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Temporal Lobe Epilepsy, Temporal Lobectomy, and Major Depression

Received December 22, 1998; revised May 3, 1999; accepted May 20, 1999. From the UCLA Department of Psychiatry and Biobehavioral Sciences; West Los Angeles VA Medical Center Psychiatry Service; and UCLA Departments of Neurology, Public Health, and Neurosurgery, Los Angeles, California. Address correspondence to Dr. Altshuler, UCLA Department of Psychiatry and Biobehavioral Sciences, Mood Disorders Research Program, 300 UCLA Medical Plaza, Suite 1544, Los Angeles, CA 90095–7057

Sixty-two patients with medically intractable complex partial seizures who had either surgical or no surgical intervention were followed up at a mean of 10.9 years after surgery or initial evaluation. Of the 49 surgical patients, 45% had a lifetime history of depression, versus 15% of the 13 patients in the nonsurgical comparison group. In the surgical group, 77% had prior history of depression; of these, 47% experienced no further episodes after surgery. Depression occurred de novo after lobectomy in 5 surgical patients (~10%) , 4 developing depression within 1 year. Presurgical presence of depressive episodes predicted continued postoperative depressive episodes. The significantly higher depression rate in patients with temporal lobe seizure foci suggests limbic system dysfunction in the increased risk for depression. Postsurgical resolution of episodes in almost 50% of these patients supports the tenet that depression per se is not a contraindication for surgery in patients with intractable seizures.

Key Words: Depression • Epilepsy • Temporal Lobe

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