Psychiatric and neuropsychological problems in epilepsy surgery: analysis of 100 cases that underwent surgery.

Purpose: For the past 20 years (1978-1997), a series of 100 cases of uncontrolled epilepsy had surgery in our department under the stated standard for surgical indications and were followed up for 2-22 years after surgery.

Methods: We evaluated 70 cases of temporal lobectomy, 20 cases of neocortical focal resection, and 10 cases of corpus callosotomy.

Results: Analysis of postoperative seizure control showed that 78 cases were class 1 or 2 (no or rare seizures), 14 cases were class 3 (worthwhile improvement), and eight cases were class 4 (no improvement). As generally accepted, temporal lobectomy was the most effective operative procedure, yielding excellent or good results in 87% of the 70 cases so treated. Among the nine cases in whom various psychiatric symptoms developed after surgery, four cases showed neurotic and five cases psychotic symptoms. Patients with psychosis had delusions of various types as a core symptom, combined with other symptoms such as anxiety, irritability, aggression, and depressive state. In two patients with psychosis who had episodes of delusions in the interictal phase before surgery, the symptoms were extremely resistant. The full IQ score of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) was increased after temporal lobectomy in 75% of the cases (p < 0.01; n = 44). The general MQ score in 31 cases, however, showed a 50:50 split between increase and decrease postoperatively. In correlation with the dominance of language by the Wada test, the general MQ score in the 15 cases of nondominant temporal lobe resection showed a significant increase (p < 0.05); whereas the MQ in the 16 cases of dominant-side operation did not change.

Conclusions: Our new test, in which hippocampal stimulation and supraspan learning are combined, seems to be efficient for estimating the postoperative outcome of memory function.