SAN DIEGO – A presurgical history of depression appears to predict the persistence of auras after an anterotemporal lobectomy in which patients became free of disabling seizures, Dr. Andres M. Kanner reported during a poster session at the annual meetings of the American Epilepsy Society and the Canadian League Against Epilepsy.
While the cause of the association remains unclear, one hypothesis is that the aura “may be an expression of epileptogenic activity in the insula, because sometimes the insula can be a culprit in the generation of the aura in patients with temporal lobe epilepsy,” said Dr. Kanner, associate director of epilepsy and clinical neurophysiology at Rush University Medical Center, Chicago. “It opens up a lot of questions that I don't have answers for.”
He and his associates studied 58 men and 39 women (mean age of 31 years) who underwent an anterotemporal lobectomy at the Rush Epilepsy Center. Of the 97 patients, 60 had mesial temporal sclerosis, 18 had lesional temporal lobe epilepsy, and 19 had idiopathic temporal lobe epilepsy.
All patients had undergone presurgical psychiatric evaluation and had a mean postsurgical follow-up time of 7 years.
Dr. Kanner reported that of the 97 patients, 37 (38%) were free of any disabling seizures and auras since having their surgery, while 43 patients (44%) were free of disabling seizures but had auras. Nearly half of the patients (47) had a lifetime history of depression.
Logistic regression analysis revealed the absence of a lifetime history of depression as the only variable that predicted a seizure-free outcome without auras.
“There is a bidirectional relationship between depression and epilepsy that has been pretty well recognized,” Dr. Kanner said. “If you have a history of epilepsy you are more likely to be at risk for depression, and if you have a history of depression you have a four- to seven-times greater risk of developing epilepsy.”