Long-term psychosocial outcomes of anterior temporal lobectomy.
OBJECTIVE
To examine the long-term psychosocial outcomes of a consecutive series of patients who underwent anterior temporal lobectomy (ATL) compared with medically managed patients. This study focused primarily on actual long-term changes (mean, 5 years) in life performance. There are relatively few long-term controlled studies of actual lifetime performance changes.


METHODS
The sample consisted of 61 adults who underwent ATL and 23 individuals who were evaluated for surgery but did not proceed to surgery and continued to receive medical management. Participants were interviewed 2-9 years after surgery. A structured clinical interview and review of medical records was conducted to obtain information regarding seizure frequency and psychosocial status, focusing on employment, education, driving status, financial assistance, and independent living. In addition, two questions regarding quality of life were included. Seizure frequency was evaluated for the year before the interview.


RESULTS
Significant differences in psychosocial outcome were found between the surgery group and medical management group. Favorable psychosocial outcomes were more common among those who had surgery (46 vs. 4%). Results indicated that 68% of the surgery group exhibited improved psychosocial status compared with 5% of the medical management group. Individuals who had surgery were more likely to be driving, working full-time, living independently, and being financially independent. Remaining seizure free was not a prerequisite for improvements in psychosocial outcomes.


CONCLUSIONS
Compared with medical management, surgery has a significant positive impact on psychosocial outcomes in terms of employment, independent living, driving, and financial independence. Additionally, a person does not necessarily have to be seizure free to achieve positive changes in psychosocial outcomes.
Department of Neurology, University of Wisconsin-Madison, Madison, Wisconsin 53792, U.S.A. jejones@neurology.wisc.edu
Jana E
JE
Jones
Norman L
NL
Berven
Lincoln
L
Ramirez
Austin
A
Woodard
Bruce P
BP
Hermann
D000203:Activities of Daily Living; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001334:Automobile Driving; D004651:Employment; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy / Q000523:psychology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D011584:Psychology; D012640:Seizures / Q000453:epidemiology; D013702:Temporal Lobe / Q000601:surgery*; D016896:Treatment Outcome
D000927:Anticonvulsants