Abstracts

Considerable research has focused on the impact of epilepsy on quality of life. Less is known regarding perceptions of handicap and the degree to which it changes over time or is affected by specific interventions. The purpose of this study was to determine prospectively the degree to which perceptions of handicap change in persons with chronic temporal lobe epilepsy who are managed medically versus undergo anterior temporal lobectomy. 71 individuals with temporal lobe epilepsy were followed prospectively over a 4 year interval and completed self-report measures of epilepsy-related handicap (Subjective Handicap of Epilepsy scale or SHE) and depression (Beck Depression Inventory) at baseline and follow-up. 49 patients were managed medically and 22 underwent anterior temporal lobectomy during the 4 year interval. Comparison of change scores between the medically managed versus surgery groups were significant on 5 of 6 scales on the SHE (p[lt].05) including [ldquo]Life Satisfaction,[rdquo] [ldquo]Change,[rdquo] [ldquo]Self-perception,[rdquo] [ldquo]Social and Personal,[rdquo] and [ldquo]Work and Activities.[rdquo] Paired sample t-tests demonstrated that persons who underwent epilepsy surgery exhibited significantly (p[lt].05) improved scores on the same five scales while, in contrast, the medically managed group did not show a significant change on SHE except on the [ldquo]Work and Activities[rdquo] scale. No significant relationships were found between changes in subjective handicap (SHE) and changes in depression scores (BDI) indicating that changes in perceptions of disability were independent of mood state. Among individuals who are managed medically, there is little change in their perceptions of handicap, either for the better or the worse, over a 4-year period. In contrast, there is a sharp improvement in perceived handicap among patients who undergo anterior temporal lobectomy. This significant change in several aspects of perceived handicap occurs independent of changes in depressive symptoms. (Supported by NIH NS R01-44351, F32 MH649882, and MO1 RR03186 (GCRC).)