Reduction in apathy following epilepsy surgery
Authors Mah L, Swearer J, Phillips CA, Benjamin S
Received 31 January 2019
Accepted for publication 28 May 2019
Published 28 June 2019 Volume 2019:15 Pages 1679—1684
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Roger Pinder
Linda Mah,1–3 Joan Swearer,4 Catherine A Phillips,4 Sheldon Benjamin5
1Rotman Research Institute, Baycrest, Toronto, Canada; 2Department of Psychiatry, Baycrest Health Sciences, Toronto, Canada; 3Department of Psychiatry, Division of Geriatric Psychiatry, University of Toronto, Toronto, Canada; 4Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA; 5Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
Introduction: Surgical treatment for patients with epilepsy who do not respond to antiepileptic medication can lead to changes in behavior, including new onset of neuropsychiatric symptoms such as depression and anxiety. In other cases, neuropsychiatric symptoms present before surgery may be alleviated. Because application of diagnostic criteria for primary psychiatric disorders may not be valid in assessing behavior in epilepsy populations, we sought to determine the feasibility of measuring behaviors associated with frontal-subcortical dysfunction using the Frontal Systems Behavior Scale (FrSBe) in patients who had received surgical intervention for medically refractory epilepsy.
Materials and methods: Twenty-three patients who had previously undergone epilepsy surgery and their family member informants completed the FrSBe. The FrSBe includes separate forms for patients and informants to rate symptoms associated with three frontal lobe syndromes – executive dysfunction, disinhibition, and apathy – prior to and following a neurological condition. Patients and informants were asked to rate frontal lobe behaviors before and after epilepsy surgery using the FrSBe.
Results: Informants rated patients as showing a significantly greater reduction in apathy on the FrSBe compared to either disinhibition or executive dysfunction subscales. A trend in reduction of apathy following right hemisphere resection was found.
Conclusions: Patients who have undergone epilepsy surgery show a reduction in apathy but it is unclear whether this behavioral change is directly related to the surgical intervention. We suggest that these preliminary findings support the utility of implementing dimensional scales such as the FrSBe to study behavioral changes following epilepsy surgery.
Keywords: epilepsy surgery, apathy, frontal lobe, disinhibition, motivation, temporal lobe epilepsy
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