Occupational adjustment following neurosurgical treatment of epilepsy

Abstract

Occupational adjustment was investigated in a group of 32 adult epileptic patients followed for 1 to 10 years after cortical resection for intractable seizures. An employment status rating was assigned according to the following scale: (1) employed (working 75 to 100% of full time); (2) underemployed (25 to 74%); and (3) unemployed (0 to 24%). The number of patients employed increased from 14 to 23, whereas the number of underemployed decreased from 8 to 0. The unemployed group showed little change. An improvement or maintenance of employment status was correlated directly with improved postoperative seizure control. Conversely, poor occupational adjustment was often associated with fair or poor seizure control following operation. Unemployment was also related to the presence of preoperative psychiatric disorders, a history of past unemployment, and cognitive disturbances affecting nondominant hemisphere function. Although improvement in seizure control is important, this investigation suggests it is only one of many influences on the occupational adjustment of patients following surgical treatment of epilepsy.

Factors Associated with Work Outcome After Anterior Temporal Lobectomy for Intractable Epilepsy

“…This magnitude of change in either direction enabled us to identify factors that were associated with a favorable work outcome after anterior temporal lobectomy. Similar to a few other reports (9,10,16,19), we found by univariate analyses that enhancement of seizure control by surgery was favorable for retaining or gaining full-time work after surgery. However, multivariate analysis failed to identify postsurgical seizure control to be independently predictive.…”

“…Of the 51 patients in one study (13), 23 were employed before temporal lobectomy and only 21 afterward. The rate of unemployment in another study was 31% before and 28% after surgery (10). The definition of employment and of unemployment varied considerably among previous series.…”

“…It is disturbing to note that past studies have not consistently demonstrated a gain in the number of employed persons after epilepsy surgery is performed (8)(9)(10)(11)(12). Of the 51 patients in one study (13), 23 were employed before temporal lobectomy and only 21 afterward.…”

“…The definition of employment and of unemployment varied considerably among previous series. One study considered students and persons in a sheltered workshop as being employed (10). Others relied on measures undefined (14,15) or subjective (11,(16)(17)(18) measures (e.g., work "ability," "capacity," "performance," or "career outcome.")…”

“…Others relied on measures undefined (14,15) or subjective (11,(16)(17)(18) measures (e.g., work "ability," "capacity," "performance," or "career outcome.") Heretofore, only five studies (10,14,16,17,19) statistically analyzed their data, and only one (19) demonstrated significant improvement in unemployment rates. Some studies (14,17,19) examined a limited number of factors as predictors of work outcome, but none performed multivariable analysis to identify factors that are independently predictive.…”