Abstracts

RATIONALE: Employment status has been shown to improve following epilepsy surgery, but in many cases, not to the extent that one might expect in seizure free patients. Psychosocial factors have been implicated to explain poor occupational status. The aim of this study is to investigate the influence of age of seizure onset before and after education completion on employment status in epilepsy surgery candidates.
METHODS: We studied 355 patients with epilepsy that were admitted to the VEEG monitoring unit between June 1997 and June 2001. The patients were 15 to 77 years old (mean=37.05 years, SD+/-11.65). 51.3% were female. The sample was divided in two groups according to whether the age of seizure onset occurred before or after they completed their education. Groups were compared considering highest educational and occupational level achieved and current employment status or major day activity. Data were obtained from the 89-item QOL questionnaire developed at the Cleveland Clinic Foundation. Educational and occupational levels were classified on a scale from 1 to 8 where 1 corresponded to the highest level of education and occupation and 8 to the lowest. Chi square and t-test were used for comparison among groups.
RESULTS: 199 patients (56.1%) had seizure onset before they completed education and 112 (31.5%) afterwards. The mean occupational level in patients with seizure onset before education was completed was significantly lower (5.07) than those whose seizures started after (4.27) (T-test = 0.001). Unskilled employees [30 patients (17.9%)] and patients who never worked [18 patients (10.7%)] were more likely to have seizure onset before completion of education (x2=16.40; p=0.022). Patients with seizure onset after completion of education were significantly more likely to be disabled [24 patients (21.8%)], retired [5 patients (4.5%)] or homemakers [22 patients (20%)], while students [31 patients (15.8%)] were more likely to have had seizure onset before completion of education (x2=19.07; p=0.004). No differences were found for the mean educational level (mean=0.13; t-test=0.482) or the level of education achieved between the two groups (x2=10.11; p=0.182).
CONCLUSIONS: Patients with seizure onset before education completion achieve lower occupational status. Seizure onset after education is completed leads to more disability and early retirement. The impact of education status in patients with seizures deserves further study.