Multidomain neuropsychiatric outcomes after epilepsy surgery: A systematic review and meta-analysis of depression, psychosis, cognition, and psychosocial adjustment

Objective: To systematically evaluate neuropsychiatric outcomes—depression, anxiety, psychosis, cognition, quality of life, and psychosocial adjustment—following epilepsy surgery in adults, and to quantify pooled effect sizes. Methods: We searched MEDLINE, Embase, PsycINFO, and the Cochrane Library from inception through December 2024, Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020). Eligible cohort studies (prospective or retrospective) reported standardized neuropsychiatric outcomes in adults undergoing epilepsy surgery with ≥3 month follow-up. Random-effects meta-analyses (DerSimonian–Laird) pooled continuous outcomes as Hedges' g and dichotomous outcomes as proportions (Freeman–Tukey transformation). Heterogeneity (I²) was explored via pre-specified subgroups by seizure outcome, follow-up (<2 vs ≥2 years), and instrument. Publication bias was assessed by funnel plots and Egger's and Begg's tests, and risk of bias by the Newcastle–Ottawa Scale. Results: Forty-two studies (n = 6218) met the inclusion criteria; 26 contributed to quantitative meta-analyses. Pooled depression improvement was small-to-moderate (Standardized Mean Difference (SMD) = −.24; 95% confidence interval [CI] −.34 to −.14; k = 12; I² = 30.5%), with larger effects in seizure-free patients (−.47; −.65 to −.29) and no significant change with persistent seizures (−.08; −.28 to.12). De novo psychiatric disorders occurred in 16.3% (95% CI: 11.4–21.8%), most commonly depression (9.8%), anxiety (7.1%), and psychosis (2.7%). Epilepsy-related psychoses decreased from 17.5% preoperatively to 4.2% postoperatively. Verbal memory decline occurred in 17%–37% of temporal lobe surgery patients but did not independently affect quality of life when seizure freedom was achieved; 20% of seizure-free left TLE patients demonstrated verbal memory improvement. Quality of life improved continuously over 5 years in seizure-free patients. Neither the Egger's (p =.86) nor Begg's (p =.84) test indicated publication bias. Significance: Epilepsy surgery produces measurable improvements in depression, psychosis, and quality of life, with seizure freedom as the primary determinant. De novo psychiatric disorders in a substantial minority underscore the need for presurgical screening and longitudinal postoperative monitoring. By integrating evidence across five outcome domains—including psychosocial adjustment, not quantitatively synthesized in prior reviews—this meta-analysis offers a comprehensive framework for informed surgical counseling.