A recent study revealed that most patients succeed in getting a job after temporal lobe surgery. But the most important predictor wasn’t seizure freedom, it was whether they were employed before the operation.

Andres Kanner, M.D., Professor of Neurological Sciences, Rush Medical College, Chicago, Illinois, and his colleagues Marlis Frey, R.N., a certified nurse practitioner, and Richard Byrne, M.D., a neurosurgeon, presented the results of their study at the 58th Annual Meeting of the American Academy of Neurology in San Diego, CA, this past April.

Kanner and his colleagues reviewed the charts of 88 patients who had temporal lobe surgery. Fifty-two of the patients had mesial temporal sclerosis, 18 had another type of lesion in the temporal lobe and 18 had idiopathic temporal lobe epilepsy. Most of the patients (66) were working before their epilepsy surgery.

The results of the study indicated that the best predictor for employment after epilepsy surgery was presurgical employment, followed by seizure freedom and lack of severe psychiatric problems.

In addition, prior to surgery, many patients had psychiatric problems as well as epilepsy; 22 patients had depressive disorder, 21 had depressive and anxiety disorders, and 8 had other psychiatric problems. Kanner explained that the most important predictor of psychiatric problems after surgery was the presence of depression before surgery.

“Our interest in this research grew out of our experience with postsurgical epilepsy patients. We wanted to get a better understanding of which factors contribute to gainful postsurgical employment and ultimately what we could do better to prepare patients to seek and obtain such employment”, said Frey. She further noted that, “This research has important implications for patients and their caregivers as it shows that seizure freedom does not necessarily lead to postsurgical employment. Rather, lack of employment following successful seizure surgery may be related to numerous issues, such as lack of experience in the work force, lack of adequate support system in the home and community, and reaction to psychological stress associated with seizures and their treatment. Such issues are rarely addressed in studies of postsurgery employment because they are often considered to be secondary to seizure.”

Future Goals

“We are working on developing, implementing and evaluating a comprehensive psychosocial program for patients undergoing epilepsy surgery. This program will discuss with patients specific goals following successful epilepsy surgery, help them develop a realistic plan and time frame to reach these goals, and provide feedback and reevaluation on an ongoing basis,” said Frey.

Recommendations

Kanner encourages patients with epilepsy who are unemployed to either seek out or ask for a referral from their doctor for vocational evaluation and rehabilitation to ensure gainful employment as soon as they are diagnosed with epilepsy. In addition, he believes that vocational and psychiatric evaluations should be included in all presurgical evaluations.

References

1. Kanner, AM, Frey M, Byrne R. Predictors of postsurgical gainful employment following epilepsy surgery for the treatment of refractory temporal lobe epilepsy. Neurology 2006;66 (Suppl 2):A322.