Outcome assessment in seizure surgery: The role of postoperative adjustment

doi:10.1016/S0967-5868(99)90054-1

Journal of Clinical Neuroscience

Volume 6, Issue 4, July 1999, Pages 313-318

https://doi.org/10.1016/S0967-5868(99)90054-1 Get rights and content

Abstract

The usual criteria employed in assessing the outcome of seizure surgery is almost always that of success in abolition of seizures. Whilst this is a logical method of assessment, experience with large series of such patients shows that this is by no means the only significant criterion. Here we examine the process of postoperative adjustment and the role it plays in determining the outcome of temporal lobectomy for refractory epilepsy. The specific domains involved in this process are examined and it is shown that in a number of cases what is thought to have been surgical success has in fact been significantly diminished by difficulties encountered in postoperative adjustment — to such an extent that total seizure abolition has not resulted in clinical advantage.

References (11)

PF Bladin
Medical and social prognosis of temporal lobectomy
DC Taylor
Psychiatric and social issues in measuring the input and output of epilepsy surgery
BG Vickrey et al.
Outcomes with respect to quality of life
PF Bladin
Psychosocial difficulties and outcome after temporal lobectomy
Epilepsia
(1992)
RDC Elwes et al.
Outcome following resective surgery for temporal lobe epilepsy: a prospective follow-up study of 102 consecutive cases
J Neurol Neurosurg Psychiat
(1991)

There are more references available in the full text version of this article.

Cited by (19)

Common experiences of patients following suboptimal treatment outcomes: Implications for epilepsy surgery
2014, Epilepsy and Behavior
Citation Excerpt :
Negative emotions following seizure recurrence have also been implied in the literature. Bladin and colleagues found that 47% of their epilepsy sample with postsurgical seizures experienced regrets about having surgery [7]. Furthermore, in his earlier study, Bladin suggested that there was a pervasive sense of hopelessness and despair reported by patients within the unsuccessful group and their families [2].
Few studies have investigated the patient experience of unsuccessful medical interventions, particularly in the epilepsy surgery field. The present review aimed to gain insight into the patient experience of seizure recurrence after epilepsy surgery by examining the broader literature dealing with suboptimal results after medical interventions (including epilepsy surgery). To capture the patient experience, the literature search focused on qualitative research of patients who had undergone medically unsuccessful interventions, published in English in scholarly journals. Twenty-two studies were found of patients experiencing a range of suboptimal outcomes, including seizure recurrence, cancer recurrence and progression, unsuccessful joint replacement, unsuccessful infertility treatment, organ transplant rejection, coronary bypass graft surgery, and unsuccessful weight-loss surgery. In order of frequency, the most common patient experiences included the following: altered social dynamics and stigma, unmet expectations, negative emotions, use of coping strategies, hope and optimism, perceived failure of the treating team, psychiatric symptoms, and control issues. There is support in the epilepsy surgery literature that unmet expectations and psychiatric symptoms are key issues for patients with seizure recurrence, while other common patient experiences have been implied but not systematically examined. Several epilepsy surgery specific factors influence patient perceptions of seizure recurrence, including the nature of postoperative seizures, the presence of postoperative complications, and the need for increased postoperative medications. Knowledge of common patient experiences can assist in the delivery of patient follow-up and rehabilitation services tailored to differing outcomes after epilepsy surgery.
Long-term outcome and determinants of quality of life after temporal lobe epilepsy surgery in adults
2009, Epilepsy Research
To find determinants of quality of life (QOL) in long-term follow-up after temporal lobe epilepsy (TLE) surgery in adults.
The QOLIE-31 questionnaire was sent to 400 of 524 patients who were operated on for refractory TLE between 1991 and 2003 in the Bethel Epilepsy Centre fulfilling the inclusion criteria of this study. Mainly patients with severe cognitive deficits and patients with progressive brain disorders were excluded. There were 222/400 patients who replied to the QOLIE-31 questionnaire and 147/222 of these patients replied to an additional questionnaire.
Univariate analyses showed that seizure freedom, presence of auras, intake of antiepileptic drugs (AEDs), severity of AED side effects, and driving a car were significantly correlated with all subscales of QOLIE-31. Furthermore, employment status, psychiatric problems, tumors and hippocampus sclerosis pathology, the presence of a partner, age at reply, age at surgery and medical co-morbidities were significantly correlated with some subscales of the QOLIE-31. Multivariate analyses (stepwise regression analyses) revealed that especially the time since the last seizure and the severity of AED side effects had a strong impact on QOL. However, aura at last follow-up, psychiatric treatment and employment were seen in the multivariate analyses as significant predictors of some QOL subscales as well. Most subscales of QOL showed a steep, non-linear increase within the first years of seizure freedom and remained relatively stable except for cognitive function which showed continuous improvement parallel to seizure freedom. For patients who were seizure free since surgery, side effects of AED and/or psychiatric treatment were the strongest determinants of QOL.
Duration of seizure freedom and AED side effects have the strongest impact on QOL in the long-term follow-up. Therefore it is important not only to register intake of AEDs but also to assess side effects of AEDs. Persistence of auras also had an impact on different facets of QOL, but was significantly correlated with intake of AEDs. Apart from factors directly related to epilepsy QOL was dependent of psychosocial factors as employment status, psychiatric complications, and driving a car underlining the necessity of postoperative rehabilitation in this group.
Characterising de novo depression after epilepsy surgery
2009, Epilepsy Research
Citation Excerpt :
In three cases this desire to redress previous imbalances within the relationship was met with resistance from partners. This significant aggravation of marital tension has been previously described as a sociological feature of the ‘burden of normality’ (Bladin et al., 1999; Wilson et al., 2001a). This syndrome characterizes the often difficult process of adjustment following successful epilepsy surgery as patients learn to live without their epilepsy and can occur in up to two thirds of patients (Wilson et al., 2001a, 2004).
De novo depression is a common psychiatric sequelae of epilepsy surgery. To date, no studies have described possible clinical correlates of de novo depression in this population. This qualitative study presents a detailed analysis of five cases of de novo depression. Data were collected from patients’ medical files and routine in-depth psychosocial and psychiatric interviews (the Austin CEP Interview). All patients who developed de novo depression underwent anterior temporal lobectomy (ATL). Four out of five cases occurred within the first 3 months following surgery, and all were preceded by significant post-operative irritability reported by the patient's family. All experienced post-operative marital/relationship conflict that appeared to be a catalyst for deteriorating mood. Post-operative seizures were not temporally linked to the onset of depressive symptoms. This series provides an initial account of factors associated with de novo depression following anterior temporal lobectomy and may be of use in guiding larger scale studies.
Temporal lobe epilepsy
2005, Magnetic Resonance in Epilepsy
Temporal Lobe Epilepsy
2004, Magnetic Resonance in Epilepsy: Neuroimaging Techniques: Second Edition
Paradoxical results in the cure of chronic illness: The "burden of normality" as exemplified following seizure surgery
2004, Epilepsy and Behavior
Little has been written about processes of recovery following life-changing medical interventions for chronic illness. This article reviews our research with chronic epilepsy patients undergoing neurosurgery for the relief of intractable partial seizures. This research has given rise to a new conceptualization of adjustment and outcome following effective treatment of chronic illness, representing the first, detailed characterization of this process from a psychological and psychosocial perspective. Crucial to outcome are patient and family expectations prior to treatment, and learning to discard roles associated with chronic illness after treatment. These and the posttreatment affective functioning of the patient temper the view of medical outcome, and can account for paradoxical clinical effects, such as worsening patient psychosocial functioning in the context of medical treatment success. Our results have clear implications for the clinical management of chronically ill patients and their families to optimize treatment outcome.

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Clinical studyOutcome assessment in seizure surgery: The role of postoperative adjustment

Abstract

Medical and social prognosis of temporal lobectomy

Psychiatric and social issues in measuring the input and output of epilepsy surgery

Outcomes with respect to quality of life

Psychosocial difficulties and outcome after temporal lobectomy

Epilepsia

Outcome following resective surgery for temporal lobe epilepsy: a prospective follow-up study of 102 consecutive cases

J Neurol Neurosurg Psychiat

Clinical study
Outcome assessment in seizure surgery: The role of postoperative adjustment