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 ( I 2 ) 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; I 2 = 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.