Abstracts

RATIONALE: For patients with pharmacoresistant focal epilepsies surgical treatment provides the opportunity for a seizure-free life. However, expectations of psychosocial improvements are equally important.
This prospective study, launched in 1997, asked for effects of epilepsy surgery on medical, neuropsychological, and psychosocial/socioeconomic changes. Since the newly-formed German states show several regional characteristics (such as changes of educational conditions, high unemployment rate) this study has been carried out at the Epilepsy Center of the University of Greifswald, Germany.
The goal of the study was to identify predictors for a generally good post-surgical outcome at the different levels. Furthermore, it was intended to detect difficulties for the patients and in this case to offer appropriate help.
METHODS: Forty-three adults with focal epilepsy participated in the study. They all received anti-epileptic drugs. Thirty-five of these patients received surgery (group 1). For the remaining eight, it was not possible to operate (group 2). All patients were tested presurgically (t[sub]1[/sub]) and at 12-month follow-up (t[sub]2[/sub]) by standardized assessment instruments such as cognitive performance tests, self-rating scales to determine personality profile, clinical-psychological parameters, health-related quality of life, and a structured interview to assess psychosocial aspects.
RESULTS: At t[sub]1[/sub] those patients treated with surgery and those who were treated conservatively did not differ significantly. One third of patients suffered from cognitive problems which were mostly related to memory dysfunction. Fifty percent of patients showed an increased level of anxiety whereas 25% of subjects showed an increased level of depression. Approximately half of the patients were unemployed or retired due to their epileptic condition. Vocational rehabilitation was available for only half of those patients. Approximately forty percent of all patients were tested to have a poor quality of life.
At t[sub]2[/sub] cognitive abilities such as attention and visiospatial functions of the patients treated with surgery were improved. The amount of emotional difficulties was significantly reduced. This result was in contrast to the conservatively treated patients. Twenty percent of the surgery patients compared to forty percent of the conservatively treated patients were tested to have a poor quality of life. The vocational situation in the surgical group deteriorated at t[sub]2[/sub]. For these patients there was a trend from unemployment toward retirement.
Employment at t[sub]1[/sub], cognitive improvement, and absence of emotional difficulties at t[sub]2[/sub], but not the seizure freedom were found to be the best predictors for a good post-surgical quality of life.
CONCLUSIONS: Successful surgical treatment of epilepsy is not necessarily related to improvement of socioeconomic factors. It is possible to improve both psychological difficulties and, to a certain extent, cognitive functioning which are the basis for a better psychosocial and socioeconomic integration of patients. Additional pre- and post-surgical rehabilitative interventions are necessary, especially with respect to the poor employment situation.