher rates of depression and anxiety. Given evidence that health contexts influence medical outcomes and published data suggesting that preoperative depression may be associated with worse post-surgical outcome, this study aims to establish the relationship between psychiatric status and SES in people with drug resistant epilepsy (DRE) and determine the significance of both in the prediction of post-operative seizure outcome. 

Methods: A prospectively maintained epilepsy surgery database was queried for focal resections performed between 2012 and April 2021; patients were eligible for inclusion when neuropsychological and seizure outcome data was available. The area deprivation index (ADI) was used as a proxy for individual SES. Pre-surgical mood was assessed through the Beck Depression and Beck Anxiety Inventories (BDI and BAI respectively). Multiple regression analyses evaluated patients with any focal resection (temporal or extra-temporal) and the subset of patients receiving temporal lobectomy. BDI, BAI and post-operative seizure outcome measured 12 and 24 months postoperatively and were the dependent variables in the multiple regression analyses. Key clinical epilepsy (presence of tonic/clonic seizures, side of surgery, age at surgery, side effect drug class, duration of illness) and demographic factors (gender, race, housing, education) were included as predictors in the regression models.

Results: 166 patients (mean age = 38.5+12.9 years; males = 92, females = 74) were eligible for inclusion in this study. For all focal resections, ADI showed an association with preoperative BDI (Pearson correlation, .227, p = .003), but added less than 1% of the explanatory variance after accounting for key clinical factors. The model combining ADI with clinical factors predicted preoperative BAI (p = .059) but explained little variance (Adj. R2 = .042). Only the presence of absence of tonic/clonic seizures in the year preceding surgery was significant (beta = .189, p = .019). In the temporal lobectomy subgroup, ADI was the strongest predictor (beta = .34, p = .00) of preoperative BDI, reliably predicting BDI beyond clinical factors (p = .006) and explaining 9.3% of the variance. ADI explained 15.1% of the variance in preoperative BDI on a more complex model (model (F[10,93] = 4.1, p = .00) including clinical and demographic factors. Finally, ADI alone or in combination with either BDI or BAI did not reliably predict surgical outcome at 12 or 24 months.

Conclusions: ADI and depression were modestly associated, as ADI predicted preoperative BDI in the temporal resection group. However, it did not predict anxiety and was not related to surgical outcome. Finally, neither preoperative BDI nor BAI, either alone or when modeled with ADI, were associated with surgical outcome.

Funding: Please list any funding that was received in support of this abstract.: No funding was received in support of this abstract.