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Systematic review
Resective epilepsy surgery and its impact on depression in adults: a systematic review, meta-analysis, and implications for future research
  1. Natalia Hernandez Poblete1,
  2. Florian Gay2,
  3. Francesco Salvo3,
  4. Jean-Arthur Micoulaud-Franchi1,4,
  5. Thomas Bienvenu2,5,
  6. Julien Coelho1,
  7. Jerome Aupy1,6
  1. 1Clinical Neurosciences, CHU de Bordeaux, Bordeaux, Nouvelle-Aquitaine, France
  2. 2CERPAD, CH Charles Perrens, Bordeaux, Aquitaine, France
  3. 3INSERM, Pharmaco-epidemiology Team, Université de Bordeaux, Bordeaux, France
  4. 4CNRS, SANPSY, Université de Bordeaux, Bordeaux, France
  5. 5INSERM, Neurocentre Magendie, Université de Bordeaux, Bordeaux, France
  6. 6CNRS, IMN, Université de Bordeaux, Bordeaux, France
  1. Correspondence to Jerome Aupy, Clinical Neurosciences, CHU de Bordeaux, Bordeaux, Nouvelle-Aquitaine, France; jerome.aupy{at}


Background How epilepsy surgery influences the bidirectional relationship of epilepsy and depression remains poorly defined.

Method For a better understanding of this question, we conducted a systematic review and meta-analysis of risk ratio on depression prevalence before and after epilepsy surgery, using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Three databases were comprehensively screened for all studies assessing depression before and after resective surgery in adult epileptic patients until 8 October 2022. Studies were included if depression was assessed before and after epilepsy surgery regardless of the time of follow-up. A total of 1917 studies were screened for eligibility and 91 full-texts up for inclusion; 35 studies were finally included, 25 studies and 2563 patients were included in main meta-analysis and 10 for exploratory analysis. Risk of bias was assessed using Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) from Cochrane. To derive the pooled depression rates before and after surgery, a meta-analysis with inversed-variance was performed using random-effects logistic models with Peto’s correction and a 95% CI. Heterogeneity was assessed with Cochran’s Q-test along with its derived measure of inconsistency I2.

Results Overall, the depression rates before and after resective epilepsy surgery were 0.70 (0.53 to 0.91) 95% CI, suggesting that the rate of depression at last follow-up evaluation tends to decrease after Resective Epilepsy Surgery (RES). Subgroup analysis suggest a positive long-term effect appears with a significant lower rates of depression already 6 months (0.61 (0.38 to 0.98)), after surgery which is maintained over time after 1 year (0.53 (0.31 to 0.90)), and after 2 years (0.62 (0.42 to 0.92)).

Conclusion This important finding should be taken in consideration before resective surgery for drug-resistant epilepsies. However, prospective studies should be conducted to characterise which patient, at the individual level, might be at risk of de novo or worsening of depression.

PROSPERO registration number CRD42022355386.

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors JA : responsible for the overall content as the guarantor ; NHP and JA: conception of the work, acquisition, analysis, interpretation of data, and drafting; FG: analysis and interpretation of data; FS and J-AM-F: conception of the work and interpretation of data; TB: interpretation of data, drafting; JC: analysis and interpretation of data and drafting.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. We confirm that you we used the 2020 PRISMA criteria.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.