Psychiatric changes after stereotactic laser amygdalohippocampotomy for medial temporal lobe epilepsy

Abstract

Purpose: Stereotactic laser amygdalohippocampotomy (SLAH) is a minimally invasive surgical treatment for drug-resistant temporal lobe epilepsy (TLE) that has comparable rates of seizure freedom to traditional open resective TLE surgery. The objective of this study was to determine psychiatric outcome (i.e., depression and anxiety changes, psychosis) after SLAH, to explore possible contributory factors to these changes, and to determine the prevalence of de novo psychopathology.

Methods: We explored mood and anxiety in 37 adult patients with TLE undergoing SLAH using the Beck psychiatric symptoms scales (i.e., Beck Depression Inventory-II [BDI-II] and Beck Anxiety Inventory [BAI]) preoperatively and 6 months following surgery. Multivariable regression analysis was conducted to identify predictors of worse depression or anxiety symptoms following SLAH. The prevalence of de novo psychopathology following SLAH was also determined.

Results: We found a significant decrease in BDI-II (mean decline from 16.3 to 10.9, p = 0.004) and BAI (mean decline from 13.3 to 9.0, p = 0.045) scores following SLAH at the group level. While the rate of resolution of depression (from 62% to 49%) did not achieve statistical significance (p = 0.13, McNemar's), the rate of resolution of anxiety (from 57% to 35%) was statistically significant (p = 0.03, McNemar's). The de novo rate of psychopathology (i.e., new onset depression or anxiety) following SLAH was 1 of 7 (14%). Using a metric of meaningful change rather than complete symptom resolution, 16 of 37 (43%) patients experienced improvement in depression and 6 of 37 (16%) experienced worsening. For anxiety, 14 of 37 (38%) experienced meaningful improvement and 8 of 37 (22%) experienced worsening. Baseline performance on the Beck Scales was the only factor contributing to outcome status.

Discussion: In one of the first studies to evaluate psychiatric outcomes after SLAH, we found promising overall trends toward stability or significant improvement in symptom burden at the group level for both depression and anxiety. There was also a significant improvement in clinical anxiety, though the decrease in clinical depression was not significant, likely owing to the limitations of sample size. SLAH may improve overall psychiatric symptoms, similarly to traditional resective TLE surgery, but de novo psychopathology and postoperative psychiatric morbidity remain significant issues, and larger samples are necessary to determine causal contributory factors.

Keywords: Laser interstitial thermal therapy (LITT); Mental health; Mood; Psychiatric outcome.

Fig. 1.

Pre- and Post-surgical performance on the Beck Depression Inventory-II and the Beck Anxiety Inventory for SLAH patients, highlighting patients who moved from a pathological state to normal or vice versa. Note. A box plot summary is shown for Pre and Post-surgical scales, along with individual data. Patients with complete resolution of symptoms are shown with black solid lines, and patients who experienced new symptomatology are shown with red dashed lines. Patients whose binary classification (i.e., symptomatic or not) remained unchanged are shown with gray dotted lines.

Fig. 2.

Pre- and Post-surgical performance on the Beck Depression Inventory-II and the Beck Anxiety Inventory for SLAH patients, highlighting patients who exhibited clinically meaningful change (whether or not they experienced complete symptom resolution). Note. A box plot summary is shown for Pre and Post-surgical scales, along with individual data. Patients who had a clinically meaningful improvement in symptoms are shown with black solid lines, patients who a clinically meaningful worsening of symptoms are shown with red dashed lines, and patients whose categorization was unchanged are shown with gray dotted lines.