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Iurina E, Bailles E, Carreño M, Donaire A, Rumià J, Boget T, Bargalló N, Setoain X, Roldan P, Conde-Blanco E, Centeno M, Pintor L. Personality changes in patients suffering from drug-resistant epilepsy after surgical treatment: a 1-year follow-up study. Epilepsy Res 2021; 177:106784. [PMID: 34688182 DOI: 10.1016/j.eplepsyres.2021.106784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine changes in dimensions of personality in a sample of patients suffering from drug-resistant epilepsy at the 1-year follow-up following surgery, compared to non-surgically treated controls. METHODS We conducted a prospective comparative controlled study, including drug-resistant epilepsy surgery candidates. Demographic, psychiatric, neurological, and psychological data were recorded. Presurgical and 12-months follow-up evaluations were performed. Personality dimensions were measured by the NEO Five-Factor Inventory, Revised version (NEO-FFI-R), anxiety and depression symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS: HADA-Anxiety and HADD-Depression), psychiatric evaluations were performed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Axis-I disorders classification. Statistical analysis consisted of comparative tests, correlation analysis, and the stepwise multiple regression test (ANOVA). RESULTS A 1-year follow-up was completed by 70 out of 80 patients. Through the study, the surgical group decreased in neuroticism and increased in agreeableness. The controls increased in consciousness, and these changes were predicted by the earlier age of epilepsy onset and lesser score in HADD at the baseline. No personality changes were associated with seizure frequency. The presurgical evaluation concluded that both groups had no differences in demographic, psychiatric, or neurological variables with the only exception being for the number of seizures per month, which was higher in the surgical group. Psychiatric comorbidity in patients was associated with their higher degree of neuroticism and agreeableness at the baseline. Comparing control and surgical groups at the one-year follow-up, the agreeableness personality variable was higher in the surgical group, and as expected, HADS scores were higher in the control group, and seizure frequency was also higher in the control group. SIGNIFICANCE Higher agreeableness was the most relevant difference in personality dimensions in patients who underwent surgical treatment compared with the non-surgical treatment group. After surgery patients decreased in neuroticism and increased in agreeableness scores.
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Affiliation(s)
- Elena Iurina
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona (UAB), Barcelona, 08007, Spain.
| | - Eva Bailles
- Mental Health Service, Nostra Senyora de Meritxell Hospital, Andorra
| | - Mar Carreño
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Antonio Donaire
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Jordi Rumià
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Teresa Boget
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Núria Bargalló
- Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Xavier Setoain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Imaging Group, Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 08034, Barcelona, Spain
| | - Pedro Roldan
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Estefanía Conde-Blanco
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - María Centeno
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Luis Pintor
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Department of Medicine, University of Barcelona (UB), 08036, Barcelona, Spain
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Moncrief GG, Aita SL, Tyson BT, Abecassis M, Roth RM, Caller TA, Schmidt SS, Jobst BC. Self-rated executive dysfunction in adults with epilepsy and effects of a cognitive-behavioral intervention (HOBSCOTCH). Epilepsy Behav 2021; 121:108042. [PMID: 34058488 DOI: 10.1016/j.yebeh.2021.108042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
RATIONALE Cognitive problems are common in adults with epilepsy and significantly affect their quality of life. HOBSCOTCH (HOme Based Self-management and COgnitive Training CHanges lives) was developed to teach problem-solving and compensatory memory strategies to these individuals. This study examined whether HOBSCOTCH is associated with improvement in specific aspects of subjective executive functions. METHODS Fifty-one adults, age 18-65, with epilepsy and subjective cognitive concerns were randomized to receive HOBSCOTCH (n = 31) or a care-as-usual control sample (n = 20). Participants completed the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A), as well as the Patient Health Questionnaire-9 (PHQ-9) to assess depression. Rates of elevated (i.e., T ≥ 65, impaired) BRIEF-A scores at baseline, as well as pre-post score changes for the BRIEF-A clinical scales were evaluated. Significance was set at α = 0.05, one-tailed, given our directional hypothesis. RESULTS At baseline, a considerable percentage of patients in the overall sample endorsed executive dysfunction on BRIEF-A scales: Inhibit = 28%, Shift = 51%, Emotional Control = 45%, Self-Monitor = 33%, Initiate = 35%, Working Memory = 88%, Plan/Organize = 45%, Task Monitor = 47%, Organization of Materials = 28%. Significant improvement was seen in mean T-scores for Inhibit, Shift, Initiate, and Working Memory in the treatment group, but only Working Memory improved in the control group. The control group endorsed worse task monitoring and organization of materials at baseline and follow-up. Change in depression was not observed for either group, and there was no association between changes in depression and BRIEF-A scores. CONCLUSIONS A sizeable subset of adults with epilepsy reported experiencing executive dysfunction in their everyday lives, especially for working memory. HOBSCOTCH resulted in amelioration of subjective executive functioning independent of changes in mood.
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Affiliation(s)
- Grant G Moncrief
- Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
| | - Stephen L Aita
- Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Brad T Tyson
- EvergreenHealth Neuroscience Institute, EvergreenHealth Medical Center, Kirkland, WA, United States
| | - Maurissa Abecassis
- Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Robert M Roth
- Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Tracie A Caller
- Cheyenne Regional Medical Center, Cheyenne, WY, United States; Department of Neurology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Samantha S Schmidt
- Department of Neurology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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Personality changes in patients with refractory epilepsy after surgical treatment: A systematic review. Seizure 2021; 85:95-101. [PMID: 33453594 DOI: 10.1016/j.seizure.2020.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/01/2020] [Accepted: 12/31/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE We aimed to conduct a systematic review to evaluate the personality changes in adult patients with drug-resistant epilepsy following surgical treatment. METHODS A systematic review was conducted using the Preferred Reporting Items of Systematic Reviews and MetaAnalyses (PRISMA) statement. We searched PubMed, Medline databases, and the Cochrane Controlled Trials Register, with search terms 'personality', 'epilepsy', and 'surgery'. RESULTS Eleven studies were selected. In 7 out of 11 studies, personality changes were more adaptive, with patients experiencing decreased neuroticism, impulsivity, hypochondriasis, psychasthenia. One study showed increased emotional lability. The remainder of the studies showed no changes in personality dimensions. Changes in personality differed according to the localization of the epileptogenic area, depended on seizure status after treatment and duration of follow-up. Seizure freedom as an outcome of surgical treatment influenced the existence of personality changes, and their severity. Adaptive personality changes could be seen from early follow-up assessments even in patients who were not seizure-free, though further follow-ups showed that improvements after 1-2 years were specific to seizure-free patients. LIMITATIONS The main limitation of our research is the heterogeneity of approaches used to evaluate personality in the included studies. Furthermore, the included studies also had different sample sizes and comparison groups, different designs, and different follow-up durations. We only included studies that were written in English. CONCLUSIONS The majority of studies reported changes in personality dimensions in patients suffering from refractory epilepsy.
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