Abstracts

Patients often suffer detrimental effects of longstanding epilepsy with respect to social adjustment, education and employment before undergoing resective surgery as a last resort. Post-operative employment gains have been shown to enhance the impact of epilepsy surgery, so studying employment patterns may inform interventions aimed at reintegrating patients into society. At 7 US centers, 396 patients with focal epilepsy enrolled in a cohort study and underwent resective surgery. Eligible patients had refractory epilepsy for at least 2 years, failed 2 or more AED[apos]s, and had at least 20 seizures in the 24 months prior to enrollment. Data were collected from interviews and medical records at baseline and at 3, 12, and 24 months following surgery. Descriptive data on employment pre- and post-surgery were examined. Associations between employment patterns and disability status, race (white vs. non-white) and age [lt] 35 were assessed using the Wilcoxon rank sum test. The cohort was 48% male; average age was 37 years. Mean duration of intractable epilepsy was 13 years. Prior to surgery 45% of the cohort was regularly employed, including 148 (38%) employed full-time and 27 (7%) part-time. Other categories at baseline included 102 (26%) disabled and unemployed; 45 (11%) unemployed; 27 (7%) in school; 22 (6%) homemakers; 12 (3%) irregular or seasonal work; 7 (2%) retired; 3 (1%) volunteer work only; and 1 other. Two years after surgery 52% of the cohort was employed, representing a net employment gain of 7%. Twenty-two percent of those who were disabled and unemployed before surgery obtained regular work, compared with 23% of those who were unemployed but not disabled (p=.93). Whites were more likely than non-whites to be employed before surgery (49% vs 25%, p=.002) and 24 months after surgery (56% vs. 37%, p=.007) but were not significantly more likely to change employment status at 24 months (p=.35). Age under 35 did not influence work status before surgery (p=.55) and 24 months after surgery (p=.77) or change in employment at 24 months (p=.07). Improved employment status is seen in all categories following epilepsy surgery except the retired (0 of 7). However, overall employment gains remain low after 2 years because 12% of the cohort found work but 5% concurrently lost their jobs. Vocational rehabilitation efforts should be enhanced and should include those who were working prior to surgery but unemployed at follow up. The potential for post-operative employment among those who were formerly disabled from epilepsy does not appear to differ from that of the non-disabled unemployed. Race and age below 35 did not affect post-operative change in employment. (Supported by NIH NINDS RO1 32375-06 and the RWJ Foundation.)