Wyniki neuropsychiatryczne po operacji epilepsji: przegląd systematyczny i metaanaliza depresji, psychozy, funkcji poznawczych i przystosowania społecznego

OBJECTIVE: To systematically evaluate neuropsychiatric outcomes-depression, anxiety, psychosis, cognition, quality of life, and psychosocial adjustment-following epilepsy surgery in adults, and to quantify pooled effect sizes. METHODS: We searched MEDLINE, Embase, PsycINFO, and the Cochrane Library from inception through December 2024, Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020). Eligible cohort studies (prospective or retrospective) reported standardized neuropsychiatric outcomes in adults undergoing epilepsy surgery with ≥3 month follow-up. Random-effects meta-analyses (DerSimonian-Laird) pooled continuous outcomes as Hedges' g and dichotomous outcomes as proportions (Freeman-Tukey transformation). Heterogeneity (I) was explored via pre-specified subgroups by seizure outcome, follow-up (<2 vs ≥2 years), and instrument. Publication bias was assessed by funnel plots and Egger's and Begg's tests, and risk of bias by the Newcastle-Ottawa Scale. RESULTS: Forty-two studies (n = 6218) met the inclusion criteria; 26 contributed to quantitative meta-analyses. Pooled depression improvement was small-to-moderate (Standardized Mean Difference (SMD) = -.24; 95% confidence interval [CI] -.34 to -.14; k = 12; I = 30.5%), with larger effects in seizure-free patients (-.47; -.65 to -.29) and no significant change with persistent seizures (-.08; -.28 to .12). De novo psychiatric disorders occurred in 16.3% (95% CI: 11.4-21.8%), most commonly depression (9.8%), anxiety (7.1%), and psychosis (2.7%). Epilepsy-related psychoses decreased from 17.5% preoperatively to 4.2% postoperatively. Verbal memory decline occurred in 17%-37% of temporal lobe surgery patients but did not independently affect quality of life when seizure freedom was achieved; 20% of seizure-free left TLE patients demonstrated verbal memory improvement. Quality of life improved continuously over 5 years in seizure-free patients. Neither the Egger's (p = .86) nor Begg's (p = .84) test indicated publication bias. SIGNIFICANCE: Epilepsy surgery produces measurable improvements in depression, psychosis, and quality of life, with seizure freedom as the primary determinant. De novo psychiatric disorders in a substantial minority underscore the need for presurgical screening and longitudinal postoperative monitoring. By integrating evidence across five outcome domains-including psychosocial adjustment, not quantitatively synthesized in prior reviews-this meta-analysis offers a comprehensive framework for informed surgical counseling.