Surgical treatment for epilepsy can be a very distressing emotional experience. Surgery is often the last hope for seizure control for people who have tried many AEDs. In carefully selected candidates, it has a good chance of success, though it doesn't stop seizures in everyone. The emotional burden of desperation, worry and anger about epilepsy and the hope of a cure can be huge. Emotions will change significantly after the operation too, depending on whether seizures are reduced or not.

Dr Meldolesi and colleagues from Pozzilli and Rome, carried out a study looking into the emotional changes associated with having surgery for epilepsy. Fifty-two patients completed a range of quality of life questionnaires looking at their emotions about their surgery, recovery afterwards and any continuing seizures. To monitor how these changed over time, patients completed the questionnaires before surgery, and then again one year and then two years after the operation.

In general, patients reported becoming steadily less introverted (more outgoing socially) and less irritable after the operation. Anxiety decreased gradually but significantly over the two years after the operation. Anger remained almost at pre-surgery levels over the first year but did fall after that. Younger patients, and those who had had epilepsy for fewer years had larger decreases in anger scores than others. Depression rates on average also fell gradually, but not remarkably.

The patients who showed the greatest decreases in anger, anxiety and depression scores tended to be those who reported the greatest increases in quality of life scores, as they reported increased satisfaction with income, work capacity and personal relationships.

This study shows that emotional distress associated with seizures and epilepsy surgery decreases only slowly after the operation. This is interesting because it suggests that some patients find it hard to adapt psychologically from considering themselves "ill" to considering themselves "well". Because it can take a while for it to become clear that the surgery has worked (usually a year before a conclusion can be reached), some patients expecting quick major improvements in life quality are disappointed at the results, thus causing more anger and frustration. If the surgery is not successful and seizures continue then we would expect some anger and anxiety to remain.

The authors suggest in their article in the journal Epilepsy Research that some counselling after surgery, even for those patients whose surgery appears to be completely successful, will probably be useful. The findings also confirm that having surgery earlier rather than later leads to better outcomes.

All patients in this study had had surgery to control temporal lobe epilepsy which had not responded to AEDs. Surgery was generally highly successful for patients in this study, with 89% free of seizures (though some still might have auras) two years after the operation.