ReviewPredicting and preventing psychopathology following temporal lobe epilepsy surgery

Less than 3% of temporal lobe epilepsy (TLE) surgical outcome studies have investigated the psychiatric sequelae and morbidity associated with surgery. This is disproportionate to the extent of the problem. Variable prevalence rates have been reported for post-surgical depression, anxiety, and interictal psychosis. Until recently, very few studies distinguished de novo postoperative presentations from pre-existing conditions, making it difficult to accurately assess the impact of TLE surgery on psychiatric morbidity. Predictors of de novo postoperative presentations have proved elusive. This current review summarizes the findings from a systematic literature review of the psychiatric morbidity associated with TLE surgery including newly published follow-up data from our own series of 280 surgical patients. A framework for future research, possible pathophysiological mechanisms, and translational models are also discussed.This article is part of a Special Issue entitled “The Future of Translational Epilepsy Research”.

► We review the literature regarding the psychiatric sequelae following TLE surgery. ► Predictors of de novo psychiatric conditions are limited. ► We discuss possible pathophysiological mechanisms for post-surgical psychopathology. ► We report our retrospective Queen Square Series (Cleary, Thompson, Fox, Foong).