Psychiatric symptoms and comorbidities in patients with drug-resistant epilepsy in presurgical assessment-A prospective explorative single center study

Fabian Friedrich; Ekaterina Pataraia; Susanne Aull-Watschinger; Sonja Zehetmayer; Lisbeth Weitensfelder; Clara Watschinger; Nilufar Mossaheb

doi:10.3389/fpsyt.2022.966721

Psychiatric symptoms and comorbidities in patients with drug-resistant epilepsy in presurgical assessment-A prospective explorative single center study

Front Psychiatry. 2022 Oct 6:13:966721. doi: 10.3389/fpsyt.2022.966721. eCollection 2022.

Authors

Fabian Friedrich¹, Ekaterina Pataraia², Susanne Aull-Watschinger², Sonja Zehetmayer³, Lisbeth Weitensfelder⁴, Clara Watschinger², Nilufar Mossaheb¹

Affiliations

¹ Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
² Department of Neurology, Medical University of Vienna, Vienna, Austria.
³ Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
⁴ Center for Public Health, Department of Environmental Health, Medical University of Vienna, Vienna, Austria.

Abstract

Introduction: People with epilepsy (PWE) have a higher prevalence of psychiatric disorders. Some individuals with drug-resistant epilepsy might benefit from surgical interventions. The aim of this study was to perform an assessment of psychiatric comorbidities with a follow-up period of 12 months in patients with drug-resistant epilepsy, comparing those who underwent surgery to those who did not.

Material and methods: We assessed psychiatric comorbidities at baseline, after 4 months and after 12 months. Psychiatric symptoms and diagnoses were assessed using SCID-Interview, Hamilton Rating Scale for Depression, Beck-Depression Inventory, Hamilton Anxiety Rating Scale, Prodromal-Questionnaire and the Global Assessment of Functioning Scale.

Results: Twenty-five patients were included in the study, 12 underwent surgery, 11 were esteemed as being neurologically unqualified for surgery and two refused surgery. Patients in the no-surgery group were significantly older, reported more substance use, had significantly higher levels of anxiety and were more often diagnosed with a personality disorder. Age and levels of anxiety were significant predictors of being in the surgery or the no-surgery group. The described differences between surgery and no-surgery patients did not change significantly over the follow-up period.

Discussion: These data point toward a higher expression of baseline psychiatric symptoms in drug-resistant PWE without surgery. Further studies are warranted to further elucidate these findings and to clarify potential psychotropic effects of epilepsy itself, drug-resistant epilepsy and of epilepsy surgery and their impact on psychopathology. Clinically, it seems highly relevant to include psychiatrists in an interdisciplinary state-of-the-art perioperative management of drug-resistant PWE.

Keywords: drug-resistant epilepsy; epilepsy; neuropsychiatry; neurosurgery; psychiatric comorbidity; psychopathology.