Abstracts

Of the more than 2 million persons in the United States with epilepsy, 400,000-600,000 are refractory to antiepileptic medication. Of these, 100,000-300,000 persons may have an epileptic region that can be surgically removed. It has already been established that the length of time a patient is referred to a tertiary epilepsy center is about 20 years. Once referred, the question becomes, what additional factors motivate a person to proceed with epilepsy surgery.
Epilepsy surgery remains an underused treatment modality. To investigate factors associated with subjects who do or do not undergo epilepsy surgery, we compared two groups of subjects with refractory TLE, comparing subjects with and without a history of epilepsy surgery., We retrospectively reviewed all subjects who were evaluated at The Greater Midwest Epilepsy Treatment Center at Saint Louis University during the period of 1990-2001. The epilepsy surgery group was selected by consecutive review of subjects with a diagnosis of mesial temporal lobe epilepsy due to mesial temporal sclerosis who underwent epilepsy surgery. Subjects were matched, on a case by case basis, with subjects with chronic intractable temporal lobe epilepsy with no history of epilepsy surgery. The groups were matched for age, gender and total lifetime seizures. Using Fisher[apos]s Exact test, we compared marital status, insurance, race, and employment between the groups. For the epilepsy surgery subjects, all clinical data was taken from the pre-surgical evaluation., There were 15 men and 15 women in each group. Mean ages were 34.8 for surgery and 37.7 for non-surgery groups (p=0.34). Total lifetime seizures between groups were comparable (p=0.25). Employment between the groups was significantly different (the surgery group being more likely to be employed), p=0.0127. Defining insurance as Medicaid with or without Medicare, there was a near-significant finding (the non-surgery group being more likely to have Medicaid), p= 0.0692. Race (defined as white/non-white) (p=0.47), and marital status (p=0.79) were non-significant., Employment is associated with subjects who underwent epilepsy surgery. While there are many factors that may lead patients to undergo epilepsy surgery, our findings are suggestive that the wish to sustain employment is an important factor, regardless of severity of epilepsy. Of note, a U.S. Department of Health and Human Services research findings, identified that a major concern of persons with disabilities receiving SSDI and/or SSI was this: [ldquo]SSDI and/or SSI benefits were not sufficient to live on, but fear of loss of benefits discouraged work attempts for some, and for others the benefits disappeared too soon after first work attempts were made[rdquo]. This may indicate possible hesitancy on the part of some with epilepsy to proceed with surgery.,