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Beyond Seizure Freedom: A Critical Examination of Research Gaps in Anxiety Outcomes Following Temporal Lobe Epilepsy Surgery
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2026
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Infante, Hailey Domonique. (2026). Beyond Seizure Freedom: A Critical Examination of Research Gaps in Anxiety Outcomes Following Temporal Lobe Epilepsy Surgery (Master's thesis, University of Arizona, Tucson, USA).
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Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction, presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
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Temporal lobe epilepsy (TLE) is the most common form of drug-resistant focal epilepsy, often accompanied by a significant, yet frequently overlooked, psychiatric burden. Among these comorbidities, anxiety stands out as the most prevalent and undertreated, affecting an estimated 20–40% of surgical candidates and occurring at two to three times the rate seen in the general population, representing the most common Axis I diagnosis in pre-surgical TLE cohorts. While surgical interventions including anterior temporal lobectomy (ATL), selective or corticoamygdalohippocampectomy (SAH/CAHP), and stereotactic laser amygdalohippocampotomy (SLAH) offer many patients a path toward seizure freedom, their impact on anxiety, a comorbidity that, unlike depression, has not yet been the focus of a dedicated technique-specific synthesis, remains less clearly understood.This critical narrative review brings together evidence from a systematic search of Ovid MEDLINE and Embase (from inception to February 10, 2026), identifying 9,791 records and ultimately including 80 studies. The most comprehensive meta-analysis to date (Rashidi et al., 2025; 18 studies, 1,403 patients) suggests that anxiety tends to improve following TLE surgery. Significant reductions were observed on the Hamilton Anxiety Rating Scale (HAM-A) and the Hospital Anxiety and Depression Scale–Anxiety subscale (HADS-A), although not all instruments demonstrated consistent change, notably, the State-Trait Anxiety Inventory (STAI) showed no significant pooled effect, a finding that reflects differences in what each scale measures rather than a true inconsistency in outcomes. Instruments capturing somatic and reactive anxiety, such as the HAM-A and HADS-A, are sensitive to the surgical reduction of ictal fear and anticipatory anxiety; by contrast, the STAI primarily measures stable trait anxiety mediated by structures less disrupted by mesial temporal surgery. A critical distinction must be drawn between the present work and Rashidi et al. (2025). Rashidi performed a systematic review and pooled meta-analysis that confirmed overall anxiety improvement following TLE surgery but was explicitly unable to stratify findings by surgical technique due to insufficient primary data. The present study is a critical narrative review specifically designed to address this gap using structured narrative synthesis to examine, for the first time, whether ATL, SAH/CAHP, and SLAH produce meaningfully different anxiety trajectories. This distinction defines the original contribution of the review. Across the literature, the overall trend suggests that surgery often leads to either improvement or stabilization of anxiety, particularly in patients who achieve seizure freedom. However, most of this evidence comes from studies focused on ATL, with far fewer examining selective or minimally invasive approaches like SAH or SLAH. As a result, meaningful comparisons between techniques remain limited. Several factors appear to shape anxiety outcomes, including a patient's psychiatric history, the side and extent of resection, and underlying cognitive function. At the same time, the field is constrained by important limitations, including variability in how anxiety is measured, small sample sizes, short follow-up periods, and a lack of direct comparisons between surgical approaches. Current evidence offers cautious reassurance that TLE surgery does not worsen, and may often improve, anxiety. It also highlights a clear need for more consistent, technique-specific research. Future studies should prioritize standardized anxiety assessments and prospective comparisons across surgical approaches to better guide both clinical decision-making and patient counseling.
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Electronic Thesis
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M.S.