Temporal Lobectomy for Refractory Epilepsy in the U.S. Military

Erickson, Jay C.; Ellenbogen, Richard G.; Khajevi, Kaveh; Mulligan, Lisa P.; Ford, Gwendolyn C.; Jabbari, Bahman

doi:10.7205/milmed.170.3.201

Cited by 9 publications

(6 citation statements)

References 13 publications

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“…reported comparable findings in an epilepsy rehabilitation program not focused on epilepsy surgery. Similar to the results of our study, seizure outcome has been found as a relevant factor for postoperative employment in most studies, but not all studies . In those studies that found an influence of seizure outcome on postoperative employment it is not clear if complete freedom of seizures is a prerequisite for improvement of the employment situation or if a decreased seizure frequency or a lower seizure severity have an effect.…”

Section: Discussionsupporting

confidence: 72%

“…Similar to the results of our study, seizure outcome has been found as a relevant factor for postoperative employment in most studies, 4,5,7,11,26,27,[35][36][37][38] but not all studies. 28,39,40 In those studies that found an influence of seizure outcome on postoperative employment it is not clear if complete freedom of seizures is a prerequisite for improvement of the employment situation or if a decreased seizure frequency or a lower seizure severity have an effect. Our data suggest that only those patients who are free of disabling seizures (Engel class I) will have employment gains.…”

Section: Discussionmentioning

confidence: 99%

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Effects of an inpatient rehabilitation program after temporal lobe epilepsy surgery and other factors on employment 2 years after epilepsy surgery

Thorbecke

May²,

Koch-Stoecker

et al. 2014

Epilepsia

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SUMMARYObjective: To evaluate the effects of a postsurgical rehabilitation program on employment status 2 years after temporal lobe epilepsy surgery in relation to other predictors. Methods: Employment outcome 2 years after temporal lobe resection in a group of 232 adult patients with the offer of a 3-week inpatient rehabilitation program immediately after surgery ("Reha group") was compared to a group of 119 patients who had surgery before such a rehabilitation program existed. One hundred thirty-nine (59.9%) of the Reha group patients attended the rehabilitation program. Further predictors for employment outcome were analyzed using multivariate logistic regression analysis. Results: Preoperatively, the groups did not differ significantly in variables relevant for employment, including employment rate. Two years after surgery, the rate of those not being employed had decreased in the Reha group from 38.4% to 27.6% (p < 0.001, McNemar test), and slightly increased in the control group (37.8-42.0%; n.s.), resulting in a difference of 14.4% in favor of the Reha group (p = 0.008). General unemployment rates during the two observation periods were similar. In addition to the offer of rehabilitation support ("Reha group") and preoperative employment, the following other variables were shown as significant predictors of employment post surgery in multivariate regression analysis: seizure outcome, diagnosis of a personality disorder preoperatively, and age at surgery (all, p < 0.01; Nagelkerkes R 2 = 0.59). Significance: Independently from other factors, a 3-week inpatient rehabilitation program after temporal lobe epilepsy surgery seems to improve employment status 2 years after surgery.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Effects of an inpatient rehabilitation program after temporal lobe epilepsy surgery and other factors on employment 2 years after epilepsy surgery

Thorbecke

May²,

Koch-Stoecker

et al. 2014

Epilepsia

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“…Improvement in driving status was noted in 7–65% (median 48%) of patients depending on the study. Ability to drive was dependent on seizure freedom postsurgery (Reeves et al., 1997; Jones et al., 2002; Reid et al., 2004; Erickson et al., 2005; Asztely et al., 2007). Driving outcomes tended to be poorer in those who were older at the time of surgery (Britton et al., 1994).…”

Section: Resultsmentioning

confidence: 99%

“…Surgical treatment for epilepsy can significantly improve the chances for seizure freedom (Erickson et al., 2005). However, patient‐related changes after epilepsy surgery may go beyond controlling seizures and include social factors such as employment, driving, social relationships, independence, and education.…”

mentioning

confidence: 99%

Social outcomes after temporal or extratemporal epilepsy surgery: A systematic review

et al. 2011

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Summary Purpose: The objective of this study was to systematically review the literature to assess social outcomes after epilepsy surgery. Methods: A systematic literature search was conducted as part of a larger project on the development of an appropriateness and necessity rating tool to identify patients with focal epilepsy that may benefit from an epilepsy surgery evaluation. Studies were included if they reported postsurgical data on social outcomes (employment, driving, social relationships, marriage, education, financial status, behavior, and social interactions) and had a follow‐up period of at least 24 months. Our search strategy yielded 5,061 studies. Sixty‐five of these studies addressed social outcomes, but only 19 met all eligibility criteria. Key Findings: In adults, a significant improvement in full‐time employment postsurgery was documented. The ability to drive was significantly increased after surgery and was dependent on seizure freedom. Patients generally perceived improved relationships, independence, and overall lifestyle postsurgery. Marital status generally remained unchanged when compared to controls, education improved modestly, and income/financial status changes depended on how it was assessed (e.g., income level vs. receipt of disability pension). In children, a study examining behavior showed improved social interactions in those who underwent surgery compared to controls. The results for other social outcome categories were more variable. Significance: Overall, the majority of studies reported improvement in social outcomes after surgery. However, prospective controlled observational studies using objective social outcome measures are necessary prior to making specific conclusions about the influence of surgery on social outcomes other than employment or driving status in all age groups, but particularly in children and the elderly.

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“…Subdural electrode recordings were performed in cases without a discernable temporal lobe abnormality on MRI. The characteristics, presurgical evaluation, and surgical outcomes of patients undergoing partial temporal lobectomy for refractory seizures at our center have been previously reported (13).…”

Section: Methodsmentioning

confidence: 99%

Somatosensory Auras in Refractory Temporal Lobe Epilepsy

Erickson¹,

Clapp²,

Ford³

et al. 2006

Epilepsia

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Summary:Purpose: To determine the prevalence, manifestations, lateralizing value, and surgical prognostic value of somatosensory auras (SSAs) in patients with refractory temporal lobe epilepsy (TLE).Methods: Eighty-one consecutive patients undergoing temporal lobectomy for refractory complex-partial seizures were screened for SSAs. The characteristics of the somatosensory phenomena, occurrence of other aura types, seizure semiology, findings of EEG and imaging studies, temporal lobe neuropathology, and postoperative seizure outcome were determined in each patient with SSAs.Results: Nine (11%) of 81 patients with refractory temporal lobe seizures reported distinct SSAs as part of their habitual seizures. The most common manifestation of SSAs was tingling (eight of nine, 89%), but sensory loss (one of nine, 11%) and pain (one of nine, 11%) also were reported. Five patients had unilateral somatosensory symptoms, and four patients had bilateral somatosensory symptoms. Seizure origin was in the contralateral temporal lobe in four (80%) of five patients with unilateral SSAs, including all patients with unilateral SSAs affecting a limb. Partial temporal lobe resection produced complete seizure remission in all nine (100%) patients 1 year after surgery and in seven (78%) of nine patients 2 years after surgery.Conclusions: SSAs occur more frequently than previously appreciated in patients with refractory temporal lobe seizures and usually manifest as either unilateral or bilateral tingling. In patients with temporal lobe seizures, unilateral SSAs involving a limb suggest a seizure origin in the contralateral temporal lobe. The surgical outcome of TLE patients with SSAs is favorable. Thus the presence of SSAs should not serve as a deterrent to temporal lobe resection in patients with clearly defined TLE.

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Temporal Lobectomy for Refractory Epilepsy in the U.S. Military

Cited by 9 publications

References 13 publications

Effects of an inpatient rehabilitation program after temporal lobe epilepsy surgery and other factors on employment 2 years after epilepsy surgery

Effects of an inpatient rehabilitation program after temporal lobe epilepsy surgery and other factors on employment 2 years after epilepsy surgery

Social outcomes after temporal or extratemporal epilepsy surgery: A systematic review

Somatosensory Auras in Refractory Temporal Lobe Epilepsy

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