Patient-perceived impact of resective epilepsy surgery.
OBJECTIVE
To evaluate the patient-perceived impact of resective epilepsy surgery, a key outcome to consider in evaluating such a highly invasive, elective procedure.


METHODS
Impact measures obtained from 396 patients in a multicenter cohort study of resective epilepsy surgery included (1) willingness to undergo surgery if that decision could be made again and (2) the overall impact of surgery on the patient's life. Predictors of impact were analyzed using multivariate ordinal logistic regression.


RESULTS
Of study participants, 73.8%, 77.4%, and 75.5% would definitely undergo surgery again and 78.2%, 80.2%, and 79.1% reported a very strong or strong positive overall impact of surgery at 3, 12, and 24 months. Multivariate ordinal logistic regression showed that seizure freedom predicted more positive perceptions at 3, 12, and 24 months (all p < 0.04). Becoming employed was uniquely associated with willingness to undergo surgery again and with overall impact at 24 months (all p < 0.05), but only a net 7% of the cohort improved their employment status. Right-sided resection (at 12 and 24 months, p < 0.005) and female gender (at 3 and 12 months, p = 0.006) were each positively associated with perceived overall impact.


CONCLUSIONS
Most epilepsy surgery patients report a positive overall impact of the procedure on their lives and a high willingness to undergo surgery again if that choice could be made. Seizure-free individuals express consistently more positive perceptions of the procedure. Findings suggest that it is important to make early efforts to reintegrate epilepsy surgery patients into employment.
Chin
P S
PS
Robert Wood Johnson Clinical Scholars Program, Department of Neurology and Medicine at UCLA and the Greater Los Angeles VA Health Care System, USA. neuroepi@yahoo.com
Berg
A T
AT
Spencer
S S
SS
Lee
M L
ML
Shinnar
S
S
Sperling
M R
MR
Langfitt
J T
JT
Walczak
T S
TS
Pacia
S V
SV
Bazil
C W
CW
Vassar
S
S
Vickrey
B G
BG
D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D015331:Cohort Studies; D004651:Employment; D004827:Epilepsy / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D018434:Sickness Impact Profile; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology