Rationale: People with epilepsy (PWE) have a lower educational level and employment rate compared to the background population
1 which usually is as a consequence of their underlying neurological and/or psychiatric disorder. However, in many cases PWE without a disabling comorbidity struggle with maintaining a job or completing their education for less obvious reasons. In this study, we aimed to evaluate the effect of neuropsychological counseling in changes of subjective symptoms in a group of Danish PWE with educational and vocational difficulties.
Methods: In total 99 Danish outpatients, 18-50 years (mean age 31 years) with problems in maintaining a job or completing an education within reasonable time were enrolled in a cross-sectional study. PWE in special education, sheltered jobs or pension, or with psychiatric or neurological disabling disorder were not included. At inclusion 62/99 were under education or in full time work and 37 worked part time (12 %), unemployed (23 %) or were on sick leave (2 %). Most patients were treated with one antiseizure medication (60 %). Almost half of the patients were seizure-free (46%). Overall clinical neuropsychological assessment showed signs of cognitive dysfunction in 60%, all though often to a discrete degree.
All patients received a written neuropsychological report, including interview, test results, conclusion, suggested coping strategies and recommendations for further interventions. All patients were screened for subjective cognitive complaints (PDQ, Perceived Deficits Questionnaire), depressive symptoms (NDDI-E, Neurological Depressive Disorder in Epilepsy), anxiety symptoms (GAD-7, Generalized Anxiety Disorder-7) and quality of life (QOLIE-10, Quality of Life-10) before and 4 months after the neuropsychological counselling.
Results: All subjective symptoms were improved at follow up.
Conclusions: We found significant positive changes of medium effect size in subjective cognitive complaints, psychiatric symptoms and quality of life four months after neuropsychological counseling of PWE with educational or vocational problems. Systematic managing of psychosocial problems seems to be effective and should be a key issue in the epilepsy clinic in addition to the traditional focus on seizures. Significant limitations of our study are the lack of a control group and reported long term effect on psychosocial outcomes such as employment and educational achievement.
References
1 Jennum P, Gyllenborg J, Kjellberg J. The social and economic consequences of epilepsy: a controlled national study.
Epilepsia. May 2011;52(5):949-56. doi:10.1111/j.1528-1167.2010.02946.x
2 Baxendale S. Cognitive rehabilitation and prehabilitation in people with epilepsy.
Epilepsy Behav. May 2020;106:107027. doi:10.1016/j.yebeh.2020.107027
3 Azuma H, Akechi T. Effects of psychosocial functioning, depression, seizure frequency, and employment on quality of life in patients with epilepsy.
Epilepsy Behav. Dec 2014;41:18-20. doi:10.1016/j.yebeh.2014.09.025
Funding: None