Abstracts

Rationale: Patient related changes after epilepsy surgery often go beyond seizure control to also include social factors such as employment, driving, social relationships, independence, and education. The goal of this study was to systematically review the literature to assess social outcomes in individuals after epilepsy surgery. Methods: A literature search was conducted as part of a larger project on the development of an appropriateness and necessity rating tool to identify patients with potentially resectable focal epilepsy. This was an extensive search using PubMed, EmBase and the Cochrane database, yielding 5061 articles related to epilepsy surgery. Abstracts were reviewed to ensure they met the following inclusion criteria: partial epilepsy, temporal and extra-temporal only, focal resections (e.g. lesionectomy, lobectomy, corticectomy), English only, all ages except neonates (excluded: hypothalamic hamartoma, subpial transactions, hemispherectomies, callosotomies, other palliative procedures, stimulation studies, case reports (single or n≤20), abstracts not published as full papers). 763 met eligibility criteria and were hand searched, yielding 65 articles specifically related to social outcomes including employment, driving, social relationships, independence, behaviour and education. Studies were included in the present systematic review if they also reported post-surgical data on social outcomes and had a follow-up period of at least 24 months. Results: 19 studies met all eligibility criteria. Most showed significant improvement in full-time employment post-surgery. Driving was significantly increased after surgery but this was dependent on seizure-freedom. Patients generally perceived their relationships, independence, and overall lifestyle to be improved post-surgery. One study examining behaviour in children showed improvement in social interaction in those who had surgery compared to those who did not. The results for other social outcome categories were more variable. Marital status generally remained unchanged when compared to controls, education improved modestly, and income/financial status changes depended on how it was assessed (e.g., income level vs. receipt of disability pension). One study demonstrated that more surgical patients were receiving disability pensions than a medically treated control group over time and a second study found an increase in surgical patients receiving sick pay from 22% pre-surgery to 43% at long-term follow-up. Conclusions: Overall, the majority of studies reported improvement in social outcomes. However, more research is required, particularly prospective controlled studies of objective social outcome variables, prior to making clear conclusions about the influence of surgery on social outcomes other than employment or driving status. Studies in children and the elderly addressing social outcomes after epilepsy surgery are also needed.