Emotional/Psychiatric Symptom Change and Amygdala Volume After Anterior Temporal Lobectomy

JHN Journal Volume 10 | Issue 1 Article 4 Winter 2015 Emotional/Psychiatric Symptom Change and Amygdala Volume After Anterior Temporal Lobectomy Daniel Moadel, BA Department of Neurological Surgery and Neurology, Thomas Jefferson University, Gaelle Eve Doucet, PhD Department of Neurological Surgery and Neurology, Thomas Jefferson University, Dorian Pustina, PhD Department of Neurological Surgery and Neurology, Thomas Jefferson University, Robert Rider, PhD Department of Neurological Surgery and Neurology, Thomas Jefferson University, Nathan Taylor, BA Department of Neurological Surgery and Neurology, Thomas Jefferson University, See next page for additional authors Follow this and additional works at: https://jdc.jefferson.edu/jhnj Let us know how access to this document benefits you Recommended Citation Moadel, BA, Daniel; Doucet, PhD, Gaelle Eve; Pustina, PhD, Dorian; Rider, PhD, Robert; Taylor, BA, Nathan; Barnett, MS, Paul; Sperling, MD, Michael R.; Sharan MD, Ashwini; and Tracy, PhD, Joseph l. (2015) "Emotional/Psychiatric Symptom Change and Amygdala Volume After Anterior Temporal Lobectomy," JHN Journal: Vol. 10 : Iss. 1 , Article 4. DOI: https://doi.org/10.29046/JHNJ.010.1.003 Available at: https://jdc.jefferson.edu/jhnj/vol10/iss1/4 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in JHN Journal by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: . Emotional/Psychiatric Symptom Change and Amygdala Volume After Anterior Temporal Lobectomy Authors Daniel Moadel, BA; Gaelle Eve Doucet, PhD; Dorian Pustina, PhD; Robert Rider, PhD; Nathan Taylor, BA; Paul Barnett, MS; Michael R. Sperling, MD; Ashwini Sharan MD; and Joseph l. Tracy, PhD This review article is available in JHN Journal: https://jdc.jefferson.edu/jhnj/vol10/iss1/4 Moadel, BA et al.: Emotional/Psychiatric Symptom Change and Amygdala Volume After Anterior Temporal Lobectomy Emotional/Psychiatric Symptom Change and Amygdala Volume After Anterior Temporal Lobectomy Daniel Moadel, BA, Gaelle Doucet, PhD, Dorian Pustina, PhD, Robert Rider, PhD, Nathan Taylor, BA, Paul Barnett, MS, Michael Sperling, MD, Ashwini Sharan, MD, Joseph I. Tracy, PhD Departments of Neurological Surgery and Neurology, Thomas Jefferson University Introduction Patients who undergo anterior temporal lobectomy (ATL) to treat temporal lobe epilepsy (TLE) often experience worsened or de novo psychiatric symptoms. There is evidence to suggest that the pathophysiology of epilepsy and mood disorders are linked both functionally or structurally in the brain.1,2 While several studies have examined the role that changes in hippocampal volume may play in predicting post-surgical depression, the role of the amygdala in such prediction has been overlooked, despite extensive literature demonstrating its contribution to emotion processing and expression. 3,4 The goal of this project was to determine if change in amygdala volume is a predictor of depression and/or anxiety in TLE patients who undergo ATL, with specific attention given to side of surgery. Methods Data was collected from 32 patients who underwent ATLs (19 right, 13 left, matched samples). Pre- and post-surgery Personality Assessment Inventory (PAI) data were collected on 14 ATL patients. The following PAI subscales were utilized in this analysis: Anxiety: PAIANX; Anxiety Related Disorder: PAIARD; Depression: PAIDEP). Volumetric analysis was performed on pre- and post-surgical T1 MRIs using Freesurfer’s longitudinal processing function. Left and right amygdala volumes, change scores, and amygdala asymmetry ratios were calculated taking into account whole brain volume. 55% of the patients were seizurefree after 1 year (RTLE= 8, LTLE= 9); 29% received an Engel Class score of 2 or 3 (RTLE= 7, LTLE= 2) Results The two experimental groups, right TLE and left TLE, showed no significant differences either pre- or post-ATL: age, age of seizure onset, full-scale IQ or amygdala volume or asymmetry (Table 1). Table 1: . Clinical and Demographics Characteristics of each TLE group RTLE LTLE Significant (?) N (female) 18 (12) 13 (10) NS Age (years) 45 ± 12 48 ± 12 NS Years of Education Time between surgery and Second Test (months) Age of seizure onset (years) 15 ± 2 15 ± 3 NS 15.4 ± 24.7 14.7 ± 16.2 NS 21 ± 11 25 ± 14 NS L amygdala volume, pre-/post- surgery 0.18 ± 0.04/0.17 ± 0.04 0.17 ± 0.07/0.03 ± 0.03 NS/0.0 R amygdala volume, pre-/post- surgery 0.19 ± 0.06/0.03 ± 0.05 0.21 ± 0.08/0.17 ± 0.06 NS/0.0 Amygdala Asymmetry 0.03 ± 0.08/-0.73 ± 0.42 0.11 ± 0.06/0.62 ± 0.48 0.005/0.0 PAIANX 57 ± 12/48 ± 6 53 ± 9/59 ± 13 NS/NS PAIARD 53 ± 12/49 ± 12 51 ± 9/60 ± 16 NS/NS PAIDEP 59 ± 11/54 ± 9 51 ± 7/64 ± 18 0.042/NS Psychiatric Scores, pre-/post- surgery All measures are shown as means ± standard deviation. Amygdala volume was calculated as a ratio with total gray matter volume. Amygdala was calculated as the difference between right and left maygdala volume rations over the combined right and left amygdala volume. Group comparisions were examined throug independent sample t-test. Abbreviations: Personality Assessment Inventory measures Anixiety (PAIANX), Anxiety Related Disorders Depression (PAIDEP). 12 Published by Jefferson Digital Commons, 2015 JHN JOURNAL 1 Functional Neurosurgery JHN Journal, Vol. 10 [2015], Iss. 1, Art. 4 Table 2: Post Surgical Psychiatric Scores. Results of regression analyses for PAIDEP, PAIANX, and PAIARD scores to amygdala volume, amygdala volume change, amygdala pre-surgery, and amygdala asymmetry change measurements. Significant results are marked with an asterisk. Model PAIDEP Adj. R2=0.64, F[7,15]=4.7, p=0.02 PAIANX Adj. R2=0.56, F[7,15]=3.7, p=0.04 PAIARD Adj. R2=0.6, F[7,15]=4.2, p=0.03 Stand. b Coef., p-value Stand. b Coef., p-value Stand. b Coef., p-value ATL group -0.24, .0.68 1.2, 0.08 0.57, 0.35 Left AMYG vol, pre-surg. 6.5, 0.008* 4.5, 0.06 5.8, 0.02* Right AMYG vol, pre-surg. -5.9, 0.02* -4.2, 0.08 -5.2, 0.03* Left AMYG vol change -0.46, 0.72 -0.38, 0.79 -1.2, 0.38 Right AMYG vol change 4.4, 0.005* 2.5, 0.08 4.2, 0.009* AMYG asym., pre-surg. 4.7, 0.02 3.2, 0.11 4.1, 0.04* AMYG asym., change -3.9, 0.04* -3.5, 0.08 -5.3, 0.01* Results of regression analyses for PAIDEP, PAIANX, and PAIARD scores to amygdala volume, amygdala volume change, amygdala pre-surgery, and amygdala asymmet (...truncated)