June 4, 2019

Achieving Social Milestones After Epilepsy Surgery May Take Longer than Expected: Identifying the Trajectory of Social Milestones 15 to 20 Years After Epilepsy Surgery

Objective: Patients often undertake epilepsy surgery with the expectation that it will lead to improvements in their social situation. Short- to medium-term research consistently points towards improvements in social outcomes, however, no study has mapped out post-surgical social timelines, particularly for longer-term (>15 years) outcomes.

Methods: The research team recruited 39 patients who had undergone anterior temporal lobectomy (ATL) for drug-resistant temporal lobe epilepsy (TLE) between 1994 and 2002. The cohort (24 female) had a median age of 49 years (range 38-67), age of habitual seizure onset was 9.5 years (range 0.5-29 years) and age at surgery was 31 years (range 20-53). Patients were followed up a median of 18.4 years post-surgery (IQR=4.4). Using data obtained from semi-structured interviews, the team conducted a comprehensive qualitative analysis of patients’ self-reported post-surgical social trajectories. Self-report questionnaires were used to assess mood and health-related quality of life (HRQOL) at the time of interview.

Results: There was a common sequence of social milestone achievement, spanning 20 years post-surgery. Typically, patients first (re)gained their license, then attempted educational and vocational gains, followed by establishing long-term relationships and finally a family unit. Rare, intermittment seizures post-surgery did not appear to have detrimental effects on social trajectories. Those who experienced a reduction in seizures showed increased likelihood of attaining social milestones compared to those with ongoing seizures.

Significance: Achieving social milestones after epilepsy surgery may take considerably longer than patients are expecting prior to surgery. The pattern of social milestone outcome resembled a process of psychosocial development. These findings have important implications for pre-surgical counselling and post?surgical rehabilitation.

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