Psychosocial adjustment following surgery for intractable epilepsy.

Abstract

Contemporary surgical techniques have proven effective in eliminating seizures in patients who suffer from intractable epilepsy. While the medical benefits of seizure control are well-documented, relatively little attention has been paid to the positive and negative psychosocial consequences of an abrupt cessation of seizure activity. This project investigated the psychosocial functioning, expectations, and satisfaction of patients who underwent epilepsy surgery. Study 1, a retrospective record review of surgery patients' scores on the Washington Psychosocial Seizure Inventory and the Minnesota Multiphasic Personality Inventory, examined the psychosocial functioning of 79 patients prior to surgery, 2 months post-surgery, and 1 year post-surgery. Results of Study 1 indicate that patients who became seizure-free showed marked improvement at the 2 month follow-up in a number of areas of psychosocial functioning, including emotional and interpersonal adjustment. At the 1 year follow-up, these patients continued to show improvement in psychosocial functioning. In contrast, patients with continued seizures showed some improvement in these areas at 2 months post-surgery but returned to baseline or worse by the 1 year follow-up. Study 2 investigated 32 of the patients in Study 1, as well as 17 of their significant others, before and after epilepsy surgery in an effort to detect relationships among expectations for surgery, satisfaction with surgery, quality of life, and adjustment to surgery. A semi-structured interview was used to assess subjects' pre-surgery predictions and post-surgery reports of positive and negative changes associated with seizure elimination and reduction. Study 2 found that patients and their relatives had high pre-surgery expectations concerning seizure elimination and that their post-surgery ratings of satisfaction with surgery and quality of life were higher when their pre-surgery expectations were met. Subjects in the seizure-free group were more likely than subjects in the continued seizures group to report positive changes in the areas of interpersonal relationships, independent functioning, and mood. Findings from both studies imply that pre- and post-surgery counseling may enhance the likelihood of good adjustment to surgery in patients whose seizures are reduced but not eliminated.