{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T13:01:17Z","timestamp":1791464477032,"version":"4.3.4"},"reference-count":53,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T00:00:00Z","timestamp":1781308800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T00:00:00Z","timestamp":1781308800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically evaluate neuropsychiatric outcomes\u2014depression, anxiety, psychosis, cognition, quality of life, and psychosocial adjustment\u2014following epilepsy surgery in adults, and to quantify pooled effect sizes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We searched MEDLINE, Embase, PsycINFO, and the Cochrane Library from inception through December 2024, Preferred Reporting Items for Systematic reviews and Meta\u2010Analyses (PRISMA 2020). Eligible cohort studies (prospective or retrospective) reported standardized neuropsychiatric outcomes in adults undergoing epilepsy surgery with \u22653 month follow\u2010up. Random\u2010effects meta\u2010analyses (DerSimonian\u2013Laird) pooled continuous outcomes as Hedges' g and dichotomous outcomes as proportions (Freeman\u2013Tukey transformation). Heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      ) was explored via pre\u2010specified subgroups by seizure outcome, follow\u2010up (&lt;2 vs \u22652\u2009years), and instrument. Publication bias was assessed by funnel plots and Egger's and Begg's tests, and risk of bias by the Newcastle\u2013Ottawa Scale.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty\u2010two studies (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096218) met the inclusion criteria; 26 contributed to quantitative meta\u2010analyses. Pooled depression improvement was small\u2010to\u2010moderate (Standardized Mean Difference (SMD)\u2009=\u2009\u2212.24; 95% confidence interval [CI] \u2212.34 to \u2212.14;\n                      <jats:italic>k<\/jats:italic>\n                      \u2009=\u200912;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200930.5%), with larger effects in seizure\u2010free patients (\u2212.47; \u2212.65 to \u2212.29) and no significant change with persistent seizures (\u2212.08; \u2212.28 to .12). De novo psychiatric disorders occurred in 16.3% (95% CI: 11.4\u201321.8%), most commonly depression (9.8%), anxiety (7.1%), and psychosis (2.7%). Epilepsy\u2010related psychoses decreased from 17.5% preoperatively to 4.2% postoperatively. Verbal memory decline occurred in 17%\u201337% of temporal lobe surgery patients but did not independently affect quality of life when seizure freedom was achieved; 20% of seizure\u2010free left TLE patients demonstrated verbal memory improvement. Quality of life improved continuously over 5\u2009years in seizure\u2010free patients. Neither the Egger's (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.86) nor Begg's (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.84) test indicated publication bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>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\u2014including psychosocial adjustment, not quantitatively synthesized in prior reviews\u2014this meta\u2010analysis offers a comprehensive framework for informed surgical counseling.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70301","type":"journal-article","created":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T12:10:36Z","timestamp":1781352636000},"page":"3863-3877","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Multidomain neuropsychiatric outcomes after epilepsy surgery: A systematic review and meta\u2010analysis of depression, psychosis, cognition, and psychosocial adjustment"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7576-1142","authenticated-orcid":false,"given":"Margil","family":"Ranpariya","sequence":"first","affiliation":[{"name":"Department of Neurology University at Buffalo  Buffalo 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