Long-term employment outcomes after epilepsy surgery in childhood

Abstract

ObjectiveTo analyze long-term employment outcomes in a population-based cohort of adults who underwent epilepsy surgery in childhood or adolescence and to compare the results to general population reference data.MethodsProspective data on epilepsy surgery procedures performed on patients <19 years of age between 1995 and 2012 were extracted from the Swedish National Epilepsy Surgery Register. Five-, 10-, 15- and 20-year follow-up data were analyzed. Patients aged ≥19 years at follow-up were eligible for inclusion. Educational attainment and employment status were analyzed in relation to seizure outcome. Education and employment outcomes of seizure-free patients with a preoperative IQ of ≥70 were compared to general population reference data.ResultsA total of 203 patients were included. The mean age at surgery was 13.6 years and 66% had IQ ≥70. Of these, a majority had attained at least high school education 5 years after surgery. Employment rates were 44%, 69%, 71%, and 77% at the 5-, 10-, 15-, and 20-year follow-ups, respectively. Seizure-free patients were significantly more likely to work full-time. Educational attainment and rates of full-time employment of seizure-free patients were similar to the general population. A majority of patients with IQ <70 had attended special education and were reliant on social benefits.ConclusionLong-term overall employment rates were higher compared to most previous studies on surgery in adults. Seizure-free patients with a preoperative IQ ≥70 showed rates of full-time employment similar to the general population. Further research is needed to determine whether this also applies for occupational complexity and wages.

Epilepsy Surgery in Childhood Versus Adulthood: What Are We Waiting for?

“…In seizure-free patients with IQ ≥70, 62% to 76% worked full time after age 25 years at the 10-, 15-, and 20-year follow-ups, consistent with full-time employment rates of the general population at the same time points (66%-68%). 2 Seizure freedom was a positive predictor of employment. 2 These 2 studies suggest employment rates in adults who undergo epilepsy surgery remain lower than the general population, even in seizure-free patients who worked full time before surgery.…”

“… 2 Seizure freedom was a positive predictor of employment. 2 These 2 studies suggest employment rates in adults who undergo epilepsy surgery remain lower than the general population, even in seizure-free patients who worked full time before surgery. By comparison, children with IQ ≥ 70 who undergo epilepsy surgery go on to have employment rates consistent with the general population.…”

“… 3 In this cohort, seizure freedom in those with IQ >70 was 62% to 66% throughout follow-up. 2 Therefore, even though seizure freedom is a predictor of full-time employment, rates of seizure freedom do not explain the differences in employment.…”

“…In this cohort, approximately 1/3 had IQ <70 (vs approximately 5% in the adult cohort). 1 , 2 Therefore, the results were dichotomized, based on IQ. In seizure-free patients with IQ ≥70, 62% to 76% worked full time after age 25 years at the 10-, 15-, and 20-year follow-ups, consistent with full-time employment rates of the general population at the same time points (66%-68%).…”

Long-term outcomes of pediatric epilepsy surgery: Individual participant data and study level meta-analyses

“…Pertaining only to participants with data for at least 10 years of postoperative follow-up, 12 of the studies reported IPD [15][16][17][18][19][20][21][22][23][24][25] for a total of 122 participants with a mean duration of postoperative follow-up of 14.6 years (Range = 10-38 years) and long-term seizure freedom observed in 79 participants (64.8%). Thirteen of the studies reported SL data only [26][27][28][29][30][31][32][33][34][35][36][37][38] for a total of 719 participants with a stratified follow-up of up to 21 years and long-term seizure freedom observed in 414 participants (57.6%) (Table 1).…”