Presurgery Expectations, Postsurgery Satisfaction, and Psychosocial Adjustment After Epilepsy Surgery

Abstract

Summary: Purpose:The medical benefits of epilepsy surgery are well documented, but the psychosocial consequences of surgery have received less attention. This is especially true of the roles of expectations and satisfaction in postsurgery functioning. The present study was designed to examine the relationships between expectation, satisfaction with surgery, and psychosocial functioning in patients and their significant others before and after epilepsy surgery.Methods: The neuropsychology findings of 79 patients undergoing epilepsy surgery were examined from assessments made before, 2 months after, and 1 year after anterior temporal lobectomy (ATL) was performed. The Minnesota Multiphasic Personality Inventory (MMPI) and the Washington Psychosocial Seizure Inventory (WPSI) were used to assess psychosocial functioning. A subset of 32 patients and their significant others were followed prospectively with an additional semistructured interview to assess expectations for and satisfaction with surgery outcome.Results: Before surgery, patients showed considerable problems with psychosocial adjustment. After surgery, patients in the seizure-free group showed improvements on the psychosocial measures at both follow-ups, whereas patients with continued seizures showed improvement at the 2-month follow -up and then a decline to baseline or worse at the time of the 1-year follow-up. Subjects who were studied prospectively had high presurgery expectations for seizure elimination. After surgery, subjects whose expectations were met reported high satisfaction whereas subjects whose expectations were not met reported low satisfaction. Satisfaction with surgery was associated with better psychosocial functioning.Conclusions: Such data help elucidate the ways in which successful epilepsy surgery results in improved psychosocial functioning. The results identify ways to increase the likelihood that both patients who are seizure-free and those with reduced seizure frequency may benefit from surgery.

Mood Disturbance before and after Seizure Surgery: A Comparison of Temporal and Extratemporal Resections

“…The higher rate of anxiety and depression in temporal patients in the early postoperative period points to the role of neurobiological factors in the evolution of mood disturbance after seizure surgery. Despite previous research suggesting a positive linear relation between seizure freedom and postoperative psychological functioning (24,25,55–58), we found no such relation at any of the review periods. On the contrary, temporal patients had higher rates of postoperative psychopathology than did extratemporal patients despite having less frequent postoperative seizures.…”

Mood Disturbance before and after Seizure Surgery: A Comparison of Temporal and Extratemporal Resections

“…The higher rate of anxiety and depression in temporal patients in the early postoperative period points to the role of neurobiological factors in the evolution of mood disturbance after seizure surgery. Despite previous research suggesting a positive linear relation between seizure freedom and postoperative psychological functioning (24,25,55–58), we found no such relation at any of the review periods. On the contrary, temporal patients had higher rates of postoperative psychopathology than did extratemporal patients despite having less frequent postoperative seizures.…”

Life Outcomes of Anterior Temporal Lobectomy

“…These rates are similar to those reported by Téllez-Zenteno et al 16 Driving status was the only psychosocial outcome found to correlate with seizure freedom. This finding is in contrast to Kellett et al 17 and Wheelock et al 18 who reported improved psychosocial outcomes with seizure freedom.…”

Psychosocial outcomes in children two years after epilepsy surgery: Has anything changed?

“…Fifty percent of the surgical group remained seizure free at time 3 (see Table 2), while none of those in the comparison group were seizure free. Our finding of seizure freedom as a predictor of improved social function concurs with other childhood and adult studies (McLachlan et al, 1997; Keene et al, 1998; Wheelock et al, 1998; Sabaz et al, 2006).…”

Mood Disturbance before and after Seizure Surgery: A Comparison of Temporal and Extratemporal Resections

“…The higher rate of anxiety and depression in temporal patients in the early postoperative period points to the role of neurobiological factors in the evolution of mood disturbance after seizure surgery. Despite previous research suggesting a positive linear relation between seizure freedom and postoperative psychological functioning (24,25,55–58), we found no such relation at any of the review periods. On the contrary, temporal patients had higher rates of postoperative psychopathology than did extratemporal patients despite having less frequent postoperative seizures.…”

Life Outcomes of Anterior Temporal Lobectomy

“…These rates are similar to those reported by Téllez-Zenteno et al 16 Driving status was the only psychosocial outcome found to correlate with seizure freedom. This finding is in contrast to Kellett et al 17 and Wheelock et al 18 who reported improved psychosocial outcomes with seizure freedom.…”

Psychosocial outcomes in children two years after epilepsy surgery: Has anything changed?

“…Fifty percent of the surgical group remained seizure free at time 3 (see Table 2), while none of those in the comparison group were seizure free. Our finding of seizure freedom as a predictor of improved social function concurs with other childhood and adult studies (McLachlan et al, 1997; Keene et al, 1998; Wheelock et al, 1998; Sabaz et al, 2006).…”

Mood Disturbance before and after Seizure Surgery: A Comparison of Temporal and Extratemporal Resections

“…The higher rate of anxiety and depression in temporal patients in the early postoperative period points to the role of neurobiological factors in the evolution of mood disturbance after seizure surgery. Despite previous research suggesting a positive linear relation between seizure freedom and postoperative psychological functioning (24,25,55–58), we found no such relation at any of the review periods. On the contrary, temporal patients had higher rates of postoperative psychopathology than did extratemporal patients despite having less frequent postoperative seizures.…”

Life Outcomes of Anterior Temporal Lobectomy

“…These rates are similar to those reported by Téllez-Zenteno et al 16 Driving status was the only psychosocial outcome found to correlate with seizure freedom. This finding is in contrast to Kellett et al 17 and Wheelock et al 18 who reported improved psychosocial outcomes with seizure freedom.…”

Psychosocial outcomes in children two years after epilepsy surgery: Has anything changed?

“…Fifty percent of the surgical group remained seizure free at time 3 (see Table 2), while none of those in the comparison group were seizure free. Our finding of seizure freedom as a predictor of improved social function concurs with other childhood and adult studies (McLachlan et al, 1997; Keene et al, 1998; Wheelock et al, 1998; Sabaz et al, 2006).…”