[Psychopathology in medically refractory partial seizures]

Area of Science:

• Neurology
• Psychiatry
• Epileptology

Context:

• Psychiatric comorbidities are prevalent in medically refractory epilepsy.
• Understanding these comorbidities is essential for optimizing outcomes in epilepsy surgery.
• Current knowledge is based on descriptive classifications and prospective evaluations.

Purpose:

• To review the psychiatric status of patients undergoing evaluation for resective epilepsy surgery.
• To highlight the challenges and needs in managing psychiatric conditions in this population.
• To advocate for the integration of psychiatric expertise in presurgical teams.

Summary:

• Three categories of psychiatric comorbidities are observed: postictal syndromes, interictal disorders (depression, anxiety, psychosis), and adverse events from antiepileptic drugs.
• Depression is the most common interictal psychiatric disorder.
• There is a lack of published guidelines for managing these psychiatric issues.

Impact:

• Improved identification and management of psychiatric comorbidities can enhance surgical outcomes.
• There is a need for prospective trials to better understand psychiatric status in presurgical evaluations.
• Integrating psychiatrists into presurgical teams is recommended for comprehensive patient care.