title: Family interactions as targets for intervention to improve social adjustment after epilepsy surgery.
abstract: OBJECTIVE
  To identify family interactions associated with psychosocial outcome of epilepsy surgery, to design interventions to improve patient outcome.
  
  
  METHODS
  A cross-sectional, case series study of relations among observed family behavior and psychosocial outcome of 43 patients after temporal lobectomy. Videotaped family behavior during family discussion tasks was rated for predominant family affect, affective range, and support of patient autonomy. Multiple regression analyses tested the relation of observed family characteristics to outcomes, controlling for seizure control and other psychological and disease characteristics.
  
  
  RESULTS
  Predominant family affect predicted patients' social adjustment independent of postoperative seizure status and other disease characteristics. The relation between predominant affect and social adjustment was stronger among patients with persisting complex partial seizures (CPSs; r = -0.91), versus patients with auras (r = -0.38) and seizure-free patients (r = -0.28; multiple R = 0.71; p < 0.05). Families with a positive affective climate supported patients' autonomy.
  
  
  CONCLUSIONS
  Two potential targets were identified for family intervention to improve postsurgical social adjustment: (a) family interactions that support a predominantly positive affective climate, and (b) family interactions that support patient autonomy. These findings are consistent with findings in normal and other clinical populations. They identify specific interactions that give rise to positive versus negative affective climate and support versus undermining of autonomy. These results lay the groundwork for intervention studies targeting these specific family interactions. Such intervention studies would clarify the direction of effect of the observed relationships and would test the efficacy of family intervention for improving psychosocial outcomes for patients with epilepsy.
authors.affiliation: Department of Neurology, University of Rochester School of Medicine, New York 14642, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Langfitt
authors.forename: B L
authors.initials: BL
authors.lastname: Wood
authors.forename: K L
authors.initials: KL
authors.lastname: Brand
authors.forename: J
authors.initials: J
authors.lastname: Brand
authors.forename: G
authors.initials: G
authors.lastname: Erba
mesh_terms: D000328:Adult; D017668:Age of Onset; D002648:Child; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000453:epidemiology / Q000601:surgery*; D005192:Family Health; D005195:Family Relations; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012044:Regression Analysis; D012917:Social Adjustment; D012944:Social Support; D016896:Treatment Outcome