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Cornwell MA, Kohn A, Spat-Lemus J, Bender HA, Koay JM, McLean E, Mandelbaum S, Wing H, Sacks-Zimmerman A. Foundations of Neuropsychology: Collaborative Care in Neurosurgery. World Neurosurg 2023; 170:268-276. [PMID: 36782425 DOI: 10.1016/j.wneu.2022.09.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 02/11/2023]
Abstract
The disciplines of neuropsychology and neurosurgery have a history of partnership that has improved prognoses for patients with neurologic diagnoses that once had poor outcomes. This article outlines the evolution of this relationship and describes the current role that clinical neuropsychology has within a department of neurological surgery across the preoperative, intraoperative, and postoperative stages of treatment. Understanding the foundations of collaboration between neuropsychology and neurosurgery contextualizes present challenges and future innovations for advancing excellence along the continuum of care for all neurosurgical patients.
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Affiliation(s)
- Melinda A Cornwell
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aviva Kohn
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Ferkauf Graduate School of Psychology, Bronx, New York, USA
| | - Jessica Spat-Lemus
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - H Allison Bender
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
| | - Jun Min Koay
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Erin McLean
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Sarah Mandelbaum
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Ferkauf Graduate School of Psychology, Bronx, New York, USA
| | - Hannah Wing
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Fordham University Graduate School of Education, New York, New York, USA
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Pintor L. Temporal Lobectomy: Does It Worsen or Improve Presurgical Psychiatric Disorders? Curr Top Behav Neurosci 2022; 55:307-327. [PMID: 33959938 DOI: 10.1007/7854_2021_224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Temporal lobe epilepsy (TLE) is the type of epilepsy most frequently associated with psychiatric morbidity. Respective surgery for focal epilepsy remains the preferred treatment for medically resistant epilepsy. The aim of this chapter is to review what happens with psychiatric disorders once patients have undergone surgery.Early studies demonstrated a post-surgical increase in the incidence rates of anxiety and depressive disorders, while recent studies found that the prevalence of depression and anxiety decreased 12 months after surgery. In spite of this improvement, de novo anxiety and depressive or psychotic cases can be seen. In particular, de novo psychosis ranges from 1% to 14%, with risk factors including bilateral temporal damage, tumors rather than mesial temporal sclerosis, and seizures emerging after surgery again.Personality changes after temporal lobectomy are yet to be established, but decline in schizotypal behavior and neuroticism is the most replicated so far.In children's studies surgery resolved 16% of the participants' psychiatric problems, while 12% presented a de novo psychiatric diagnosis, but further, more conclusive results are needed.The main limitations of these studies are the inconsistent systematic post-surgical psychiatric evaluations, the small sample sizes of case series, the short follow-up post-surgical periods, and the small number of controlled studies.A psychiatric assessment should be conducted before surgery, and most of all, patients with a psychiatric history should be followed after surgery.
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Consales A, Casciato S, Asioli S, Barba C, Caulo M, Colicchio G, Cossu M, de Palma L, Morano A, Vatti G, Villani F, Zamponi N, Tassi L, Di Gennaro G, Marras CE. The surgical treatment of epilepsy. Neurol Sci 2021; 42:2249-2260. [PMID: 33797619 DOI: 10.1007/s10072-021-05198-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/16/2021] [Indexed: 01/07/2023]
Abstract
In 2009, the Commission for Epilepsy Surgery of the Italian League Against Epilepsy (LICE) conducted an overview about the techniques used for the pre-surgical evaluation and the surgical treatment of epilepsies. The recognition that, in selected cases, surgery can be considered the first-line approach, suggested that the experience gained by the main Italian referral centers should be pooled in order to provide a handy source of reference. In light of the progress made over these past years, some parts of that first report have accordingly been updated. The present revision aims to harmonize the general principles regulating the patient selection and the pre-surgical work-up, as well as to expand the use of epilepsy surgery, that still represents an underutilized resource, regrettably. The objective of this contribution is drawing up a methodological framework within which to integrate the experiences of each group in this complex and dynamic sector of the neurosciences.
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Affiliation(s)
- Alessandro Consales
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Sara Casciato
- Epilepsy Surgery Centre, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Florence, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Luca de Palma
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Giampaolo Vatti
- Department of Neurological and Sensorial Sciences, University of Siena, Siena, Italy
| | - Flavio Villani
- Division of Neurophysiology and Epilepsy Centre, IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Nelia Zamponi
- Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Giancarlo Di Gennaro
- Epilepsy Surgery Centre, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy.
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
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Salpekar J. Psychiatric Residue of Epilepsy Surgery: De Novo or Not. Epilepsy Curr 2019; 19:227-228. [PMID: 31189385 PMCID: PMC6891840 DOI: 10.1177/1535759719854753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Predicting De Novo Psychopathology After Epilepsy Surgery: A 3-Year Cohort Study Novais F, Pestana LC, Loureiro S, Andrea M, Figueira ML, Pimentel J. Epilepsy Behav. 2019;90:204-208. doi:10.1016/j.yebeh.2018.11.037. PMID: 30573340. OBJECTIVE The aim of this study was to determine the potential risk factors for de novo psychiatric syndromes after epilepsy surgery. METHODS Refractory epilepsy surgery candidates were recruited from our Refractory Epilepsy Reference Centre. Psychiatric evaluations were made before surgery and every year, during a 3-year follow-up period. Demographic, psychiatric, and neurological data were recorded. The types of surgeries considered were resective surgery (resection of the epileptogenic zone) and palliative surgery (deep brain stimulation of the anterior nuclei of the thalamus [ANT-DBS]). A survival analysis model was used to determine pre- and postsurgical predictors of de novo psychiatric events after surgery. RESULTS One hundred and six people with refractory epilepsy submitted to epilepsy surgery were included. Sixteen (15%) people developed psychiatric disorders that were never identified before surgery. Multilobar epileptogenic zone (P = .001) and DBS of the ANT-DBS (P = .003) were found to be significant predictors of these events. CONCLUSION People with more generalized epileptogenic activity and those who undergo ANT-DBS seem to present an increased susceptibility for the development of mental disorders, after neurosurgical interventions, for the treatment of refractory epilepsy. People considered to be at higher risk should be submitted to more frequent routine psychiatric assessments."
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Psychosurgery, Epilepsy Surgery, or Surgical Psychiatry: The Tangled Web of Epilepsy and Psychiatry as Revealed by Surgical Outcomes. Epilepsy Curr 2017; 17:351-352. [PMID: 29217975 DOI: 10.5698/1535-7597.17.6.351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Psychiatric symptoms after temporal epilepsy surgery. A one-year follow-up study. Epilepsy Behav 2017; 70:154-160. [PMID: 28427025 DOI: 10.1016/j.yebeh.2017.02.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 11/22/2022]
Abstract
Psychiatric symptoms must be considered in patients with refractory temporal lobe epilepsy after epilepsy surgery. The main objectives of our study were to describe clinical and socio-demographical characteristics of a cohort of patients with pharmacoresistant temporal lobe epilepsy who underwent temporal lobe epilepsy surgery, and moreover, to evaluate possible risk factors for developing psychiatric symptoms. In order to achieve those goals, we conducted a prospective evaluation of psychopathology throughout the first year after surgery in a clinical sample of 72 patients, by means of three clinical rated measures; the Hamilton Anxiety Rating Scale (HARS), the Hamilton Depression Rating Scale (HDRS), and the Brief Psychiatric Rating Scale (BPRS). The psychopathological evaluations were performed by an experienced psychiatrist. A presurgical evaluation was done by a multidisciplinary team (that includes neurologist, psychiatrist, neurosurgeon, neurophysiologist, radiologists, and nuclear medicine specialist) in all patients. The decision to proceed to surgery was taken after a surgical meeting of all members of the Multidisciplinary Epilepsy Unit team. The psychiatrist conducted two postoperative assessments at 6months and 12months after surgery. The main finding was that past history of mental illness (patients who were receiving psychiatric treatment prior to the baseline evaluation) was a risk factor for anxiety, depression, and psychosis after temporal lobe epilepsy surgery.
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Abstract
Mood disorders associated with epilepsy are very common and overrepresented compared with other chronic medical conditions. Depression is a particularly common and worrisome comorbidity, especially because suicidality seems to be increased significantly in the context of epilepsy. Although psychosocial stressors commonly are associated, intrinsic characteristics of seizure disorders may contribute to the expression of depressive symptoms. Depression and epilepsy may exacerbate each other. Epilepsy with seizure foci in the temporal lobe may represent a higher risk of developing depression, especially if the seizures do not generalize. Treatment of depression is multifaceted and includes psychotherapy and sophisticated regimens of anticonvulsants. Most antidepressants may be used safely and effectively in the context of depression, although high-quality evidence is lacking. Ultimately, treatment of comorbid mood disorder has important implications for outcome and quality of life, perhaps even more than treatment of epilepsy itself.
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Affiliation(s)
- Jay Salpekar
- Dr. Salpekar is director of the Neuropsychiatry and Epilepsy Program, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore (e-mail: )
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