Abstracts

RATIONALE: There are few (n=7) controlled long-term psychosocial outcome studies of anterior temporal lobectomy (ATL). The present study assessed long-term (mean = 5 years) psychosocial outcomes in patients with chronic temporal lobe epilepsy treated by ATL versus medical management. Psychosocial outcomes of interest included employment, independent living, driving, financial independence, and overall quality of life.
METHODS: Subjects were a consecutive series of patients with medically intractable complex partial seizures of temporal lobe origin who were candidates for ATL between 1990 to 1997. A total of 84 individuals participated in the follow-up study (92% of initial sample); 61 underwent ATL and 23 were evaluated but did not undergo surgery and served as the medical management control (MM) group. The surgery and MM groups did not differ in chronological age, age at seizure onset, or time to follow-up (m=5.8, 5.7 respectively). All participants underwent medical record review and structured clinical interview to obtain information regarding seizure frequency and psychosocial status. Information was obtained retrospectively for the one month prior to the initial surgical evaluation, and outcome information was garnered for the one month prior to the follow-up interview.
RESULTS: Both groups were comparable in baseline seizure, cognitive, clinical, and psychosocial characteristics; the only difference concerned more frequent complex partial seizures in the surgery group. At follow-up surgery patients were significantly more likely to be employed full-time, living independently, driving, and not dependent on state or federal subsidies compared to MM patients. The surgery group rated their quality of life at follow-up as significantly better than MM patients. 63.9% of surgery patients were seizure free at follow-up compared to 4.3% of MM patients. In the surgery group, there was a trend toward more favorable psychosocial outcomes as a function of better seizure outcome, but this relationship did not reach statistical significance. There was, however, a significant difference in self-reported quality of life with the seizure-free group indicating a higher quality of life as compared to the not-seizure-free group.
CONCLUSIONS: This controlled long-term follow-up investigation showed ATL patients to exhibit significantly better outcomes across all psychosocial categories compared to patients who were managed medically. Notably, complete seizure freedom was not required to achieve long-term positive changes in psychosocial outcomes. As expected, seizure frequency is significantly reduced by ATL. The results of this study, one of only a few to utilize a non-surgical control group, highlight the significant positive impact of ATL on long-term psychosocial status.