1
|
Hoppe C, Beeres K, Witt J, Sassen R, Helmstaedter C. How are they doing as adults? Psychosocial and socioeconomic outcomes 11-30 years after pediatric epilepsy surgery. Epilepsia Open 2023; 8:797-810. [PMID: 37003960 PMCID: PMC10472367 DOI: 10.1002/epi4.12736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE Pediatric epilepsy surgery yields cure from epilepsy or complete seizure control with continued medication in many patients early in life. This study aimed to evaluate the long-term (>10 years) psychosocial and socioeconomic outcomes of pediatric epilepsy surgery and examine the role of comorbid disability, type of surgery, seizure freedom, and age at surgery. METHODS A novel ad hoc parent/patient questionnaire was used to assess educational and occupational attainment, marital/familial status, mobility, and other outcomes in patients who underwent unilobar or multilobar surgery for drug-refractory epilepsy during their childhood. The questionnaire also captured information on comorbid disability. RESULTS Of the 353 eligible patients, 203 could still be contacted and 101 of these (50%) returned appropriately filled-in questionnaires (follow-up intervals: 11-30 [mean: 19.6] years). The cure from epilepsy rate was 53%. Type of surgery was strongly confounded by comorbid disability. Patients with comorbid disabilities had significantly lower rates of regular school degrees, gainful employment, marriage, and driving license (N = 29; 12%, 4%, 0%, 3%) compared with non-disabled patients (N = 69; 89%, 80%, 43%, and 67%, respectively). Patients achieved lower school degrees than their siblings and parents. Non-disabled seizure-free patients had better employment and mobility outcomes compared with non-seizure-free patients. Age at surgery (<10 vs. ≥10 years of age) did not have any effect on any outcome in patients with preschool seizure onset. SIGNIFICANCE Pediatric epilepsy surgery can lead to permanent relief from epilepsy in many patients, but comorbid disability strongly impacts adult life achievement. In non-disabled patients, favorable outcomes in academic, occupational, marital, and mobility domains were achieved, approaching respective rates in the German population. Complete seizure freedom had additional positive effects on employment and mobility in this group. However, in case of chronic comorbid disability the overall life prospects may be limited despite favorable seizure outcomes.
Collapse
Affiliation(s)
- Christian Hoppe
- Department of EpileptologyUniversity Hospital BonnBonnGermany
| | | | | | - Robert Sassen
- Department of EpileptologyUniversity Hospital BonnBonnGermany
- Department of NeuropediatricsUniversity Hospital BonnBonnGermany
| | | |
Collapse
|
2
|
Mulligan BP, Carniello TN. A procedure for predicting, illustrating, communicating, and optimizing patient-centered outcomes of epilepsy surgery using nomograms and Bayes' theorem. Epilepsy Behav 2023; 140:109088. [PMID: 36702057 DOI: 10.1016/j.yebeh.2023.109088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023]
Abstract
Clinicians have an ethical obligation to obtain and convey relevant information about possible treatment outcomes in a manner that can be comprehended by patients. This contributes to the processes of informed consent and shared prospective decision-making. In epilepsy neurosurgery, there has historically been an emphasis on studying clinician-centered (e.g., seizure- and cognition-related) outcomes and using these data to inform recommendations and, by extension, to frame pre-surgical counseling with respect to patients' decisions about elective neurosurgery. In contrast, there is a relative dearth of available data related to patient-centered outcomes of epilepsy neurosurgery, such as functional (e.g., employment) status, and there is also a lack of methods to communicate these data to patients. Here, illustrated using a hypothetical case scenario, we present a potential solution to the latter of these problems using principles of evidence-based neuropsychology; published data on patient employment status before and after epilepsy neurosurgery; and Bayes' theorem. First, we reviewed existing literature on employment outcomes following epilepsy neurosurgery to identify and extract data relevant to our hypothetical patient, clinical question, and setting. Then, we used the base rate (prior probability) of post-surgical unemployment, contingency tables (to derive likelihood ratios), and Bayes' theorem to compute the conditional (posterior) probability of post-surgical employment status for our hypothetical patient scenario. Finally, we translated this information to an intuitive visual format (Bayesian nomogram) that can support evidence-based pre-surgical counseling. We propose that the application of our patient-centered decision-support process and visual aid will improve clinician-patient communication about prospective risks and benefits of epilepsy neurosurgery and will empower clinicians and patients to make informed decisions about whether or not to pursue elective neurosurgery with a greater degree of confidence and with more realistic and concrete expectations about possible outcomes. We further propose that clinicians and patients would benefit from incorporating this evidence-based framework into a broader sequence of function-focused epilepsy treatment that includes pre-surgical assessments and interventions ("prehabilitation"), neurosurgery, and post-surgical cognitive/vocational rehabilitation.
Collapse
Affiliation(s)
- Bryce P Mulligan
- Epilepsy Program, The Ottawa Hospital, Ottawa, ON, Canada; Department of Psychology, The Ottawa Hospital, Ottawa, ON, Canada; School of Psychology, University of Ottawa, Ottawa, ON, Canada.
| | - Trevor N Carniello
- Behavioural Neuroscience Program, Laurentian University, Sudbury, ON, Canada; Department of Psychology, Laurentian University, Sudbury, ON, Canada
| |
Collapse
|
3
|
Hoppe C, Beeres K, Witt JA, Sassen R, Helmstaedter C. Clinical adult outcome 11-30 years after pediatric epilepsy surgery: Complications and other surgical adverse events, seizure control, and cure of epilepsy. Epilepsia 2023; 64:335-347. [PMID: 36468792 DOI: 10.1111/epi.17477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Pediatric epilepsy surgery promises seizure freedom or even cure of epilepsy. We evaluated the long-term (≥10 years) adult clinical outcome including surgery-related adverse events and complications, which are generally underreported. METHODS A monocentric, single-arm, questionnaire study in now adult patients who underwent epilepsy surgery during childhood. A novel ad hoc parental/patient questionnaire, which addressed diverse outcome domains was applied. RESULTS From a total of 353 eligible patients, 203 could be contacted (3 patients died of causes unknown) and 101 (50%) returned appropriately filled-in surveys. No evidence for a survey-response bias was found. The rate of surgical complications according to the patient records was 9%. As regards the survey, half of the parents/patients reported surgical adverse events (expected and unexpected issues) and one-third reported permanent aversive sequels. Two-thirds of the patients were seizure-free during the last year before follow-up; 63% were Engel class 1A; favorable seizure outcomes (including auras only) were obtained in 73%; and 54% were seizure-free and off antiseizure medicine (ASM), that is, cured of epilepsy. In non-seizure-free patients, seizure relapse occurred at any time during the follow-up interval but 87% of those with a seizure-free first postoperative year were seizure-free at follow-up. One patient experienced a seizure relapse during the ASM withdrawal trial but became seizure-free again with ASMs. Eleven patients reported an increased number of ASMs as compared to the time before surgery. Earlier focal surgery did not affect the long-term clinical outcome. SIGNIFICANCE Pediatric epilepsy surgery was capable of curing epilepsy in about one-half of the children and to significantly control seizures in about three-fourths. Long-term success of focal surgery did not depend on age at surgery or duration of epilepsy. Surgical adverse events including complications may be underreported and must be assessed more thoroughly.
Collapse
Affiliation(s)
- Christian Hoppe
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Kassandra Beeres
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Robert Sassen
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Department of Neuropediatrics, University Hospital Bonn, Bonn, Germany
| | | |
Collapse
|
4
|
Associations between cognition and employment outcomes after epilepsy surgery. Epilepsy Behav 2022; 131:108709. [PMID: 35526464 DOI: 10.1016/j.yebeh.2022.108709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/31/2022] [Accepted: 04/15/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Previous studies have shown that younger age, higher education, and seizure freedom after epilepsy surgery are associated with employment. However, very few studies have investigated associations with cognition and employment status in epilepsy surgery patients. METHODS This retrospective study consists of 46 adult patients, who underwent resective epilepsy surgery in the Helsinki University Hospital between 2010 and 2018 and who had been assessed by a neuropsychologist prior to surgery and 6 months after surgery using a systematic test battery. In addition to neuropsychological evaluation, neurologists assessed the patients prior to surgery and followed up the patients up to 24 months after the surgery and evaluated work status of the patients. Logistic regression models were used to assess the effects of cognition on changes in employment status, while controlling for age and education. RESULTS Out of the 46 patients 38 (82.6%) were seizure free and 7 (15.2%) had their seizures reduced 2 years postsurgically. From prior to surgery to 2 years postsurgery, use of antiseizure medication was reduced in most of the patients, mean reduction of the dosage being 26.9%. Employment status improved in 10 (21.7%) patients, remained unchanged in 27 (58.7%) and worsened in 3 (6.5%). An additional 6 patients were already not working prior to surgery. Subsequent analyses are based on the subsample of 37 patients whose employment status improved or remained unchanged. Mistakes in executive function tasks (p = 0.048) and working memory performance (p = 0.020) differentiated between the group whose employment status remained similar and those who were able to improve their employment status. Epilepsy surgery outcome or changes in antiseizure medication (ASM) use were not associated with changes in employment status. CONCLUSIONS In the subsample of 37 patients, errors in executive function tasks and poorer working memory differentiated patients whose employment status did not change from those patients who could improve their employment status. Problems in executive function and working memory tasks might hinder performance in a complex work environment. When assessing the risks and opportunities in returning to work after surgery, difficulties in working memory and executive function performance should be taken into consideration as they may predispose the patient to challenges at work.
Collapse
|
5
|
Siriratnam P, Foster E, Shakhatreh L, Neal A, Carney PW, Jackson GD, O'Brien TJ, Kwan P, Chen Z, Ademi Z. The effect of epilepsy surgery on productivity: A systematic review and meta-analysis. Epilepsia 2022; 63:789-811. [PMID: 35088411 DOI: 10.1111/epi.17172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES An important but understudied benefit of resective epilepsy surgery is improvement in productivity; that is, people's ability to contribute to society through participation in the workforce and in unpaid roles such as carer duties. Here, we aimed to evaluate productivity in adults with drug-resistant epilepsy (DRE) pre- and post-resective epilepsy surgery, and to explore the factors that positively influence productivity outcomes. METHODS We conducted a systematic review and meta-analysis using four electronic databases: Medline (Ovid), EMBASE (Ovid), EBM Reviews - Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Library. All studies over the past 30 years reporting on pre- and post-resective epilepsy surgical outcomes in adults with DRE were eligible for inclusion. Meta-analysis was performed to assess the post-surgery change in employment outcomes. RESULTS A total of 1005 titles and abstracts were reviewed. Seventeen studies, comprising 2056 unique patients, were suitable for the final quantitative synthesis and meta-analysis. Resective epilepsy surgery resulted in a 22% improvement in overall productivity (95% confidence interval [CI]: 1.07-1.40). The factors associated with increased post-surgery employment risk ratios were lower pre-surgical employment in the workforce (relative risk ratio [RRR] =0.34; 95% CI: 0.15-0.74), shorter follow-up duration (RRR = 0.95; 95% CI: 0.90-0.99), and lower mean age at time of surgery (RRR= 0.97; 95% CI: 0.94-0.99). The risk of bias of the included studies was assessed using Risk Of Bias In Non-randomised Studies - of Interventions and was low for most variables except "measurement of exposure." SIGNIFICANCE There is clear evidence that resective surgery in eligible surgical DRE patients results in improved productivity. Future work may include implementing a standardized method for collecting and reporting productivity in epilepsy cohorts and focusing on ways to reprioritize health care resource allocation to allow suitable candidates to access surgery earlier. This will ultimately benefit individuals with DRE, their families, our communities, and the wider health care system.
Collapse
Affiliation(s)
- Pakeeran Siriratnam
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Neurology Department, Eastern Health, Box Hill, Victoria, Australia
| | - Emma Foster
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lubna Shakhatreh
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Andrew Neal
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Patrick W Carney
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Graeme D Jackson
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Terence J O'Brien
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Kwan
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia.,Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Neurology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Nozaki T, Fujimoto A, Yamazoe T, Niimi K, Baba S, Yamamoto T, Sato K, Enoki H, Okanishi T. Freedom From Seizures Might Be Key to Continuing Occupation After Epilepsy Surgery. Front Neurol 2021; 12:585191. [PMID: 33643186 PMCID: PMC7907155 DOI: 10.3389/fneur.2021.585191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: We hypothesized that epilepsy surgery for adult patients with temporal lobe epilepsy (TLE) who obtained freedom from seizures could provide opportunities for these patients to continue their occupation, and investigated continuity of occupation to test this postulation. Methods: Data were obtained from patients who had undergone resective surgery for medically intractable TLE between October 2009 and April 2019 in our hospital. Inclusion criteria were as follows: (1) ≥16 years old at surgery; (2) post-operative follow-up ≥12 months; (3) seizure-free period ≥12 months. As a primary outcome, we evaluated employment status before and after surgery, classified into three categories as follows: Level 0, no job; Level 1, students or homemakers (financially supported by a family member); and Level 2, working. Neuropsychological status was also evaluated as a secondary outcome. Results: Fifty-one (87.9%) of the 58 enrolled TLE patients who obtained freedom from seizures after surgery continued working as before or obtained a new job (employment status: Level 2). A significant difference in employment status was identified between before and after surgery (p = 0.007; Wilcoxon signed-rank test). Twenty-eight patients (48.3%) were evaluated for neuropsychological status both before and after surgery. Significant differences in Wechsler Adult Intelligence Scale-III scores were identified between before and after surgery (p < 0.05 each; paired t-test). Conclusion: Seizure freedom could be a factor that facilitates job continuity, although additional data are needed to confirm that possibility. Further investigation of job continuity after epilepsy surgery warrants an international, multicenter study.
Collapse
Affiliation(s)
- Toshiki Nozaki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Tomohiro Yamazoe
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Keiko Niimi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Shimpei Baba
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Takamichi Yamamoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| |
Collapse
|
7
|
Reinholdson J, Olsson I, Edelvik Tranberg A, Malmgren K. Long-term employment outcomes after epilepsy surgery in childhood. Neurology 2019; 94:e205-e216. [PMID: 31796526 PMCID: PMC6988983 DOI: 10.1212/wnl.0000000000008681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/09/2019] [Indexed: 11/15/2022] Open
Abstract
Objective To analyze long-term employment outcomes in a population-based cohort of adults who underwent epilepsy surgery in childhood or adolescence and to compare the results to general population reference data. Methods Prospective data on epilepsy surgery procedures performed on patients <19 years of age between 1995 and 2012 were extracted from the Swedish National Epilepsy Surgery Register. Five-, 10-, 15- and 20-year follow-up data were analyzed. Patients aged ≥19 years at follow-up were eligible for inclusion. Educational attainment and employment status were analyzed in relation to seizure outcome. Education and employment outcomes of seizure-free patients with a preoperative IQ of ≥70 were compared to general population reference data. Results A total of 203 patients were included. The mean age at surgery was 13.6 years and 66% had IQ ≥70. Of these, a majority had attained at least high school education 5 years after surgery. Employment rates were 44%, 69%, 71%, and 77% at the 5-, 10-, 15-, and 20-year follow-ups, respectively. Seizure-free patients were significantly more likely to work full-time. Educational attainment and rates of full-time employment of seizure-free patients were similar to the general population. A majority of patients with IQ <70 had attended special education and were reliant on social benefits. Conclusion Long-term overall employment rates were higher compared to most previous studies on surgery in adults. Seizure-free patients with a preoperative IQ ≥70 showed rates of full-time employment similar to the general population. Further research is needed to determine whether this also applies for occupational complexity and wages.
Collapse
Affiliation(s)
- Jesper Reinholdson
- From the Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (J.R., A.E.T., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
| | - Ingrid Olsson
- From the Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (J.R., A.E.T., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Anna Edelvik Tranberg
- From the Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (J.R., A.E.T., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Kristina Malmgren
- From the Department of Clinical Neuroscience, Institute of Neuroscience and Physiology (J.R., A.E.T., K.M.), and Department of Paediatrics, Institute of Clinical Sciences (I.O.), Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| |
Collapse
|
8
|
Parfenova EV, Rider FK, Gersamia AG, Yakovlev AA, Guekht AB. [Epilepsy as a social problem]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:77-85. [PMID: 30335077 DOI: 10.17116/jnevro201811809177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article considers the problem of social restrictions caused by epilepsy. Information on historical aspects and discrimination of patients with epilepsy is presented. The authors consider factors influencing marital status of patients in different countries and present information on the differences in medical restrictions to driving in different countries and in the Russian Federation. Employment status of patients with epilepsy, restrictions related to objective reasons and attitudes of patients and others toward epilepsy are elucidated.
Collapse
Affiliation(s)
- E V Parfenova
- Solovyov Moscow Research and Practical Psychoneurological Center, Moscow, Russia
| | - F K Rider
- Solovyov Moscow Research and Practical Psychoneurological Center, Moscow, Russia
| | - A G Gersamia
- Solovyov Moscow Research and Practical Psychoneurological Center, Moscow, Russia
| | - A A Yakovlev
- Institute of Higher Nervous Activity and Neurophysiology of RAS, Moscow, Russia
| | - A B Guekht
- Solovyov Moscow Research and Practical Psychoneurological Center, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| |
Collapse
|
9
|
Walther K, Dogan Onugoren M, Buchfelder M, Gollwitzer S, Graf W, Kasper BS, Kriwy P, Kurzbuch K, Lang J, Rössler K, Schwab S, Schwarz M, Stefan H, Hamer HM. Psychosocial outcome in epilepsy after extratemporal surgery. Epilepsy Behav 2018; 81:94-100. [PMID: 29454606 DOI: 10.1016/j.yebeh.2018.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/29/2018] [Accepted: 01/29/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Only limited data exist on psychosocial long-term outcome after epilepsy surgery in patients with extratemporal epilepsy. The aim of this study was to investigate psychosocial outcome after extratemporal epilepsy surgery and to assess factors predicting favorable outcome. METHOD Sixty-five out of 104 eligible patients who had undergone extratemporal epilepsy surgery at our epilepsy center between 1990 and 2015 (mean age: 42.2. years; 75% of the resections in the frontal lobe) completed a questionnaire asking about seizure status, employment status, marital and living situation, driving status, depressive symptoms, and quality of life (QOL). Follow-up was on average 9.2years after surgery (range: 1-26years). RESULTS Thirty-eight (58%) patients were free of disabling seizures (Engel class I), and 28 (43%) have not experienced any seizures after surgery (Engel class IA). Employment rate in the primary labor market remained at 45%, but more patients lost employment (14%) than gained employment (8%). Postoperative employment was predicted by preoperative employment (p=.007), seizure freedom (p=.025), older age at seizure onset (p=.018), younger age at follow-up (p=.035), and female gender (p=.048). Seizure-free patients were more likely to be driving; have a partner, particularly in males; and have lower depressive scores. Quality of life at follow-up was best predicted by employment (p=.012), partnership (p=.025), and seizure freedom (p=.025). In contrast, recurrence of seizures and early seizure onset were associated with poor psychosocial outcome, particularly in men. CONCLUSION The study provides support that extratemporal surgery can lead to improved QOL and favorable psychosocial outcome. Seizure freedom is important but not the only determinant of good psychosocial outcome.
Collapse
Affiliation(s)
- Katrin Walther
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Müjgan Dogan Onugoren
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Stephanie Gollwitzer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Wolfgang Graf
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Burkhard S Kasper
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Peter Kriwy
- Institute of Sociology, Chemnitz University of Technology, Thüringer Weg 9, 09126 Chemnitz, Germany
| | - Katrin Kurzbuch
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Johannes Lang
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Michael Schwarz
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hermann Stefan
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| |
Collapse
|
10
|
Malmgren K, Edelvik A. Long-term outcomes of surgical treatment for epilepsy in adults with regard to seizures, antiepileptic drug treatment and employment. Seizure 2016; 44:217-224. [PMID: 27839670 DOI: 10.1016/j.seizure.2016.10.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/06/2016] [Accepted: 10/16/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE There is Class I evidence for short-term efficacy of epilepsy surgery from two randomized controlled studies of temporal lobe resection. Long-term outcome studies are observational. The aim of this narrative review was to summarise long-term outcomes taking the study methodology into account. METHODS A PubMed search was conducted identifying articles on long-term outcomes of epilepsy surgery in adults with regard to seizures, antiepileptic drug treatment and employment. Definitions of seizure freedom were examined in order to identify the proportions of patients with sustained seizure freedom. The quality of the long-term studies was assessed. RESULTS In a number of high-quality studies 40-50% of patients had been continuously free from seizures with impairment of consciousness 10 years after resective surgery, with a higher proportion seizure-free at each annual follow-up. The proportion of seizure-free adults in whom AEDs have been withdrawn varied widely across studies, from 19-63% after around 5 years of seizure freedom. Few long-term vocational outcome studies were identified and results were inconsistent. Some investigators found no postoperative changes, others found decreased employment for patients with continuing seizures, but no change or increased employment for seizure-free patients. Having employment at baseline and postoperative seizure freedom were the strongest predictors of employment after surgery. CONCLUSIONS Long-term studies of outcomes after epilepsy surgery are by necessity observational. There is a need for more prospective longitudinal studies of both seizure and non-seizure outcomes, considering individual patient trajectories in order to obtain valid outcome data needed for counselling patients about epilepsy surgery.
Collapse
Affiliation(s)
- Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Anna Edelvik
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
11
|
Picot MC, Jaussent A, Neveu D, Kahane P, Crespel A, Gelisse P, Hirsch E, Derambure P, Dupont S, Landré E, Chassoux F, Valton L, Vignal JP, Marchal C, Lamy C, Semah F, Biraben A, Arzimanoglou A, Petit J, Thomas P, Macioce V, Dujols P, Ryvlin P. Cost-effectiveness analysis of epilepsy surgery in a controlled cohort of adult patients with intractable partial epilepsy: A 5-year follow-up study. Epilepsia 2016; 57:1669-1679. [DOI: 10.1111/epi.13492] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Marie-Christine Picot
- Clinical Research and Epidemiology Unit; CHU Montpellier; Montpellier France
- INSERM; Clinical Investigation Center 1411; Montpellier France
| | - Audrey Jaussent
- Clinical Research and Epidemiology Unit; CHU Montpellier; Montpellier France
| | - Dorine Neveu
- INSERM U 1058; Montpellier France
- University Montpellier; Montpellier France
| | - Philippe Kahane
- Department of Neurology; GIN; CHU Grenoble; Grenoble France
- INSERM U836, UJF; Grenoble Alpes University; Grenoble France
| | | | | | - Edouard Hirsch
- Department of Neurology; CHU Strasbourg; Strasbourg France
| | - Philippe Derambure
- Lille University Medical Center; CHU Lille, EA 1046; University of Lille2; Lille France
| | - Sophie Dupont
- Epileptology Unit; Assistance Publique-Hôpitaux de Paris; an UPMC University Paris 06; Paris France
| | - Elizabeth Landré
- Department of Neurosurgery; AP-HP and University Paris Descartes; Paris France
| | - Francine Chassoux
- Department of Neurosurgery; AP-HP and University Paris Descartes; Paris France
| | - Luc Valton
- Department of Neurology; University Hospital, and UMR 5549; CNRS; Toulouse France
| | - Jean-Pierre Vignal
- Clinical Neurophysiology and Epileptology Department; University Hospital of Nancy; Nancy France
| | | | - Catherine Lamy
- Department of Neurology; AP-HP and University Paris Descartes; Paris France
| | - Franck Semah
- Lille University Medical Center; CHU Lille, EA 1046; University of Lille2; Lille France
- Department of Neurosurgery; AP-HP and University Paris Descartes; Paris France
- Department of Neurology; AP-HP and University Paris Descartes; Paris France
| | - Arnaud Biraben
- Department of Neurology; University Hospital of Rennes; Rennes France
| | - Alexis Arzimanoglou
- Epilepsy; Sleep and Paediatric Neurophysiology Department (ESEFNP); University Hospitals of Lyon (HCL) and DYCOG Team; Lyon Neuroscience Research Centre (CRNL); INSERM U1028; CNRS UMR 5292; Lyon France
| | - Jérôme Petit
- La Teppe Epilepsy Center; Tain l'Hermitage France
| | - Pierre Thomas
- Department of Neurology; University Hospital of Nice; Nice France
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit; CHU Montpellier; Montpellier France
| | - Pierre Dujols
- Clinical Research and Epidemiology Unit; CHU Montpellier; Montpellier France
- INSERM U 1058; Montpellier France
- University Montpellier; Montpellier France
| | - Philippe Ryvlin
- Department of Functional Neurology and Epileptology and the Institute of Epilepsies; Hospices Civils de Lyon; Lyon France
- Lyon 1 University; Lyon's Neuroscience Research Center; Lyon France
- Department of Clinical Neurosciences, CHUV; Lausanne Switzerland
| |
Collapse
|
12
|
Fabris RR, Cascino TG, Mandrekar J, Marsh WR, Meyer FB, Cascino GD. Drug-resistant focal epilepsy in women of childbearing age: Reproduction and the effect of epilepsy surgery. Epilepsy Behav 2016; 60:17-20. [PMID: 27176879 DOI: 10.1016/j.yebeh.2016.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/22/2016] [Accepted: 04/02/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Women with epilepsy (WWE) have lower birth rates than expected. The reasons for this are multifactorial and involve a complex interaction between reproductive endocrine and psychosocial factors. The effect of epilepsy surgery on reproduction in women with drug-resistant focal epilepsy has not previously been studied. METHODS Adult women of childbearing age (18-45years old) with drug-resistant focal epilepsy who had undergone a focal cortical resection between 1997 and 2008 at the Mayo Clinic in Rochester, MN were included in the study. Patients who had a history of hysterectomy or tubal ligation or who were menopausal at the time of surgery were excluded. Data on prior pregnancies and births, epilepsy history, surgical treatment, hormonal dysfunction, and socioeconomic status were obtained using a retrospective chart review. Associations between various clinical and demographic variables with changes in pregnancies and births from pre- to postsurgery were assessed using Chi-square or Fisher's exact test for categorical variables and Wilcoxon rank sum test for continuous variables. All tests were 2-sided, and p-values less than 0.05 were considered statistically significant. All analyses were performed using SAS software version 9.2 (SAS INC, Cary NC). RESULTS One hundred and thirteen women (average age: 30.5years) were included in the study. Average length of follow-up was 5.7years (SD-3.90). Sixty-four patients (57.5%) were nulliparous at the time of surgery. Sixty-one patients (54%) had never been married. Average number of pregnancies per patient prior to surgery was 0.93, and average number of births prior to surgery was 0.73. After surgery, a total of 17 women had a total of 35 pregnancies and 25 births. The average number of pregnancies and births after surgery was 1.27 and 0.96, respectively. Infertility was reported in one patient postoperatively. Patients who were younger at the time of surgery experienced a greater change in the number of pregnancies and births after surgery (p=0.0036 and 0.0060, respectively). Patients who received fewer antiepileptic drug medication trials by the time of surgery also had a greater change in the number of births after surgery (p=0.0362). Seizure onset localization and lateralization, presurgical seizure frequency, age at seizure onset, duration of epilepsy, and postoperative seizure outcome were not statistically significant factors. CONCLUSION The present retrospective observational study provides additional evidence for the importance of early surgical treatment in women with drug-resistant focal epilepsy. Patients who had received fewer medications prior to surgery were more likely to experience an increase in births following surgery. The significance of these findings requires further investigation but may support a role for earlier surgical intervention in the management of drug-resistant focal epilepsy.
Collapse
Affiliation(s)
- Rachel R Fabris
- Mayo Clinic, Division of Epilepsy, Department of Neurology, Rochester, MN, United States
| | | | - Jay Mandrekar
- Mayo Clinic, Department of Health Sciences Research, Rochester, MN, United States
| | - W Richard Marsh
- Mayo Clinic, Department of Neurosurgery, Rochester, MN, United States
| | - Frederic B Meyer
- Mayo Clinic, Department of Neurosurgery, Rochester, MN, United States
| | - Gregory D Cascino
- Mayo Clinic, Division of Epilepsy, Department of Neurology, Rochester, MN, United States
| |
Collapse
|
13
|
Alonso NB, Mazetto L, de Araújo Filho GM, Vidal-Dourado M, Yacubian EMT, Centeno RS. Psychosocial factors associated with in postsurgical prognosis of temporal lobe epilepsy related to hippocampal sclerosis. Epilepsy Behav 2015; 53:66-72. [PMID: 26520878 DOI: 10.1016/j.yebeh.2015.09.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 11/28/2022]
Abstract
We examined the long-term psychosocial trajectory in a consecutive and homogeneous series of 120 patients followed up for five years after corticoamygdalohippocampectomy (CAH). Evaluation of psychosocial variables at baseline and at five-year follow-up were compared. After five years of CAH, a significant improvement in educational level (p=0.004) and employment status (p<0.001) was observed, although retirement (p<0.001) and divorce (p=0.021) rates increased. In a long-term follow-up, a tendency to have similar QOL profile was observed between Engel classes IA and IB (p>0.05). A more favorable surgical outcome (Engel IA) was related to better psychiatric status (p=0.012). Poor psychosocial adjustment before surgery was the most important predictor of QOL outcome (p<0.05). Patients' trajectory after surgical treatment showed positive effects mainly in those with better seizure outcome. Our results emphasized the influence regarding baseline psychosocial functioning on postoperative psychosocial adjustment. Furthermore, many psychosocial gains and difficulties after surgery may be similar in developing and developed countries.
Collapse
Affiliation(s)
| | - Lenon Mazetto
- Department of Neurology, Escola Paulista de Medicina/UNIFESP, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
14
|
Employability in people with epilepsy: A systematic review. Epilepsy Res 2015; 116:67-78. [DOI: 10.1016/j.eplepsyres.2015.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/12/2015] [Accepted: 06/23/2015] [Indexed: 11/20/2022]
|
15
|
Edelvik A, Flink R, Malmgren K. Prospective and longitudinal long-term employment outcomes after resective epilepsy surgery. Neurology 2015; 85:1482-90. [PMID: 26408490 PMCID: PMC4631069 DOI: 10.1212/wnl.0000000000002069] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/29/2015] [Indexed: 11/22/2022] Open
Abstract
Objective: To investigate long-term employment outcomes after resective epilepsy surgery in a national population-based cohort of adults. Methods: In the Swedish National Epilepsy Surgery Register, all adults who were operated with resective epilepsy surgery from 1995 to 2010 were identified. Two-year follow-up was available for 473/496, 5-year follow-up for 220/240, 10-year follow-up for 240/278, and 15-year follow-up for 85/109 patients. Results: There were no significant changes in employment outcome over time at group level, but for those with full-time employment at baseline, 79%, 79%, 57%, and 47% of seizure-free patients were in full-time work at 2-, 5-, 10-, and 15-year follow-up, compared to patients with benefits at baseline, where 16%, 27%, 31%, and 33% of seizure-free patients worked full time at these time points (p = 0.018 at 10 years). More patients with full-time work had ability to drive, a family of their own, and higher educational status than patients in part-time work or on benefits. Univariate predictors for employment at long term were having employment preoperatively, higher education, favorable seizure outcome, male sex, and younger age at surgery. Multivariate predictors were having employment preoperatively, favorable seizure outcome, and younger age. Conclusions: The best vocational outcomes occurred in seizure-free patients who were employed or students at baseline, which may reflect a higher general psychosocial level of function. Younger age also predicted better employment outcomes and it therefore seems plausible that early referral for surgery could contribute to better vocational outcomes.
Collapse
Affiliation(s)
- Anna Edelvik
- From the Department of Clinical Neuroscience and Rehabilitation (A.E., K.M.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Clinical Neurophysiology (R.F.), Uppsala University Hospital, Sweden.
| | - Roland Flink
- From the Department of Clinical Neuroscience and Rehabilitation (A.E., K.M.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Clinical Neurophysiology (R.F.), Uppsala University Hospital, Sweden
| | - Kristina Malmgren
- From the Department of Clinical Neuroscience and Rehabilitation (A.E., K.M.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Clinical Neurophysiology (R.F.), Uppsala University Hospital, Sweden
| |
Collapse
|
16
|
Johnson AM, Sugo E, Barreto D, Cunningham AM, Hiew CC, Lawson JA, Somerville ER, Connolly AM, Bye AM. Clinicopathological associations in temporal lobe epilepsy patients utilising the current ILAE focal cortical dysplasia classification. Epilepsy Res 2014; 108:1345-51. [DOI: 10.1016/j.eplepsyres.2014.06.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/09/2014] [Accepted: 06/13/2014] [Indexed: 11/16/2022]
|
17
|
Jones JE, Blocher JB, Jackson DC. Life outcomes of anterior temporal lobectomy: serial long-term follow-up evaluations. Neurosurgery 2014; 73:1018-25. [PMID: 24056319 DOI: 10.1227/neu.0000000000000145] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND At 3 time points, this study examined long-term psychosocial life outcomes of individuals who underwent anterior temporal lobectomy in comparison with individuals with temporal lobe epilepsy who were medically managed. OBJECTIVE To examine seizure frequency, employment, driving, independent living, financial independence, mental health, and quality of life at each follow-up assessment, as well as predictors of outcomes. METHODS All participants were diagnosed with medically intractable complex partial seizures of temporal lobe origin with or without secondary generalization. A structured clinical interview was used at all 3 time points. Information was obtained regarding seizure frequency, antiepilepsy medications, employment, driving status, financial assistance, and independent living. Additionally, questions regarding quality of life, satisfaction with surgery, and the presence of depression or anxiety were included. Participants were, on average, 17 years postsurgery. RESULTS Surgery resulted in significantly improved and sustained seizure outcomes. At the first, second, and third follow-ups, 67%, 72%, and 67% of participants in the surgery group remained seizure-free in the year before the follow-up interview. At each follow-up, 97%, 84%, and 84% reported that they would undergo surgery again. Seizure freedom predicted driving outcomes at all 3 time points, but was not a significant predictor for employment, independent living, or financial independence. Psychosocial life outcomes in the surgical group were improved and maintained over time in comparison with the medically managed group. CONCLUSION This systematic long-term investigation provides strong support for the positive impact of anterior temporal lobectomy on psychosocial life outcomes including driving, employment, independent living, and financial independence.
Collapse
Affiliation(s)
- Jana E Jones
- *University of Wisconsin School of Medicine & Public Health, Department of Neurology, Madison, Wisconsin; ‡Long Island University, Department of Psychology, Brookville, New York
| | | | | |
Collapse
|
18
|
Thorbecke R, May TW, Koch-Stoecker S, Ebner A, Bien CG, Specht U. Effects of an inpatient rehabilitation program after temporal lobe epilepsy surgery and other factors on employment 2 years after epilepsy surgery. Epilepsia 2014; 55:725-733. [DOI: 10.1111/epi.12573] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Theodor W. May
- Epilepsy Center Bethel; Society for Epilepsy Research; Bielefeld Germany
| | - Steffi Koch-Stoecker
- Epilepsy Center Bethel; Clinic Mara; Bielefeld Germany
- Center for Psychiatry and Psychotherapy; Bielefeld Protestant Hospital; Bielefeld Germany
| | - Alois Ebner
- Epilepsy Center Bethel; Clinic Mara; Bielefeld Germany
| | | | - Ulrich Specht
- Epilepsy Center Bethel; Clinic Mara; Bielefeld Germany
| |
Collapse
|
19
|
Employment in people with epilepsy from the perspectives of patients, neurologists, and the general population. Epilepsy Behav 2012; 25:489-94. [PMID: 23153712 DOI: 10.1016/j.yebeh.2012.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 10/01/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Finding and continuing employment are among the most important issues for patients with epilepsy (PWE). Earlier studies indicated overrepresentation of PWE in manual unskilled or semiskilled positions. METHODS The questionnaire-based study was carried out throughout Poland between February and March 2009. 995 PWE (18-65 yrs), 179 neurologists, and a representative sample of the Polish population over 15 yrs of age (1042) were included. RESULTS 49% of PWE were employed. Patients with epilepsy most commonly work as service and sales workers, office workers, professionals, and technicians. 56% of Poles, 25% of patients, and 28% of neurologists believed that all PWE could work. CONCLUSIONS Almost 3/4 of PWE held non-manual positions. This contradicts the stereotype of unskilled professions being more suitable for PWE. Generally, Poles have a positive attitude towards employment of PWE, but the lack of knowledge about the condition makes them less prudent than neurologists and the PWE themselves.
Collapse
|
20
|
Abstract
Recent evidence suggests that medically resistant epilepsy can be identified if seizures persist despite adequate doses of 2 appropriate first-line antiepileptic drugs (AEDs). Patients with medically resistant epilepsy should have their seizures carefully characterized in order to confirm their diagnosis, select treatment, and assist in determining prognosis. Patients should be counseled about factors that aggravate epilepsy and the importance of adhering to treatments. Physicians should carefully inquire about side effects and alter therapy to eliminate or minimize these symptoms. Uncontrolled seizures cause injuries, disability, and increased mortality, so surgery should be considered as soon as seizures are proven to be medically resistant. Patients with incomplete response to AEDs and who are not surgical candidates may benefit from additional medication trials or from palliative nonmedical therapies, such as vagal nerve stimulation.
Collapse
Affiliation(s)
- Gregory L Krauss
- Johns Hopkins University (GLK), Baltimore; and Thomas Jefferson University (MRS), Philadelphia
| | | |
Collapse
|