Personality disorders as predictors of the postoperative course after epilepsy surgery

The prevalence of personality disorders among patients undergoing epilepsy surgery is high. These patients have a high probability of being at the pathological ends of dimensional personality traits in addition to having changes of behavior resulting from epilepsy-related functional and structural deficits. According to the vulnerabilitystress concept, it is a plausible assumption that the events around epilepsy surgery overload the capacity of stress management of this vulnerable patient group and elicit manifest psychiatric disorders. In fact, personality disorders raise the risk of the necessity of postoperative psychiatric inpatient treatment. Beyond this global prediction, some specific observations have been reported concerning the individual types of personality disorders: obsessive-compulsive disorders after surgery may result from the corresponding personality disorder, postoperative dissociative attacks spring off from borderline personality disorders, de novo psychoses are linked to paranoid (including organic) or avoidant personality disorders. Finally, a possible connection of sudden unexpected death after surgery with the diagnosis of personality disorder is discussed. Given these results it is recommended to carry out a personality assessment prior to epilepsy surgery, to prepare those patients thoroughly with respect to surgery and its sequels, and to accompany them psychiatrically during the peri-and postoperative time period.