The Concomitant Anxiety and Depression in Patients with Epilepsy Caused by Low-Grade Brain Tumors

The Concomitant Anxiety and Depression in Patients with Epilepsy Caused by Low-Grade Brain Tumors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Concomitant Anxiety and Depression in Patients with Epilepsy Caused by Low-Grade Brain Tumors Sungel Xie, Jiao Qiao, Guoming Luan, Mingxiang Xie, Shunwu Xiao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5212625/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Jan, 2025 Read the published version in Scientific Reports → Version 1 posted 13 You are reading this latest preprint version Abstract Purpose : The aim of the study was to evaluate the concomitant psychiatric disorders of anxiety and depression in patients with epilepsy caused by low-grade brain tumors (LBTs). Methods : We retrospectively reviewed the clinical data of patients who underwent preoperative neuropsychological evaluations of anxiety and depression and subsequent epilepsy surgery for LBTs. The univariate and multivariate analyses were conducted to analyze the risk factors of the occurrence of anxiety and depression. Results : Of the 107 patients included in the study, 42 patients (39.3%) were female and 28 patients (26.2%) were children. The median age at surgery was 22 years (interquartile range [IQR]: 17-27 years old), the median age of seizure onset was 12 years (IQR: 6-18 years old), and the median duration of epilepsy was 84 months (IQR: 42-180 months). In total, 21 patients (19.6%) had presence of anxiety, and 26 patients (24.3%) had presence of depression. In univariate analysis, discordant (vs. concordant) interictal electroencephalogram (EEG) findings were related to presence of anxiety (P = 0.017). Discordant (vs. concordant) ictal EEG findings (P = 0.023), larger zone of epileptic discharges that was represented by surgical resection extent (P = 0.021), temporal (vs. non-temporal) location of tumor (P = 0.009) and lower full-scale intelligence quotient (P = 0.017) were associated with presence of depression. In multivariate analysis, discordant ictal EEG findings (P = 0.015, odds ratio [OR] = 4.44) and temporal location of tumor (P = 0.015, OR = 13.52) had relevance to presence of depression. Conclusion : Psychiatric disorders of anxiety and/or depression could frequently occur in patients with epilepsy caused by LBTs, especially in patients with discordant or wider epileptic discharges and temporal invasion of tumors. Health sciences/Neurology Health sciences/Oncology Health sciences/Risk factors Epilepsy Anxiety Depression Brain tumor Surgery Introduction The comorbidity of psychiatric disorders was frequently reported in patients with epilepsy, and about 20–50% of patients experienced varying degrees of psychiatric disorders that include anxiety, depression, psychotic disorders, cognitive and personality changes [1–4]. Among them, anxiety and depression were found to be the most common psychiatric disorders in patients with epilepsy [5,6]. Low-grade brain tumors (LBTs) were one of the most common epileptogenic etiologies and often met in patients with epilepsy surgery for intractable focal epilepsy [7]. LBTs usually grow slowly and develop in children or adolescents, such as ganglioglioma (GG) and dysembroplastic neuroepithelial tumor (DNT) [8]. Although complete seizure control could be achieved in most of patients with LBTs after surgery, a rather number of patients still had unimproved quality of life, which may be primarily attributed to the concomitant psychiatric disorders [9,10]. However, there are few reports focusing on the psychiatric disorders of patients with epilepsy caused by LBTs, and the mental impairments and related risk factors are still undefined. Therefore, through this retrospective study, we aimed to evaluate the concomitant psychiatric disorders, notably anxiety and depression, and their relevant risk factors in patients with LBTs who underwent epilepsy surgery in our epilepsy treatment center in the past decade. Methods Patient selection Clinical data of patients who underwent neuropsychological evaluations and surgical treatment for LBTs between January 2008 and January 2021 at Sanbo Brain Hospital, Capital Medical University, were retrospectively reviewed. The study was approved by the Sanbo Brain Hospital Ethics Committee of Capital Medical University, and all methods were performed in accordance with relevant guidelines and regulations. Due to the retrospective nature of the study, the ethics committee waived the need of obtaining informed consent. Patients who had epilepsy caused by brain tumors that were pathologically confirmed as low-grade glial or glioneuronal tumors were enrolled in the study; but patients who didn’t accept preoperative psychological evaluations of anxiety and depression, or who didn’t have complete clinical data, were excluded. Finally, a total of 107 consecutive patients were included in the study. Preoperative examination and surgical strategy All patients underwent an individualized preoperative evaluation, including detailed medical history and physical examination, seizure semiology, electrophysiological monitoring of video electroencephalogram (EEG), and brain magnetic resonance imaging (MRI). In particular, the tumor size was represented by the mean maximum tumor diameter on 3-dimensional (axial, sagittal and coronal) T1-weighted MR images. Long-term video EEG monitoring was performed in all patients for at least 16 hours. The concordant EEG findings were defined as the epileptiform spike sources on interictal or ictal video EEG localized in the same brain hemisphere of tumor involvement, when compared to discordant EEG findings for bilateral or diffuse epileptiform spike sources on interictal or ictal video EEG. After detailed preoperative evaluations, potential surgical candidates were discussed at a multidisciplinary epilepsy surgery meeting to determine suitability for surgery, as well as the surgical plans. The aim of the operation was to remove the tumor and the relevant epileptogenic zone (EZ), which was determined by the findings of the detailed preoperative evaluations and/or intraoperative electrocorticography (ECoG). Intraoperatively, neurological electrophysiological monitoring and neuronavigation were also performed for safe tumor resection. In particular, the zone of epileptic discharges was represented by surgical resection extent, which were categorized as simple tumor resection (resection of single tumor) and extensive tumor resection (resection of tumor and perilesional brain tissue) that was confirmed by intraoperative observation and postoperative reexamination of MRI. Neuropsychological evaluation Neuropsychological evaluations were routinely recommended to patients with epilepsy before surgery. Self-Rating Anxiety Scale (SAS) with 20 items of questions or Hamilton Anxiety Scale (HAMA) with 14 items was performed for the evaluation of presence of anxiety in patients [11], and Self-Rating Depression Scale (SDS) with 20 items of questions or Hamilton Depression Scale (HAMD) with 17 items was performed for the evaluation of presence of depression in patients [12,13]. For SAS and SDS, scoring results were seemed as normal ( 70 scores). For HAMA, scoring results were seemed as normal (< 7 scores) and abnormal (≥ 7 scores: potential anxiety, 7–13 scores; definite anxiety, 14–20 scores; significant anxiety, 21–28 scores; and severe anxiety, ≥ 29 scores), and for HAMD, scoring results were seemed as normal (< 7 scores) and abnormal (≥ 7 scores: potential depression, 7–16 scores; definite depression, 17–23 scores; and severe depression, ≥ 24 scores) [14]. In addition, the Wechsler adult intelligence scale (WAIS) and Wechsler intelligence scale for children (WISC), and Wechsler memory scale (WMS) were respectively performed in patients based on different age groups. The full-scale intelligence quotient (FSIQ) and the full-scale memory quotient (FSMQ) were defined as with a deficit in patients when scoring less than 80 scores [15]. Follow-up assessment Patients were periodically followed up at the 3rd month and 6th month postoperatively and yearly thereafter. Follow-up evaluations of surgical outcomes were performed by neurosurgeons at the clinic and/or by telephone interview. Seizure outcomes were assessed according to the Engel classification [16], and neurological outcomes were assessed by the modified Rankin Scale (mRS) scoring in each patient [17]. Study variable and statistical analysis Clinical variables of interest were evaluated for their correlations with presence of anxiety and depression, respectively, including demography, tumor characteristics, seizure semiology, electrophysiological findings and surgical factors. Continuous variables were described with median and interquartile ranges (IQRs), while categorical variables were described with absolute and percentages (%). The outcome variable of anxiety and depression status was bicategorical as normal (assigned as 0) and abnormal (assigned as 1). Descriptive statistics between compared groups were analyzed by t tests and χ 2 tests for continuous and categorical variables, respectively. When necessary, the Fisher’s exact test and the Kruskal-Wallis rank-sum test were used. Variables showing a P < 0.05 in the univariate analysis were then entered into the multivariate binary logistic regression model in a forward-LR fashion. Odds ratios (ORs) are presented with 95% confidence intervals (CIs). Statistical tests were considered significant if P < 0.05. All data were analyzed using the software package of SPSS, version 21. Results Patient demographics Of the 107 included, 42 patients (39.3%) were female and 28 patients (26.2%) were children (< 18 years). The median age at surgery was 22 years (IQR: 17–27 years), the median age of seizure onset was 12 years (IQR: 6–18 years), and the median duration of epilepsy was 84 months (IQR: 42–180 months). Seizure frequency was recorded as daily in 30 patients (28.0%), weekly in 45 patients (42.1%), monthly in 19 patients (17.8%) and quarterly or yearly in 13 patients (12.1%). A total of 81 patients (75.7%) had focal seizure onsets, while 26 patients (24.3%) had generalized seizure onsets. In addition, 71 patients (66.4%) had a history of generalized tonic-clonic seizure (GTCS), 4 patients (3.7%) had a history of status epilepticus (SE). Totally, 89 patients (83.2%) were diagnosed as with drug-resistant epilepsy when admission (Table 1 ). Table 1 Univariate analysis of clinical factors with preoperative anxiety and depression in patients with epilepsy and low-grade brain tumors Presence of anxiety Presence of depression Variables Subtype No Yes P value No Yes P value 86 (80.4%) 21 (19.6%) 81 (75.7%) 26 (24.3%) Presence of depression/anxiety, n (%) no (n = 81) 72 (88.9%) 9 (11.1%) 0.000 c 72 (83.7%) 14 (16.3%) 0.000 c yes (n = 26) 14 (53.8%) 12 (46.2%) 9 (42.9%) 12 (57.1%) Patient gender, n (%) male (n = 65) 51 (78.5%) 14 (21.5%) 0.536 49 (75.4%) 16 (24.6%) 0.924 female (n = 42) 35 (83.3%) 7 (16.7%) 32 (76.2%) 10 (23.8%) Patient population, n (%) children (n = 28) 24 (85.7%) 4 (14.3%) 0.408 22 (78.6%) 6 (21.4%) 0.680 adult (n = 79) 62 (78.5%) 17 (21.5%) 59 (74.7%) 20 (25.3%) Seizure type, n (%) focal (n = 81) 65 (80.2%) 16 (19.8%) 0.953 62 (76.5%) 19 (23.5%) 0.720 generalized (n = 26) 21 (80.8%) 5 (19.2%) 19 (73.1%) 7 (26.9%) History of GTCS, n (%) no (n = 36) 29 (80.6%) 7 (19.4%) 0.973 29 (80.6%) 7 (19.4%) 0.404 yes (n = 71) 57 (80.3%) 14 (19.7%) 52 (73.2%) 19 (26.8%) History of SE, n (%) no (n = 103) 83 (80.6%) 20 (19.4%) 1.000 78 (75.7%) 25 (24.3%) 1.000 yes (n = 4) 3 (75%) 1 (25%) 3 (75%) 1 (25%) Seizure frequency, n (%) daily (n = 30) 24 (80%) 6 (20%) 0.981 22 (73.3%) 8 (26.7%) 0.826 weekly (n = 45) 36 (80%) 9 (20%) 33 (73.3%) 12 (26.7%) monthly (n = 19) 15 (78.9%) 4 (21.1%) 15 (78.9%) 4 (21.1%) yearly (n = 13) 11 (84.6%) 2 (15.4%) 11 (84.6%) 2 (15.4%) Drug-resistant epilepsy, n (%) no (n = 18) 17 (94.4%) 1 (5.6%) 0.186 14 (77.8%) 4 (22.2%) 1.000 yes (n = 89) 69 (77.5%) 20 (22.5%) 67 (75.3%) 22 (24.7%) Interictal EEG findings, n (%) concordant (n = 77) 67 (87%) 10 (13%) 0.017 c 60 (77.9%) 17 (22.1%) 0.666 discordant (n = 21) 14 (66.7%) 7 (33.3%) 15 (71.4%) 6 (28.6%) unknown (n = 9) a 5 (55.6%) 4 (44.4%) 6 (66.7%) 3 (33.3%) Ictal EEG findings, n (%) concordant (n = 56) 44 (78.6%) 12 (21.4%) 0.867 46 (82.1%) 10 (17.9%) 0.023 c discordant (n = 21) 17 (81%) 4 (19%) 12 (57.1%) 9 (42.9%) unknown (n = 30) a 25 (83.3%) 5 (16.7%) 23 (76.7%) 7 (23.3%) Resection extent, n (%) simple tumor resection (n = 41) 35 (85.4%) 6 (14.6%) 0.305 36 (87.8%) 5 (12.2%) 0.021 c extensive tumor resection (n = 66) 51 (77.3%) 15 (22.7%) 45 (68.2%) 21 (31.8%) Tumor side, n (%) right (n = 54) 46 (85.2%) 8 (14.8%) 0.206 46 (85.2%) 8 (14.8%) 0.206 left (n = 53) 40 (75.5%) 13 (24.5%) 40 (75.5%) 13 (24.5%) Tumor location, n (%) temporal (n = 73) 57 (78.1%) 16 (21.9%) 0.602 49 (67.1%) 24 (32.9%) 0.009 c non-temporal (n = 24) 21 (87.5%) 3 (12.5%) 23 (95.8%) 1 (4.2%) multilobe (n = 10) 8 (80%) 2 (20%) 9 (90%) 1 (10%) Concomitant HS, n (%) no (n = 98) 78 (79.6%) 20 (20.4%) 0.815 74 (75.5%) 24 (24.5%) 1.000 yes (n = 9) 8 (88.9%) 1 (11.1%) 7 (77.8%) 2 (22.2%) Tumor-associated FCD, n (%) no (n = 72) 61 (84.7%) 11 (15.3%) 0.104 54 (75%) 18 (25%) 0.808 yes (n = 35) 25 (71.4%) 10 (28.6%) 27 (77.1%) 8 (22.9%) Seizure outcome, n (%) Engel class I (n = 85) 70 (82.4%) 15 (17.6%) 0.931 65 (76.5%) 20 (23.5%) 0.827 Engel class II-IV (n = 13) 10 (76.9%) 3 (23.1%) 9 (69.2%) 4 (30.8%) Neurological outcome, n (%) mRS 0–1 (n = 99) 81 (81.8%) 18 (18.2%) 0.389 76 (76.8%) 23 (23.2%) 0.634 mRS 2–5 (n = 8) 5 (62.5%) 3 (37.5%) 5 (62.5%) 3 (37.5%) Full-scale IQ, n (%) normal (n = 84) 68 (81%) 16 (19%) 0.688 68 (81%) 16 (19%) 0.017 c deficit (n = 15) 11 (73.3%) 4 (26.7%) 7 (46.7%) 8 (53.3%) unknown (n = 8) b 7 (87.5%) 1 (12.5%) 6 (75%) 2 (25%) Full-scale MQ, n (%) normal (n = 79) 63 (79.7%) 16 (20.3%) 0.710 63 (79.7%) 16 (20.3%) 0.092 deficit (n = 18) 14 (77.8%) 4 (22.2%) 10 (55.6%) 8 (44.4%) unknown (n = 10) b 9 (90%) 1 (10%) 8 (80%) 2 (20%) Age at surgery/assessment, median (IQR) in years 22 (17–27) 25 (18–31) 0.065 22 (17–27) 24.5 (17.5–30.5) 0.246 Age at seizure onset, median (IQR) in years 11 (6-16.25) 15 (7–24) 0.140 12 (6–26) 12 (7.5–18.1) 0.796 Duration of epilepsy, median (IQR) in months 78 (33–183) 108 (51–186) 0.671 72 (36–162) 162 (69–213) 0.197 Tumor size, median (IQR) in millimeter 15 (15-21.3) 15 (13.8–20) 0.190 15 (15–25) 15 (15–25) 0.691 Hospitalization time, median (IQR) in days 27 (20–33) 29 (23.5–32.5) 0.588 25 (19.5–30.5) 31.5 (24.5–35.5) 0.011 c Follow-up time, median (IQR) in months 38.5 (24-78.3) 54 (24.5–89) 0.325 40 (24-77.5) 50.5 (24-84.5) 0.337 EEG, electroencephalography; FCD, focal cortical dysplasia; GTCS, generalized tonic-clonic seizure; HS, hippocampus sclerosis; IQR, interquartile range; IQ, intelligence quotient; MQ, memory quotient; SE, status epilepticus. a Patients who had unknown results in lateral concordance of interictal or ictal EEG finding with tumor lateralization were recorded in 9 patients (with no EDs or normal video EEG findings) and 30 patients (with no ictus during video EEG monitoring), respectively. b Patients who had unknown results of IQ and MQ were those without evaluations. c P < 0.05, with significance. Tumor characteristics and EEG findings Tumor locations in frontal, temporal, parietal, occipital, insular and multiple lobes were recorded in 10 patients (9.3%), 73 patients (68.2%), 8 patients (7.5%), 4 patients (3.7%), 2 patients (1.9%) and 10 (9.3%) patients, respectively. Among them, 79 patients (73.8%) had tumors invading the temporal lobe and 53 patients (49.5%) had tumors located in the left hemisphere of brain. The median tumor diameter was 15 mm (IQR: 15–20 mm). According to postoperative pathological recordings, tumors were diagnosed as GG in 83 patients (77.6%), DNT in 13 patients (12.1%), glioneuronal tumor with GG and DNT characteristics in 5 patients (4.7%) and others in 6 patients (4.7%). In addition, concomitant hippocampus sclerosis (HS) and tumor-associated focal cortical dysplasia (FCD) were found in 9 patients (8.4%) and 35 patients (32.7%), respectively. In particular, the concordant interictal and ictal EEG findings with tumor lateralization was recorded in 77 patients (72.0%) and 56 patients (52.3%), respectively; but 9 patients (8.4%) were with unknown results due to no epileptiform discharges or normal setting on interictal EEG findings, and 30 patients (28.0%) were with no ictus during monitoring of video EEG for at least 16 hours (Table 1 ). Neuropsychological results Of the 107 patients with preoperative neuropsychological evaluations of anxiety and depression, 95 patients had results of SAS and SDS examinations, and 12 patients had results of HAMA and HAMD examinations (Table 2 ). Among patients with anxiety examinations, 86 patients (80.4%) had no anxiety with normal scoring results, while 21 patients (19.6%) had different degrees of anxiety. Among patients with depression examinations, 81 patients (75.7%) had no depression with normal scoring results, while 26 patients (24.3%) had different degrees of depression. In particular, 12 patients (11.2%) had both disorders of anxiety and depression, and thus totally 35 patients (32.7%) suffered from psychiatric disorders of anxiety and/or depression. Table 2 The number of patients who underwent neuropsychological evaluations of anxiety and depression by different scales. a Evaluation of anxiety No. of cases Evaluation of depression No. of cases SAS, n (%) SDS, n (%) normal (< 50 scores) 83 (87.4%) normal (< 50 scores) 81 (85.3%) mild (50–59 scores) 9 (9.5%) mild (50–59 scores) 9 (9.5%) moderate (60–69 scores) 1 (1.1%) moderate (60–69 scores) 4 (4.2%) severe (≥ 69 scores) 2 (2.1%) severe (≥ 69 scores) 1 (1.1%) HAMA, n (%) HAMD, n (%) normal (< 7 scores) 3 (25%) normal (< 7 scores) 0 (0%) potential (7–13 scores) 3 (25%) potential (7–16 scores) 3 (25%) definite (14–28 scores) 6 (50%) definite (17–23 scores) 6 (50%) severe (≥ 29 scores) 0 (0%) severe (≥ 24 scores) 3 (25%) a Self-Rating Anxiety Scale (SAS) with 20 items of questions or Hamilton Anxiety Scale (HAMA) with 14 items were performed for the evaluation of presence of anxiety in patients, and Self-Rating Depression Scale (SDS) with 20 items of questions or Hamilton Depression Scale (HAMD) with 17 items were performed for the evaluation of presence of depression in patients. In addition, 99 patients (92.5%) had available FSIQ results and 15 patients (15.2%) had an IQ deficit; 97 patients (90.7%) had available FSMQ results and 18 patients (18.6%) had a MQ deficit. Surgical and follow-up outcomes Complete tumor resection was achieved in 105 patients (98.1%), and subtotal tumor resection was in 2 patients. In particular, among the 107 patients, 41 patients (38.3%) had simple tumor resection, while 66 patients (61.7%) had resection of tumor plus perilesional cortex (or hippocampus) that indicated a larger zone of epileptic discharges. The median length of stay was 27 days (IQR: 20–33 days). The median follow-up period was 46 months (IQR: 24–81 months), including 6 patients (5.6%) being lost. During the follow-up, 98 patients (91.6%) were followed up for at least 12 months and their seizure outcomes were evaluated by Engel classification. Finally, 85 patients (86.7%) got seizure-free (Engel class I), while 13 patients (13.3%) still had intractable seizure onsets after surgery (Engel class II-IV). In total, 99 patients (92.5%) had favorable neurological outcomes after surgery, with mRS scoring at 0–1. Statistical analyses of presence of anxiety and depression For patients with preoperative anxiety evaluations, only concordance of interictal EEG findings (P = 0.017) were found to have relevance to presence of anxiety in univariate analysis (Table 1 ). In particular, patients with discordant interictal EEG findings or bilateral epileptiform discharges were more likely to suffer anxiety than patients with concordant findings (P = 0.035, OR = 3.35) (Table 3 ). Table 3 Clinical predictors of anxiety and depression in multivariate logistic regression model Predictors B OR (95% CI) P Presence of anxiety Interictal EEG findings 0.024 discordant vs. concordant 1.209 3.35 (1.09–10.31) 0.035 unknown vs. concordant 1.679 5.36 (1.23–23.38) 0.025 Presence of depression Ictal EEG findings 0.053 discordant vs. concordant 1.491 4.44 (1.33–14.81) 0.015 unknown vs. concordant 0.501 1.65 (0.53–5.17) 0.389 Tumor location, n (%) 0.023 temporal vs. non-temporal 2.604 13.52 (1.65-110.41) 0.015 multilobe vs. non-temporal 0.993 2.70 (0.14–50.06) 0.505 CI, confidence interval; EEG, electroencephalography; OR, odds ratio. For patients with preoperative depression evaluations, several factors were found to be associated with presence of depression in univariate analysis, including concordance of ictal EEG findings (P = 0.023), surgical resection extent (P = 0.021), tumor location (P = 0.009) and lower FSIQ (P = 0.017). In multivariate logistic regression model, discordant ictal EEG findings (P = 0.015, OR = 4.44) and temporal location of tumor (P = 0.015, OR = 13.52) were related to the presence of depression. (Table 3 ). Discussion Anxiety and depression were frequently reported in patients with epilepsy, and approximately one-third of patients had varying degrees of anxiety and/or depression. However, few studies concern the occurrence, as well as the relevant risk factors, of anxiety and depression in patients with epilepsy that were exclusively caused by LBTs. The prevalence of anxiety and depression Patients with epilepsy have been found to be at higher risk of suffering from a range of psychiatric disorders (such as anxiety, depression, psychotic disorders, cognitive and personality changes) and physical disorders (including cardiac, gastrointestinal and respiratory disorders), which are up to eight times more common in people with epilepsy than in the general population [3,18]. More specifically, approximately 25–50% of patients with epilepsy were identified with psychiatric disorders, and anxiety and depression are the most common psychiatric comorbidities in patients with epilepsy, with an estimated prevalence of 15–30% compared to an average rate of 4–6% in general people [5,19]. Among the co-occurrent psychiatric disorders, depression is the most frequent psychiatric disorder in patients with epilepsy, which is more common in patients with partial seizures of temporal or frontal lobe origin and among patients with poorly controlled seizures [20]. Anxiety is the second most common psychiatric comorbidity in patients with epilepsy [5], with fear or panic being the most frequent symptom [3]. In present study, we found 19.6% and 24.3% of patients had concomitant anxiety and depression, respectively, which was in line with previous studies with respect to psychiatric disorder in patients with epilepsy [5,20]. However, the psychiatric disorders in patients with epilepsy caused by brain tumors were less reported in the literature, except that Ehrstedt et al. reported 32% and 16% of patients with epilepsy caused by glioneuronal tumors in their study exceeded the threshold level of possible anxiety and depression, respectively [10]. In present study, we exclusively observed the prevalence of patients with epilepsy caused by LBTs and found 19.6% of patients had concomitant anxiety and 24.3% of patients had concomitant depression. In particular, anxiety and depression could co-occur in some of patients. As recorded in the study, 34.3% of patients (12/35) had both disorders of anxiety and depression, and also patients with anxiety could more often suffer from depression (P < 0.001, Table 1 ). Relevant risk factors The co-occurrence of psychiatric disorders in patients with epilepsy can complicate diagnosis or have adverse prognostic implications. Early identification and management of these conditions may facilitate the treatment of epilepsy [18]. However, the occurrence of psychiatric disorders in patients with epilepsy is complicated and relevant risk factors haven’t been identified. In present study, we specifically reviewed the surgical cohort of patients with epilepsy caused by LBTs and analyzed the risk factors of comorbidity of anxiety and depression in these patients, which, notably, haven’t been identified in previous studies. Interestingly, we found patients with discordant interictal EEG findings were more likely to suffer from anxiety than patients with concordant findings (P = 0.035, OR = 3.35), and patients with discordant ictal EEG findings (P = 0.015, OR = 4.44) and temporal location of tumor (P = 0.015, OR = 13.52) were more likely to have disorder of depression than those with concordant EEG findings or extratemporal tumors. Discordant EEG findings or bilateral epileptic discharges during interictal or ictal periods may have larger influence on patient’s brain network than concordant (or focal) EEG findings or unilateral epileptic discharges, and thus those patients with epilepsy may be more likely to suffer from psychiatric disorders of anxiety and depression, as proved in our study. In particular, discordant ictal EEG findings were also found to have longer duration of epilepsy (mean: 159.5 ± 98.5 months) than concordant EEG findings (mean: 102.9 ± 91.5 months, P < 0.05) in our surgical cohort. As previous studies have found, psychiatric disorders were more common in patients with persistent or long-term seizures [5]. Thus, it is significant that early surgical intervention with seizure control for patients with epilepsy, especially caused by LBTs, may reduce the occurrence of psychiatric disorders. In addition, as reported by literature, lesions involving temporal lobe or with dysfunction of temporal lobe, the occurrence of psychiatric disorders was always higher recorded than those patients with extratemporal lesions [5]. Similarly, we recorded that patients with tumors located in temporal lobe were more likely to had presence of depression than those with extratemporal tumors (P = 0.015, OR = 13.52), which may be attributed to the impairments of neural functions of temporal lobe in mental aspects. In a word, the relationship between psychiatric disorders and epilepsy is complex, and the symptoms are not only the consequence of the epilepsy but also the etiology. By the same token, there is evidence of a bidirectional relationship between some psychiatric disorders and epilepsy [5]. Keezer, et al. proposed a classification scheme for the different mechanisms of association between epilepsy and comorbid conditions and mentioned the mechanisms of association including shared risk factors and bidirectional effects. Shared risk factors can be genetic, environmental, structural or physiological [3]. In our clinical works, understanding which comorbidities might develop in people with epilepsy is equally relevant. The idea is that early detection would lead to early intervention and tangible health-care benefits for the patient. However, at present, psychiatric, cognitive, and several somatic comorbidities are still frequently undetected and undertreated in people with epilepsy [3]. Limitations The evidence from our study with epilepsy caused by LBTs cohort may compromise its retrospective nature and limited sample size. In addition, we just analyzed the general anxiety and depression without all specific domains of psychological function. Even so, our results could also partly complement the undefined domains of the anxiety and depression outcomes in patients with epilepsy caused by LBTs. In the future, a large, prospective and well-matched surgical cohort of LBTs from multiple epilepsy centers is still needed to get more comprehensive evidences concerning psychiatric disorders to guide the clinical treatment of patients with LBTs. Conclusion The preoperative psychiatric disorders were commonly found in patients with epilepsy caused by LBTs, and clinical factors of discordant EEG findings and temporal invasion of tumor were adverse predictors of preoperative anxiety or depression deficits. However, discordant EEG findings were often found in patients with longer epilepsy duration. Therefore, early surgical intervention is necessary for patients with LBTs to avoid the occurrence of mental impairments. Declarations Funding: Not appliable. Competing interests: The authors declare that they have no conflict of interest. Authors' contributions: Xie S and Luan G had the idea for the article; Xie S, Qiao J, and Luan G performed the data collection or analysis; Xie S, Xie M and Xiao S drafted and/or critically revised the work; All authors read and approved the final manuscript. Data Availability: The data used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval: The Research Ethics Committee of Sanbo Brain Hospital approved the study. The manuscript does not contain individual clinical data, and informed consent was not required. Consent to participate: Not applicable . Consent for publication: Not applicable. References Jones R, Rickards H, Cavanna AE. The prevalence of psychiatric disorders in epilepsy: a critical review of the evidence. Functional neurology 2010;25:191-4. Kanner AM. Psychiatric comorbidities and epilepsy: is it the old story of the chicken and the egg? Annals of neurology 2012;72:153-5. 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Comparison of psychiatric comorbidities and impact on quality of life in patients with epilepsy or psychogenic nonepileptic spells. Epilepsy & behavior : E&B 2020;102:106649. Ehrstedt C, Rydell AM, Gabert Hallsten M, Strömberg B, Ahlsten G. Cognition, health-related quality of life, and mood in children and young adults diagnosed with a glioneuronal tumor in childhood. Epilepsy & behavior : E&B 2018;83:59-66. Zung WW. A rating instrument for anxiety disorders. Psychosomatics 1971;12:371-9. Zung WW. A SELF-RATING DEPRESSION SCALE. Archives of general psychiatry 1965;12:63-70. Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. Journal of affective disorders 1988;14:61-8. Dunstan DA, Scott N, Todd AK. Screening for anxiety and depression: reassessing the utility of the Zung scales. BMC psychiatry 2017;17:329. Cormack F, Cross JH, Isaacs E, et al. The development of intellectual abilities in pediatric temporal lobe epilepsy. Epilepsia 2007;48:201-4. Engel J Jr VNP, Rasmussen TB, Ojemann LM Surgical treatment of the epilepsies. New York: Raven Press 1993;1:609-21. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604-7. Gaitatzis A, Sisodiya SM, Sander JW. The somatic comorbidity of epilepsy: a weighty but often unrecognized burden. Epilepsia 2012;53:1282-93. Jones JE, Siddarth P, Almane D, Gurbani S, Hermann BP, Caplan R. Identification of risk for severe psychiatric comorbidity in pediatric epilepsy. Epilepsia 2016;57:1817-25. Ettinger A, Reed M, Cramer J. Depression and comorbidity in community-based patients with epilepsy or asthma. Neurology 2004;63:1008-14. Tables Tables 1 to 3 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Tables13..docx Cite Share Download PDF Status: Published Journal Publication published 09 Jan, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 09 Dec, 2024 Reviews received at journal 23 Nov, 2024 Reviews received at journal 22 Nov, 2024 Reviews received at journal 20 Nov, 2024 Reviewers agreed at journal 20 Nov, 2024 Reviewers agreed at journal 15 Nov, 2024 Reviewers agreed at journal 13 Nov, 2024 Reviewers agreed at journal 04 Nov, 2024 Reviewers invited by journal 04 Nov, 2024 Editor assigned by journal 30 Oct, 2024 Editor invited by journal 22 Oct, 2024 Submission checks completed at journal 21 Oct, 2024 First submitted to journal 06 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5212625","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":387797413,"identity":"090c9625-e1b3-4893-8efc-3f5b1c29db83","order_by":0,"name":"Sungel Xie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYDACZhBhYCPHxt7Y+PAD8VoK0oz5eA43G0sQb9WHw4nzJNLbBHiIUWxwnPnoxi8GhxPbJB+2MUgw2MnpNhDQItnMlnZbxiDduE06se1BAUOysdkBAlr4mXnMbksYWMsCtbQbSDAcSNxGSAsbM/83oBZmxjbJg20SPMRoAdrCdvODgbNimwQjkVqAfjG7zWCQZszGkwgMZAMi/GJw/vCzmz/+2MjJtx9/+PBDhZ0cQS0gwIyIDgMilIMA4w8iFY6CUTAKRsEIBQBl3z7bRWbk0QAAAABJRU5ErkJggg==","orcid":"","institution":"Affiliated Hospital of Zunyi Medical College","correspondingAuthor":true,"prefix":"","firstName":"Sungel","middleName":"","lastName":"Xie","suffix":""},{"id":387797414,"identity":"07306331-5e82-4e0c-a95c-61df43ef1cc2","order_by":1,"name":"Jiao Qiao","email":"","orcid":"","institution":"Beijing Sanbo Brain Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiao","middleName":"","lastName":"Qiao","suffix":""},{"id":387797415,"identity":"03f62ca4-6a94-4a94-a2b0-f0df3eb949fb","order_by":2,"name":"Guoming Luan","email":"","orcid":"","institution":"Beijing Sanbo Brain Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guoming","middleName":"","lastName":"Luan","suffix":""},{"id":387797416,"identity":"9412a4e8-3f6b-4c71-9e4e-87c6375953c6","order_by":3,"name":"Mingxiang Xie","email":"","orcid":"","institution":"Affiliated Hospital of Zunyi Medical College","correspondingAuthor":false,"prefix":"","firstName":"Mingxiang","middleName":"","lastName":"Xie","suffix":""},{"id":387797417,"identity":"c99fbefd-18e2-4e83-afc7-674eb5988f17","order_by":4,"name":"Shunwu Xiao","email":"","orcid":"","institution":"Affiliated Hospital of Zunyi Medical College","correspondingAuthor":false,"prefix":"","firstName":"Shunwu","middleName":"","lastName":"Xiao","suffix":""}],"badges":[],"createdAt":"2024-10-06 11:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5212625/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5212625/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-85499-w","type":"published","date":"2025-01-09T15:57:05+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":73694024,"identity":"453e29b0-f64b-4d09-b653-a8501ff1a869","added_by":"auto","created_at":"2025-01-13 16:10:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1058469,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5212625/v1/1da9a881-05f7-4cd5-aa18-de079236e506.pdf"},{"id":72135602,"identity":"ef58a8f1-3af0-42da-9fea-3df14d18deb6","added_by":"auto","created_at":"2024-12-23 05:27:42","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":34198,"visible":true,"origin":"","legend":"","description":"","filename":"Tables13..docx","url":"https://assets-eu.researchsquare.com/files/rs-5212625/v1/a01e7656ca22da6827412d41.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Concomitant Anxiety and Depression in Patients with Epilepsy Caused by Low-Grade Brain Tumors","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe comorbidity of psychiatric disorders was frequently reported in patients with epilepsy, and about 20\u0026ndash;50% of patients experienced varying degrees of psychiatric disorders that include anxiety, depression, psychotic disorders, cognitive and personality changes [1\u0026ndash;4]. Among them, anxiety and depression were found to be the most common psychiatric disorders in patients with epilepsy [5,6].\u003c/p\u003e \u003cp\u003eLow-grade brain tumors (LBTs) were one of the most common epileptogenic etiologies and often met in patients with epilepsy surgery for intractable focal epilepsy [7]. LBTs usually grow slowly and develop in children or adolescents, such as ganglioglioma (GG) and dysembroplastic neuroepithelial tumor (DNT) [8]. Although complete seizure control could be achieved in most of patients with LBTs after surgery, a rather number of patients still had unimproved quality of life, which may be primarily attributed to the concomitant psychiatric disorders [9,10]. However, there are few reports focusing on the psychiatric disorders of patients with epilepsy caused by LBTs, and the mental impairments and related risk factors are still undefined. Therefore, through this retrospective study, we aimed to evaluate the concomitant psychiatric disorders, notably anxiety and depression, and their relevant risk factors in patients with LBTs who underwent epilepsy surgery in our epilepsy treatment center in the past decade.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient selection\u003c/h2\u003e \u003cp\u003eClinical data of patients who underwent neuropsychological evaluations and surgical treatment for LBTs between January 2008 and January 2021 at Sanbo Brain Hospital, Capital Medical University, were retrospectively reviewed. The study was approved by the Sanbo Brain Hospital Ethics Committee of Capital Medical University, and all methods were performed in accordance with relevant guidelines and regulations. Due to the retrospective nature of the study, the ethics committee waived the need of obtaining informed consent.\u003c/p\u003e \u003cp\u003ePatients who had epilepsy caused by brain tumors that were pathologically confirmed as low-grade glial or glioneuronal tumors were enrolled in the study; but patients who didn\u0026rsquo;t accept preoperative psychological evaluations of anxiety and depression, or who didn\u0026rsquo;t have complete clinical data, were excluded. Finally, a total of 107 consecutive patients were included in the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePreoperative examination and surgical strategy\u003c/h3\u003e\n\u003cp\u003eAll patients underwent an individualized preoperative evaluation, including detailed medical history and physical examination, seizure semiology, electrophysiological monitoring of video electroencephalogram (EEG), and brain magnetic resonance imaging (MRI). In particular, the tumor size was represented by the mean maximum tumor diameter on 3-dimensional (axial, sagittal and coronal) T1-weighted MR images. Long-term video EEG monitoring was performed in all patients for at least 16 hours. The concordant EEG findings were defined as the epileptiform spike sources on interictal or ictal video EEG localized in the same brain hemisphere of tumor involvement, when compared to discordant EEG findings for bilateral or diffuse epileptiform spike sources on interictal or ictal video EEG.\u003c/p\u003e \u003cp\u003eAfter detailed preoperative evaluations, potential surgical candidates were discussed at a multidisciplinary epilepsy surgery meeting to determine suitability for surgery, as well as the surgical plans. The aim of the operation was to remove the tumor and the relevant epileptogenic zone (EZ), which was determined by the findings of the detailed preoperative evaluations and/or intraoperative electrocorticography (ECoG). Intraoperatively, neurological electrophysiological monitoring and neuronavigation were also performed for safe tumor resection. In particular, the zone of epileptic discharges was represented by surgical resection extent, which were categorized as simple tumor resection (resection of single tumor) and extensive tumor resection (resection of tumor and perilesional brain tissue) that was confirmed by intraoperative observation and postoperative reexamination of MRI.\u003c/p\u003e\n\u003ch3\u003eNeuropsychological evaluation\u003c/h3\u003e\n\u003cp\u003eNeuropsychological evaluations were routinely recommended to patients with epilepsy before surgery. Self-Rating Anxiety Scale (SAS) with 20 items of questions or Hamilton Anxiety Scale (HAMA) with 14 items was performed for the evaluation of presence of anxiety in patients [11], and Self-Rating Depression Scale (SDS) with 20 items of questions or Hamilton Depression Scale (HAMD) with 17 items was performed for the evaluation of presence of depression in patients [12,13].\u003c/p\u003e \u003cp\u003eFor SAS and SDS, scoring results were seemed as normal (\u0026lt;\u0026thinsp;50 scores) and abnormal (\u0026ge;\u0026thinsp;50 scores: mild, 50\u0026ndash;59 scores; moderate, 60\u0026ndash;69 scores; and severe\u0026thinsp;\u0026gt;\u0026thinsp;70 scores). For HAMA, scoring results were seemed as normal (\u0026lt;\u0026thinsp;7 scores) and abnormal (\u0026ge;\u0026thinsp;7 scores: potential anxiety, 7\u0026ndash;13 scores; definite anxiety, 14\u0026ndash;20 scores; significant anxiety, 21\u0026ndash;28 scores; and severe anxiety, \u0026ge; 29 scores), and for HAMD, scoring results were seemed as normal (\u0026lt;\u0026thinsp;7 scores) and abnormal (\u0026ge;\u0026thinsp;7 scores: potential depression, 7\u0026ndash;16 scores; definite depression, 17\u0026ndash;23 scores; and severe depression, \u0026ge; 24 scores) [14].\u003c/p\u003e \u003cp\u003eIn addition, the Wechsler adult intelligence scale (WAIS) and Wechsler intelligence scale for children (WISC), and Wechsler memory scale (WMS) were respectively performed in patients based on different age groups. The full-scale intelligence quotient (FSIQ) and the full-scale memory quotient (FSMQ) were defined as with a deficit in patients when scoring less than 80 scores [15].\u003c/p\u003e\n\u003ch3\u003eFollow-up assessment\u003c/h3\u003e\n\u003cp\u003ePatients were periodically followed up at the 3rd month and 6th month postoperatively and yearly thereafter. Follow-up evaluations of surgical outcomes were performed by neurosurgeons at the clinic and/or by telephone interview. Seizure outcomes were assessed according to the Engel classification [16], and neurological outcomes were assessed by the modified Rankin Scale (mRS) scoring in each patient [17].\u003c/p\u003e\n\u003ch3\u003eStudy variable and statistical analysis\u003c/h3\u003e\n\u003cp\u003eClinical variables of interest were evaluated for their correlations with presence of anxiety and depression, respectively, including demography, tumor characteristics, seizure semiology, electrophysiological findings and surgical factors.\u003c/p\u003e \u003cp\u003eContinuous variables were described with median and interquartile ranges (IQRs), while categorical variables were described with absolute and percentages (%). The outcome variable of anxiety and depression status was bicategorical as normal (assigned as 0) and abnormal (assigned as 1). Descriptive statistics between compared groups were analyzed by t tests and χ\u003csup\u003e2\u003c/sup\u003e tests for continuous and categorical variables, respectively. When necessary, the Fisher\u0026rsquo;s exact test and the Kruskal-Wallis rank-sum test were used. Variables showing a P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in the univariate analysis were then entered into the multivariate binary logistic regression model in a forward-LR fashion. Odds ratios (ORs) are presented with 95% confidence intervals (CIs). Statistical tests were considered significant if P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All data were analyzed using the software package of SPSS, version 21.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePatient demographics\u003c/h2\u003e \u003cp\u003eOf the 107 included, 42 patients (39.3%) were female and 28 patients (26.2%) were children (\u0026lt;\u0026thinsp;18 years). The median age at surgery was 22 years (IQR: 17\u0026ndash;27 years), the median age of seizure onset was 12 years (IQR: 6\u0026ndash;18 years), and the median duration of epilepsy was 84 months (IQR: 42\u0026ndash;180 months). Seizure frequency was recorded as daily in 30 patients (28.0%), weekly in 45 patients (42.1%), monthly in 19 patients (17.8%) and quarterly or yearly in 13 patients (12.1%). A total of 81 patients (75.7%) had focal seizure onsets, while 26 patients (24.3%) had generalized seizure onsets. In addition, 71 patients (66.4%) had a history of generalized tonic-clonic seizure (GTCS), 4 patients (3.7%) had a history of status epilepticus (SE). Totally, 89 patients (83.2%) were diagnosed as with drug-resistant epilepsy when admission (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate analysis of clinical factors with preoperative anxiety and depression in patients with epilepsy and low-grade brain tumors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003ePresence of anxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003ePresence of depression\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubtype\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86 (80.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (19.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e81 (75.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e26 (24.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresence of depression/anxiety, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (88.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e72 (83.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14 (16.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (53.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (46.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient gender, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale (n\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (78.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (21.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.536\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e49 (75.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.924\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale (n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32 (76.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10 (23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient population, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003echildren (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (85.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.408\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22 (78.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.680\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eadult (n\u0026thinsp;=\u0026thinsp;79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (78.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (21.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e59 (74.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20 (25.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeizure type, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efocal (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (80.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (19.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.953\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e62 (76.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e19 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.720\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egeneralized (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (80.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19 (73.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7 (26.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of GTCS, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno (n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (80.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.973\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29 (80.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.404\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (80.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (19.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e52 (73.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e19 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of SE, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno (n\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (80.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e1.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e78 (75.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25 (24.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e1.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeizure frequency, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003edaily (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.981\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22 (73.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.826\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eweekly (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33 (73.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emonthly (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (78.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15 (78.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyearly (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (84.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11 (84.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug-resistant epilepsy, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (94.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.186\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e1.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes (n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (77.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e67 (75.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22 (24.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterictal EEG findings, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econcordant (n\u0026thinsp;=\u0026thinsp;77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.017\u003c/em\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60 (77.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e17 (22.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.666\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ediscordant (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eunknown (n\u0026thinsp;=\u0026thinsp;9)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (55.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIctal EEG findings, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econcordant (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (78.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.867\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e46 (82.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10 (17.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.023\u003c/em\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ediscordant (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eunknown (n\u0026thinsp;=\u0026thinsp;30)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23 (76.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResection extent, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esimple tumor resection (n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (85.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (14.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.305\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36 (87.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5 (12.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.021\u003c/em\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eextensive tumor resection (n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (77.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e45 (68.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor side, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eright (n\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (85.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.206\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e46 (85.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.206\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eleft (n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (75.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (24.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40 (75.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13 (24.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etemporal (n\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (78.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (21.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.602\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e49 (67.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24 (32.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.009\u003c/em\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enon-temporal (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (87.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23 (95.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emultilobe (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcomitant HS, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno (n\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (79.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (20.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.815\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e74 (75.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24 (24.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e1.000\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (88.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor-associated FCD, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno (n\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (84.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (15.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.104\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e54 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e18 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.808\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27 (77.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8 (22.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeizure outcome, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEngel class I (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (82.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.931\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e65 (76.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.827\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEngel class II-IV (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (76.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (69.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4 (30.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurological outcome, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emRS 0\u0026ndash;1 (n\u0026thinsp;=\u0026thinsp;99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81 (81.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.389\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e76 (76.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23 (23.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.634\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emRS 2\u0026ndash;5 (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (62.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (62.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFull-scale IQ, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enormal (n\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.688\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e68 (81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.017\u003c/em\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003edeficit (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (73.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7 (46.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8 (53.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eunknown (n\u0026thinsp;=\u0026thinsp;8)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (87.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFull-scale MQ, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enormal (n\u0026thinsp;=\u0026thinsp;79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (79.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (20.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.710\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e63 (79.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16 (20.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.092\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003edeficit (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10 (55.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eunknown (n\u0026thinsp;=\u0026thinsp;10)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8 (80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at surgery/assessment, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ein years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (17\u0026ndash;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (18\u0026ndash;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.065\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22 (17\u0026ndash;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24.5 (17.5\u0026ndash;30.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.246\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at seizure onset, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ein years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (6-16.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (7\u0026ndash;24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.140\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e12 (6\u0026ndash;26)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e12 (7.5\u0026ndash;18.1)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.796\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of epilepsy, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ein months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (33\u0026ndash;183)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108 (51\u0026ndash;186)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.671\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e72 (36\u0026ndash;162)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e162 (69\u0026ndash;213)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.197\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor size, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ein millimeter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (15-21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (13.8\u0026ndash;20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.190\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e15 (15\u0026ndash;25)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e15 (15\u0026ndash;25)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.691\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalization time, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ein days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e27 (20\u0026ndash;33)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e29 (23.5\u0026ndash;32.5)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.588\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e25 (19.5\u0026ndash;30.5)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e31.5 (24.5\u0026ndash;35.5)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.011\u003c/em\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up time, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ein months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.5 (24-78.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (24.5\u0026ndash;89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.325\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e40 (24-77.5)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003e50.5 (24-84.5)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003e0.337\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eEEG, electroencephalography; FCD, focal cortical dysplasia; GTCS, generalized tonic-clonic seizure; HS, hippocampus sclerosis; IQR, interquartile range; IQ, intelligence quotient; MQ, memory quotient; SE, status epilepticus.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ea\u003c/sup\u003ePatients who had unknown results in lateral concordance of interictal or ictal EEG finding with tumor lateralization were recorded in 9 patients (with no EDs or normal video EEG findings) and 30 patients (with no ictus during video EEG monitoring), respectively.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003eb\u003c/sup\u003ePatients who had unknown results of IQ and MQ were those without evaluations.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003ec\u003c/sup\u003eP \u0026lt; 0.05, with significance.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTumor characteristics and EEG findings\u003c/h3\u003e\n\u003cp\u003eTumor locations in frontal, temporal, parietal, occipital, insular and multiple lobes were recorded in 10 patients (9.3%), 73 patients (68.2%), 8 patients (7.5%), 4 patients (3.7%), 2 patients (1.9%) and 10 (9.3%) patients, respectively. Among them, 79 patients (73.8%) had tumors invading the temporal lobe and 53 patients (49.5%) had tumors located in the left hemisphere of brain. The median tumor diameter was 15 mm (IQR: 15\u0026ndash;20 mm).\u003c/p\u003e \u003cp\u003eAccording to postoperative pathological recordings, tumors were diagnosed as GG in 83 patients (77.6%), DNT in 13 patients (12.1%), glioneuronal tumor with GG and DNT characteristics in 5 patients (4.7%) and others in 6 patients (4.7%). In addition, concomitant hippocampus sclerosis (HS) and tumor-associated focal cortical dysplasia (FCD) were found in 9 patients (8.4%) and 35 patients (32.7%), respectively.\u003c/p\u003e \u003cp\u003eIn particular, the concordant interictal and ictal EEG findings with tumor lateralization was recorded in 77 patients (72.0%) and 56 patients (52.3%), respectively; but 9 patients (8.4%) were with unknown results due to no epileptiform discharges or normal setting on interictal EEG findings, and 30 patients (28.0%) were with no ictus during monitoring of video EEG for at least 16 hours (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eNeuropsychological results\u003c/h2\u003e \u003cp\u003eOf the 107 patients with preoperative neuropsychological evaluations of anxiety and depression, 95 patients had results of SAS and SDS examinations, and 12 patients had results of HAMA and HAMD examinations (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Among patients with anxiety examinations, 86 patients (80.4%) had no anxiety with normal scoring results, while 21 patients (19.6%) had different degrees of anxiety. Among patients with depression examinations, 81 patients (75.7%) had no depression with normal scoring results, while 26 patients (24.3%) had different degrees of depression. In particular, 12 patients (11.2%) had both disorders of anxiety and depression, and thus totally 35 patients (32.7%) suffered from psychiatric disorders of anxiety and/or depression.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe number of patients who underwent neuropsychological evaluations of anxiety and depression by different scales.\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvaluation of anxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. of cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEvaluation of depression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo. of cases\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSAS, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSDS, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003enormal (\u0026lt;\u0026thinsp;50 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83 (87.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003enormal (\u0026lt;\u0026thinsp;50 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81 (85.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003emild (50\u0026ndash;59 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003emild (50\u0026ndash;59 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (9.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003emoderate (60\u0026ndash;69 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003emoderate (60\u0026ndash;69 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003esevere (\u0026ge;\u0026thinsp;69 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003esevere (\u0026ge;\u0026thinsp;69 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHAMA, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHAMD, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003enormal (\u0026lt;\u0026thinsp;7 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003enormal (\u0026lt;\u0026thinsp;7 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003epotential (7\u0026ndash;13 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003epotential (7\u0026ndash;16 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003edefinite (14\u0026ndash;28 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003edefinite (17\u0026ndash;23 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003esevere (\u0026ge;\u0026thinsp;29 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003esevere (\u0026ge;\u0026thinsp;24 scores)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ea\u003c/sup\u003eSelf-Rating Anxiety Scale (SAS) with 20 items of questions or Hamilton Anxiety Scale (HAMA) with 14 items were performed for the evaluation of presence of anxiety in patients, and Self-Rating Depression Scale (SDS) with 20 items of questions or Hamilton Depression Scale (HAMD) with 17 items were performed for the evaluation of presence of depression in patients.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn addition, 99 patients (92.5%) had available FSIQ results and 15 patients (15.2%) had an IQ deficit; 97 patients (90.7%) had available FSMQ results and 18 patients (18.6%) had a MQ deficit.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSurgical and follow-up outcomes\u003c/h2\u003e \u003cp\u003eComplete tumor resection was achieved in 105 patients (98.1%), and subtotal tumor resection was in 2 patients. In particular, among the 107 patients, 41 patients (38.3%) had simple tumor resection, while 66 patients (61.7%) had resection of tumor plus perilesional cortex (or hippocampus) that indicated a larger zone of epileptic discharges. The median length of stay was 27 days (IQR: 20\u0026ndash;33 days).\u003c/p\u003e \u003cp\u003eThe median follow-up period was 46 months (IQR: 24\u0026ndash;81 months), including 6 patients (5.6%) being lost. During the follow-up, 98 patients (91.6%) were followed up for at least 12 months and their seizure outcomes were evaluated by Engel classification. Finally, 85 patients (86.7%) got seizure-free (Engel class I), while 13 patients (13.3%) still had intractable seizure onsets after surgery (Engel class II-IV). In total, 99 patients (92.5%) had favorable neurological outcomes after surgery, with mRS scoring at 0\u0026ndash;1.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses of presence of anxiety and depression\u003c/h2\u003e \u003cp\u003eFor patients with preoperative anxiety evaluations, only concordance of interictal EEG findings (P\u0026thinsp;=\u0026thinsp;0.017) were found to have relevance to presence of anxiety in univariate analysis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In particular, patients with discordant interictal EEG findings or bilateral epileptiform discharges were more likely to suffer anxiety than patients with concordant findings (P\u0026thinsp;=\u0026thinsp;0.035, OR\u0026thinsp;=\u0026thinsp;3.35) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical predictors of anxiety and depression in multivariate logistic regression model\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePredictors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresence of anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterictal EEG findings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ediscordant vs. concordant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.35 (1.09\u0026ndash;10.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eunknown vs. concordant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.36 (1.23\u0026ndash;23.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresence of depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIctal EEG findings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.053\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ediscordant vs. concordant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.44 (1.33\u0026ndash;14.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.015\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eunknown vs. concordant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.501\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.65 (0.53\u0026ndash;5.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.389\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTumor location, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.023\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etemporal vs. non-temporal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.604\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.52 (1.65-110.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.015\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emultilobe vs. non-temporal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.70 (0.14\u0026ndash;50.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.505\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eCI, confidence interval; EEG, electroencephalography; OR, odds ratio.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor patients with preoperative depression evaluations, several factors were found to be associated with presence of depression in univariate analysis, including concordance of ictal EEG findings (P\u0026thinsp;=\u0026thinsp;0.023), surgical resection extent (P\u0026thinsp;=\u0026thinsp;0.021), tumor location (P\u0026thinsp;=\u0026thinsp;0.009) and lower FSIQ (P\u0026thinsp;=\u0026thinsp;0.017). In multivariate logistic regression model, discordant ictal EEG findings (P\u0026thinsp;=\u0026thinsp;0.015, OR\u0026thinsp;=\u0026thinsp;4.44) and temporal location of tumor (P\u0026thinsp;=\u0026thinsp;0.015, OR\u0026thinsp;=\u0026thinsp;13.52) were related to the presence of depression. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAnxiety and depression were frequently reported in patients with epilepsy, and approximately one-third of patients had varying degrees of anxiety and/or depression. However, few studies concern the occurrence, as well as the relevant risk factors, of anxiety and depression in patients with epilepsy that were exclusively caused by LBTs.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eThe prevalence of anxiety and depression\u003c/h2\u003e \u003cp\u003ePatients with epilepsy have been found to be at higher risk of suffering from a range of psychiatric disorders (such as anxiety, depression, psychotic disorders, cognitive and personality changes) and physical disorders (including cardiac, gastrointestinal and respiratory disorders), which are up to eight times more common in people with epilepsy than in the general population [3,18]. More specifically, approximately 25\u0026ndash;50% of patients with epilepsy were identified with psychiatric disorders, and anxiety and depression are the most common psychiatric comorbidities in patients with epilepsy, with an estimated prevalence of 15\u0026ndash;30% compared to an average rate of 4\u0026ndash;6% in general people [5,19].\u003c/p\u003e \u003cp\u003eAmong the co-occurrent psychiatric disorders, depression is the most frequent psychiatric disorder in patients with epilepsy, which is more common in patients with partial seizures of temporal or frontal lobe origin and among patients with poorly controlled seizures [20]. Anxiety is the second most common psychiatric comorbidity in patients with epilepsy [5], with fear or panic being the most frequent symptom [3]. In present study, we found 19.6% and 24.3% of patients had concomitant anxiety and depression, respectively, which was in line with previous studies with respect to psychiatric disorder in patients with epilepsy [5,20].\u003c/p\u003e \u003cp\u003eHowever, the psychiatric disorders in patients with epilepsy caused by brain tumors were less reported in the literature, except that Ehrstedt et al. reported 32% and 16% of patients with epilepsy caused by glioneuronal tumors in their study exceeded the threshold level of possible anxiety and depression, respectively [10]. In present study, we exclusively observed the prevalence of patients with epilepsy caused by LBTs and found 19.6% of patients had concomitant anxiety and 24.3% of patients had concomitant depression. In particular, anxiety and depression could co-occur in some of patients. As recorded in the study, 34.3% of patients (12/35) had both disorders of anxiety and depression, and also patients with anxiety could more often suffer from depression (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eRelevant risk factors\u003c/h2\u003e \u003cp\u003eThe co-occurrence of psychiatric disorders in patients with epilepsy can complicate diagnosis or have adverse prognostic implications. Early identification and management of these conditions may facilitate the treatment of epilepsy [18]. However, the occurrence of psychiatric disorders in patients with epilepsy is complicated and relevant risk factors haven\u0026rsquo;t been identified.\u003c/p\u003e \u003cp\u003eIn present study, we specifically reviewed the surgical cohort of patients with epilepsy caused by LBTs and analyzed the risk factors of comorbidity of anxiety and depression in these patients, which, notably, haven\u0026rsquo;t been identified in previous studies. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eInterestingly, we found patients\u003c/span\u003e with discordant interictal EEG findings were more likely to suffer from anxiety than patients with concordant findings (P\u0026thinsp;=\u0026thinsp;0.035, OR\u0026thinsp;=\u0026thinsp;3.35), and patients with discordant ictal EEG findings (P\u0026thinsp;=\u0026thinsp;0.015, OR\u0026thinsp;=\u0026thinsp;4.44) and temporal location of tumor (P\u0026thinsp;=\u0026thinsp;0.015, OR\u0026thinsp;=\u0026thinsp;13.52) were more likely to have disorder of depression than those with concordant EEG findings or extratemporal tumors.\u003c/p\u003e \u003cp\u003eDiscordant EEG findings or bilateral epileptic discharges during interictal or ictal periods may have larger influence on patient\u0026rsquo;s brain network than concordant (or focal) EEG findings or unilateral epileptic discharges, and thus those patients with epilepsy may be more likely to suffer from psychiatric disorders of anxiety and depression, as proved in our study. In particular, discordant ictal EEG findings were also found to have longer duration of epilepsy (mean: 159.5\u0026thinsp;\u0026plusmn;\u0026thinsp;98.5 months) than concordant EEG findings (mean: 102.9\u0026thinsp;\u0026plusmn;\u0026thinsp;91.5 months, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in our surgical cohort. As previous studies have found, psychiatric disorders were more common in patients with persistent or long-term seizures [5]. Thus, it is significant that early surgical intervention with seizure control for patients with epilepsy, especially caused by LBTs, may reduce the occurrence of psychiatric disorders.\u003c/p\u003e \u003cp\u003eIn addition, as reported by literature, lesions involving temporal lobe or with dysfunction of temporal lobe, the occurrence of psychiatric disorders was always higher recorded than those patients with extratemporal lesions [5]. Similarly, we recorded that patients with tumors located in temporal lobe were more likely to had presence of depression than those with extratemporal tumors (P\u0026thinsp;=\u0026thinsp;0.015, OR\u0026thinsp;=\u0026thinsp;13.52), which may be attributed to the impairments of neural functions of temporal lobe in mental aspects.\u003c/p\u003e \u003cp\u003eIn a word, the relationship between psychiatric disorders and epilepsy is complex, and the symptoms are not only the consequence of the epilepsy but also the etiology. By the same token, there is evidence of a bidirectional relationship between some psychiatric disorders and epilepsy [5]. Keezer, et al. proposed a classification scheme for the different mechanisms of association between epilepsy and comorbid conditions and mentioned the mechanisms of association including shared risk factors and bidirectional effects. Shared risk factors can be genetic, environmental, structural or physiological [3]. In our clinical works, understanding which comorbidities might develop in people with epilepsy is equally relevant. The idea is that early detection would lead to early intervention and tangible health-care benefits for the patient. However, at present, psychiatric, cognitive, and several somatic comorbidities are still frequently undetected and undertreated in people with epilepsy [3].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe evidence from our study with epilepsy caused by LBTs cohort may compromise its retrospective nature and limited sample size. In addition, we just analyzed the general anxiety and depression without all specific domains of psychological function. Even so, our results could also partly complement the undefined domains of the anxiety and depression outcomes in patients with epilepsy caused by LBTs. In the future, a large, prospective and well-matched surgical cohort of LBTs from multiple epilepsy centers is still needed to get more comprehensive evidences concerning psychiatric disorders to guide the clinical treatment of patients with LBTs.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe preoperative psychiatric disorders were commonly found in patients with epilepsy caused by LBTs, and clinical factors of discordant EEG findings and temporal invasion of tumor were adverse predictors of preoperative anxiety or depression deficits. However, discordant EEG findings were often found in patients with longer epilepsy duration. Therefore, early surgical intervention is necessary for patients with LBTs to avoid the occurrence of mental impairments.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e Not appliable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u0026nbsp;\u003c/strong\u003eXie S and Luan G had the idea for the article; Xie S, Qiao J, and Luan G performed the data collection or analysis; Xie S, Xie M and Xiao S drafted and/or critically revised the work; All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003eThe data used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e The Research Ethics Committee of Sanbo Brain Hospital approved the study. The manuscript does not contain individual clinical data, and informed consent was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eNot applicable\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJones R, Rickards H, Cavanna AE. The prevalence of psychiatric disorders in epilepsy: a critical review of the evidence. Functional neurology 2010;25:191-4.\u003c/li\u003e\n\u003cli\u003eKanner AM. Psychiatric comorbidities and epilepsy: is it the old story of the chicken and the egg? Annals of neurology 2012;72:153-5.\u003c/li\u003e\n\u003cli\u003eKeezer MR, Sisodiya SM, Sander JW. Comorbidities of epilepsy: current concepts and future perspectives. The Lancet Neurology 2016;15:106-15.\u003c/li\u003e\n\u003cli\u003eSalpekar JA, Mula M. Common psychiatric comorbidities in epilepsy: How big of a problem is it? Epilepsy \u0026amp; behavior : E\u0026amp;B 2019;98:293-7.\u003c/li\u003e\n\u003cli\u003eLaFrance WC, Jr., Kanner AM, Hermann B. Psychiatric comorbidities in epilepsy. International review of neurobiology 2008;83:347-83.\u003c/li\u003e\n\u003cli\u003eKwong KL, Lam D, Tsui S, et al. Anxiety and Depression in Adolescents With Epilepsy. Journal of child neurology 2016;31:203-10.\u003c/li\u003e\n\u003cli\u003eBlumcke I, Spreafico R, Haaker G, et al. Histopathological Findings in Brain Tissue Obtained during Epilepsy Surgery. The New England journal of medicine 2017;377:1648-56.\u003c/li\u003e\n\u003cli\u003eBl\u0026uuml;mcke I, Aronica E, Becker A, et al. Low-grade epilepsy-associated neuroepithelial tumours - the 2016 WHO classification. Nature reviews Neurology 2016;12:732-40.\u003c/li\u003e\n\u003cli\u003eAbe C, Denney D, Doyle A, et al. Comparison of psychiatric comorbidities and impact on quality of life in patients with epilepsy or psychogenic nonepileptic spells. Epilepsy \u0026amp; behavior : E\u0026amp;B 2020;102:106649.\u003c/li\u003e\n\u003cli\u003eEhrstedt C, Rydell AM, Gabert Hallsten M, Str\u0026ouml;mberg B, Ahlsten G. Cognition, health-related quality of life, and mood in children and young adults diagnosed with a glioneuronal tumor in childhood. Epilepsy \u0026amp; behavior : E\u0026amp;B 2018;83:59-66.\u003c/li\u003e\n\u003cli\u003eZung WW. A rating instrument for anxiety disorders. Psychosomatics 1971;12:371-9.\u003c/li\u003e\n\u003cli\u003eZung WW. A SELF-RATING DEPRESSION SCALE. Archives of general psychiatry 1965;12:63-70.\u003c/li\u003e\n\u003cli\u003eMaier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. Journal of affective disorders 1988;14:61-8.\u003c/li\u003e\n\u003cli\u003eDunstan DA, Scott N, Todd AK. Screening for anxiety and depression: reassessing the utility of the Zung scales. BMC psychiatry 2017;17:329.\u003c/li\u003e\n\u003cli\u003eCormack F, Cross JH, Isaacs E, et al. The development of intellectual abilities in pediatric temporal lobe epilepsy. Epilepsia 2007;48:201-4.\u003c/li\u003e\n\u003cli\u003eEngel J Jr VNP, Rasmussen TB, Ojemann LM Surgical treatment of the epilepsies. New York: Raven Press 1993;1:609-21.\u003c/li\u003e\n\u003cli\u003evan Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604-7.\u003c/li\u003e\n\u003cli\u003eGaitatzis A, Sisodiya SM, Sander JW. The somatic comorbidity of epilepsy: a weighty but often unrecognized burden. Epilepsia 2012;53:1282-93.\u003c/li\u003e\n\u003cli\u003eJones JE, Siddarth P, Almane D, Gurbani S, Hermann BP, Caplan R. Identification of risk for severe psychiatric comorbidity in pediatric epilepsy. Epilepsia 2016;57:1817-25.\u003c/li\u003e\n\u003cli\u003eEttinger A, Reed M, Cramer J. Depression and comorbidity in community-based patients with epilepsy or asthma. Neurology 2004;63:1008-14.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Epilepsy, Anxiety, Depression, Brain tumor, Surgery","lastPublishedDoi":"10.21203/rs.3.rs-5212625/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5212625/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: The aim of the study was to evaluate the concomitant psychiatric disorders of anxiety and depression in patients with epilepsy caused by low-grade brain tumors (LBTs).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: We retrospectively reviewed the clinical data of patients who underwent preoperative neuropsychological evaluations of anxiety and depression and subsequent epilepsy surgery for LBTs. The univariate and multivariate analyses were conducted to analyze the risk factors of the occurrence of anxiety and depression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Of the 107 patients included in the study, 42 patients (39.3%) were female and 28 patients (26.2%) were children. The median age at surgery was 22 years (interquartile range [IQR]: 17-27 years old), the median age of seizure onset was 12 years (IQR: 6-18 years old), and the median duration of epilepsy was 84 months (IQR: 42-180 months). In total, 21 patients (19.6%) had presence of anxiety, and 26 patients (24.3%) had presence of depression. In univariate analysis, discordant (vs. concordant) interictal electroencephalogram (EEG) findings were related to presence of anxiety (P = 0.017). Discordant (vs. concordant) ictal EEG findings (P = 0.023), larger zone of epileptic discharges that was represented by surgical resection extent (P = 0.021), temporal (vs. non-temporal) location of tumor (P = 0.009) and lower full-scale intelligence quotient (P = 0.017) were associated with presence of depression. In multivariate analysis, discordant ictal EEG findings (P = 0.015, odds ratio [OR] = 4.44) and temporal location of tumor (P = 0.015, OR = 13.52) had relevance to presence of depression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Psychiatric disorders of anxiety and/or depression could frequently occur in patients with epilepsy caused by LBTs, especially in patients with discordant or wider epileptic discharges and temporal invasion of tumors.\u003c/p\u003e","manuscriptTitle":"The Concomitant Anxiety and Depression in Patients with Epilepsy Caused by Low-Grade Brain Tumors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-23 05:27:38","doi":"10.21203/rs.3.rs-5212625/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-09T05:30:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-23T20:33:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-22T16:34:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-20T22:38:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49787276672675317639798415613611792607","date":"2024-11-20T07:48:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90022027470950899593091898788474602135","date":"2024-11-15T19:09:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"145568872050010277083150578151506871481","date":"2024-11-13T12:41:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93264910123960547829988717775171029283","date":"2024-11-04T18:41:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-04T10:13:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-30T09:46:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-10-22T10:00:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-21T08:13:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-10-06T11:24:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"da3f78a9-a54c-49a0-a75b-e02e5430b7ea","owner":[],"postedDate":"December 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":41321098,"name":"Health sciences/Neurology"},{"id":41321099,"name":"Health sciences/Oncology"},{"id":41321100,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-01-13T16:03:56+00:00","versionOfRecord":{"articleIdentity":"rs-5212625","link":"https://doi.org/10.1038/s41598-025-85499-w","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-01-09 15:57:05","publishedOnDateReadable":"January 9th, 2025"},"versionCreatedAt":"2024-12-23 05:27:38","video":"","vorDoi":"10.1038/s41598-025-85499-w","vorDoiUrl":"https://doi.org/10.1038/s41598-025-85499-w","workflowStages":[]},"version":"v1","identity":"rs-5212625","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5212625","identity":"rs-5212625","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}