Quality of life after successful epilepsy surgery: evaluation by occupational achievement and income acquisition.
OBJECTIVE
A comprehensive epilepsy surgery program has been developed at Chulalongkorn University Hospital, Thailand to reach an international standard level, rendering patients good surgical outcomes comparable to developed countries. After successful operation, seizure free patients have become independent, self earning or employed. However, quality of life (QOL) in terms of occupational achievement and income acquisition after epilepsy surgery has never been studied. These indicators reflect the ultimate QOL in the aspects of actual independency, intact brain functions, mental health and psycho-social interactions. The authors therefore conduct the study on improvement of QOL after successful epilepsy surgery using these parameters.


METHODS
One hundred and eleven intractable epilepsy who have become seizure free to worthwhile improved (Engel class I to III) after standard presurgical evaluation and epilepsy surgery from January 2002 to December 2004 were evaluated. The patients were followed up for 3 years. The occupational status and incomes were categorized according to the ranking of the patients' functioning levels. The pre and post surgery work abilities, employment and incomes were interviewed and compared. Mc Nemar test and paired t-test were used for statistical analyses.


RESULTS
The average age of the 111 adults (54 males and 57 females) was 33.7 +/- 9.2 years. Eighty two percent of the patients had temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS) and underwent standard anterior temporal lobectomy. The rest had tumors, cortical dysplasia or scar and received lesionectomy or cortical resection assisted by intra-operative or intra-cranial EEG. The overall seizure free rate is 83.8%. The occupational status of the subjects was shown to improve significantly after surgery from unemployed to higher categories of professional achievement (p < 0.001). The number of unemployed and no income individuals decreased from 66 to 25 cases (62.1% reduction rate) after surgery (p < 0. 001). Reciprocally, the number of persons who achieved professional jobs with regular incomes or salaries increase from 30 to 53 cases (43.4% increasing rate) (p < 0.001). The patients who have not acquired any income increment showed improvement in working ability after epilepsy surgery. The average annual incomes per capita shows the increasing rate of 45.08%, from 55,657.85 Baht (approximately U.S. dollars 1390) to 80,748.15 Baht (approximately U.S. dollars 2018), with strong statistical significance (p < 0.001). The improvement is best seen in seizure free than in non-seizure free subjects.


CONCLUSIONS
The present study, to the authors 'knowledge, is the first to use work abilities, professional achievement and income acquisition to assess the ultimate QOL after epilepsy surgery. Most subjects have been shown to significantly improve their postoperative lives in terms of occupational accomplishment and income increment, especially in seizure free individuals. The need for expansion of epilepsy surgery is emphasized.
Locharernkul
Chaichon
C
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Kanchanatawan
Buranee
B
Bunyaratavej
Krishnapundha
K
Srikijvilaikul
Teeradej
T
Deesudchit
Tayard
T
Tepmongkol
Supatporn
S
Lertlum
Sukalaya
S
Tuchinda
Lawan
L
Shoungshotti
Chanop
C
Ounpak
Pradit
P
D000124:Achievement; D000293:Adolescent; D000328:Adult; D004827:Epilepsy / Q000517:prevention & control / Q000523:psychology / Q000601:surgery*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007182:Income / Q000145:classification*; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000145:classification* / Q000191:economics; D011184:Postoperative Period; D011788:Quality of Life; D012923:Social Class; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome