Abstracts

RATIONALE: Intractable epilepsy often is associated with neurobehavioral deficits, independent of seizures. Psychosocial adjustment is multiply-determined by medical, psychiatric, cognitive and social factors. At the conclusion, participants will understand a) how these factors combine with epilepsy to keep patients from filling age-appropriate social roles and b) the magnitude of these effects among different sub-groups. These findings argue for targeting preventive and rehabilitative strategies to specific sub-groups at risk for social failure.
METHODS: Analyzed neuroepilepsy, psychiatric, cognitive and social variables prospectively obtained in 259 consecutive patients referred for pre-surgical evaluation to a single epilepsy center from 1991-1996. Exclusion criteria were FSIQ [lt] 70 and age [lt] 20 years. Separate logistic regression analyses were used to predict marital history and current employment status. Predictor variables were gender, history of psychiatric treatment, age at onset of epilepsy, IQ, history of special education, memory impairment and polypharmacy.
RESULTS: Sample characteristics were similar to others in the literature (mean(SD): Age= 36.0 (9.4), Gender= 54% female, Age at Onset=16.4 (12.2), FSIQ=88.8 (10.7), Years of Education=12.7 (2.2). Only 42% were currently employed and 63% had ever been married. Female gender (p [lt] .02), late onset of epilepsy (p [lt] .0001) and absence of special education (p [lt] .0001) were significant and unique predictors of ever having been married. Only 27% of males with a history of special education had ever married, compared to 60% of females. Higher IQ (p [lt] .0001) and no history of psychiatric treatment (p [lt] .002) were significant and unique predictors of being employed. Absence of memory impairment showed a trend association (p =.13) with employment.
CONCLUSIONS: Persons are more likely to marry if epilepsy starts later in life, after social and vocational skills have developed, unhindered by stigma and activity restrictions associated with epilepsy. Males with a history of special education are particularly unlikely to marry, regardless of when seizures onset. The same pattern is not seen in females. Men with seizures, learning disabilities and/or behavior problems may be less attractive to women who seek a mate to fill traditional male roles of father and provider. On the other hand, epilepsy-induced dependence and lack of vocational skills in women may less often deter men who seek a mate to fill traditional female roles of mother and homemaker. Nevertheless, such dependent relationships may ultimately be unhealthy for women, as indicated by the greater incidence of divorce among women vs. men following successful epilepsy surgery. Social and vocational skills training may be particularly useful for both males and females early in the course of intractable epilepsy. Employment is most strongly related to IQ and psychiatric history. Intact cognitive skills and a stable emotional history are valued job skills. They are associated with other characteristics that predict vocational success. Nevertheless, 33% of patients with normal range IQ, no memory impairment and no psychiatric history were unemployed. Thus, intractable epilepsy is a potent barrier to employment, independent of other neurobehavioral deficits. Intractable epilepsy is a sufficient condition by itself to justify vocational services.
[Supported by: Strong Epilepsy Center]