Family Interactions as Targets for Intervention to Improve Social Adjustment After Epilepsy Surgery

Abstract

Summary: Purpose: 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.

Epilepsy and the family: a review of current literature

“…44 1989 151 patients and 249 family members A study of psychiatric problems in families of epilepsy showing increased problems in mothers and spouses. Langfitt et al 55 1999 43…”

“…A number of authors have suggested that the family environment may be important in the course of the disorder and influence both the severity and impact of the condition. Furthermore, this may negatively impinge on the family unit and its functioning 7,17,18,20,[55][56][57][58][59] .…”

“…The effect of such over-protection for the child may be far reaching. For example, the child may become emotionally immature, overdependant on the family, and lack social skills, being passive and unable to make normal peer relationships 55,[65][66][67] .…”

A review of neuropsychological services in the United Kingdom for patients being considered for epilepsy surgery

“…Since 1994 there have been several developments in the understanding of patients needs that highlight the importance of considering psychological wellbeing, patient expectations and family dynamics when assessing the likely psycho-social and quality of life benefits of epilepsy surgery [5][6][7] . A growing number of § On behalf of the Psychologists in Epilepsy Group.…”

The Family Experience of “Sudden Health”: The Case of Intractable Epilepsy

“…(Mihari, Inoue, Watanabe, et al, 1994). Finally, Langfitt, Wood, Brand, et al (1999) examined family factors that may contribute to better postoperative adjustment in patients. Their cross‐sectional case series study of observed family interactions demonstrated that patients displayed better postoperative social adjustment in families in which the patient's autonomy was respected and family members demonstrated emotional support.…”