Objective: This study explored the association between long-term epilepsy surgery outcome and changes in depressive symptoms. Methods: Adults were enrolled between 1996 and 2001 in a multicenter prospective study to evaluate outcomes of resective epilepsy surgery. The extent of depressive symptoms and depression case status (none, mild, or moderate/severe) were assessed using the Beck Depression Inventory (BDI) preoperatively and 3, 12, 24, 48, and 60 months postoperatively. A mixed-model repeated-measures analysis was performed, adjusting for covariates of seizure location, gender, age, race, education, and seizure control. Results: Of the total 373 subjects, 256 were evaluated at baseline and 5 years after surgery. At baseline, 164 (64.1%) were not depressed, 34 (13.3%) were mildly depressed, and 58 (22.7%) had moderate to severe depression. After 5 years, 198 (77.3%) were not depressed, 20 (7.8%) were mildly depressed, and 38 (14.8%) were moderately to severely depressed. Five years after surgery, the reduction in mean change from baseline in BDI score was greater in subjects with excellent seizure control than in the fair and poor seizure control groups (p = 0.0006 and p = 0.02 respectively). Those with good seizure control had a greater reduction in BDI score than the poor seizure control group (p = 0.02) and borderline significant reduction compared with the fair seizure control group (p = 0.055). Conclusion: Although study participants had initial improvement in depressive symptoms, on average, after resective surgery, only patients with good or excellent seizure control had sustained long-term improvement in mood.
Bibliographical noteFunding Information:
Dr. Hamid serves as Managing Editor of the Journal of Muslim Mental Health and receives research support from the National EpiFellows Foundation and the Epilepsy Foundation. Dr. Liu and Dr. Cong report no disclosures. Dr. Devinsky served on a speaker's bureau for and has received speaker honoraria from UCB; has served as a consultant for Medivation, Inc.; serves as an Associate Editor of Epilepsy and Behavior and Co-Editor of Reviews in Neurological Diseases ; receives royalties from the publication of Cognitive and Behavioral Neurology (Oxford University Press, 2002); and receives research support from the NIH/NINDS. Dr. Berg receives research support from the NIH/NINDS; has received funding for travel and speaker honoraria from Eisai Inc., the British Pediatric Neurological Association1, and the Epilepsy Research Center (Melbourne); has received funding for travel from UCB, the American Epilepsy Society, and the International League Against Epilepsy; has received awards from the American Epilepsy Society and British Pediatric Neurological Association; has served as a consultant for Dow Agro Science; serves on the editorial boards of Epileptic Disorders and Epilepsy & Behavior ; and is past Chair of the ILAE's Commission on Classification and Terminology, current Chair of the ILAE's Task Force on Classification-Diagnostic Manual, member of the ILAE's Pediatric Commission's Task Force on Autism, member of the AES's Commission on Nonepileptic Seizures, member ad hoc Task Force of the ILAE Commission on Therapeutic Strategies, member of the AES Suicidality Task Force, and steward for the NINDS Benchmarks in Epilepsy Research. Dr. Vickrey serves on scientific advisory boards for the Sports Concussion Institute, National Multiple Sclerosis Society, and the NIH; has received funding for travel from the French National Foundation on Alzheimer's Disease and Related Disorders and the NIH; serves on the editorial boards of Neurorehabilitation and Neural Repair, Journal of Medical Economics , and Circulation: Cardiovascular Quality and Outcomes ; serves as a consultant for EMD Serono, Inc. and the Research Triangle Institute; serves as a National Advisory Neurological Disorders and Stroke council member; and receives research support from Genentech, Inc., the NIH (NIA, NINDS), the US Veterans Administration Health Services Research and Development Service, the California Office of Statewide Health Planning and Development, the California Department of Public Health, the State of California Department of Health Services, University of Pennsylvania Udall Center, the American Heart Association, the National Multiple Sclerosis Society, and SCAN Foundation. Dr. Sperling serves on scientific advisory boards for UCB and Vertex Pharmaceuticals; has received speaker honoraria from UCB; serves as an Associate Editor for Epilepsia ; serves as a consultant for Sunovion Pharmaceuticals Inc.; served on speakers' bureaus for UCB and Pfizer Inc; and receives research support from UCB, Marinus Pharmaceuticals, Inc., Sunovion Pharmaceuticals Inc., Eisai Inc., Novartis, Lundbeck Inc., Vertex Pharmaceuticals, NeuroPace, Inc., Medtronics, Inc., Sepracor Inc., and the NIH. Dr. Shinnar has served on scientific advisory boards for Questcor, King Pharmaceuticals, and Sunovion Pharmaceuticals Inc.; serves on the editorial board of Pediatric Neurology ; receives royalties from publication of Febrile Seizures (Academic Press, 2002); serves as a consultant for Questcor and Eisai Inc.; serves on speakers' bureaus for Questcor, UCB, and Eisai Inc.; and receives research support from the NIH/NINDS. Dr. Langfitt serves as an Associate Editor for Epilepsia and for the Journal of the International Neuropsychological Society and has received research support from the NIH/NINDS. Dr. Walczak reports no disclosures. Dr. Barr serves as an Associate Editor of The Clinical Neuropsychologist and Neuropsychology Review and on the editorial boards of Neuropsychology, Archives of Clinical Neuropsychology , and Assessment ; serves as a consultant for the Brainscope Company; is President Elect of Division 40 (Clinical Neuropsychology) of the American Psychological Association; and receives research support from Finding a Cure for Epilepsy and Seizures (FACES). Dr. Dziura serves on data safety monitoring boards for MannKind Corporation and Chelsea Therapeutics. Dr. Bazil serves on the editorial boards of Current Neurology and Neuroscience Reviews and The Medical Letter ; has received speaker honoraria from Pfizer Inc; serves as a consultant for Pfizer Inc and UCB; and receives research support from Sepracor Inc. and Pfizer Inc. Dr. Spencer is deceased; disclosures are not included for this author.