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 are available upon reasonable request.

中文翻译：

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癫痫切除手术及其对成人抑郁症的影响：系统评价、荟萃分析以及对未来研究的影响

背景 癫痫手术如何影响癫痫和抑郁症的双向关系仍不清楚。方法 为了更好地理解这个问题，我们使用系统评价和荟萃分析指南的首选报告项目，对癫痫手术前后抑郁症患病率的风险比进行了系统评价和荟萃分析。截至 2022 年 10 月 8 日，对三个数据库中所有评估成人癫痫患者手术前后抑郁症的研究进行了全面筛选。如果在癫痫手术前后评估了抑郁症，则无论随访时间如何，均纳入研究。总共筛选了 1917 项研究的资格，并筛选了 91 篇全文以供纳入；最终纳入35项研究，其中25项研究、2563名患者纳入主要荟萃分析，10项研究纳入探索性分析。使用 Cochrane 的非随机研究中的偏倚风险 - 干预措施 (ROBINS-I) 评估偏倚风险。为了得出手术前后的汇总抑郁率，使用具有 Peto 校正和 95% CI 的随机效应逻辑模型进行了逆方差荟萃分析。异质性通过 Cochran 的 Q 检验及其衍生的不一致性测量 I2 进行评估。结果 总体而言，癫痫切除手术前后的抑郁发生率为 0.70（0.53 至 0.91）95% CI，表明癫痫切除手术（RES）后末次随访评估的抑郁发生率趋于下降。亚组分析表明，出现了积极的长期效果，手术后 6 个月（0.61（0.38 至 0.98））、术后 1 年后（0.53（0.31 至 0.90））和2 年（0.62（0.42 至 0.92））。结论 在耐药性癫痫切除手术前应考虑这一重要发现。然而，应进行前瞻性研究，以确定哪些患者在个体层面上可能面临抑郁症新发或恶化的风险。PROSPERO 注册号 CRD4202235538​​6。数据可根据合理要求提供。