Epilepsy Surgery in Childhood Tied to Better Long-term Employment Outcomes

By Marilynn Larkin

December 20, 2019

NEW YORK (Reuters Health) - Undergoing epilepsy surgery in childhood is associated with higher employment rates versus surgery as an adult, particularly for those whose IQ is in the normal range and who remain seizure free, an observational study suggests.

"We previously published a vocational outcome study (http://bit.ly/2tycyXP) in patients operated on as adults and found that not all seizure-free patients managed to get back to work after surgery, and also that younger age predicted better employment outcomes," Dr. Jesper Reinholdson of Gothenburg University told Reuters Health by email. "Therefore, in the current study, we investigated the employment outcomes of adults who were operated in childhood or adolescence."

Dr. Reinholdson and colleagues analyzed data on 203 patients who underwent epilepsy surgery between 1995-2012 in Sweden. Patients were under age 19 when undergoing surgery and 19 or older at follow-up.

As reported in Neurology, the mean age at surgery was 13.6 years, 61% were male, and 66% had an IQ of at least 70.

Temporal lobe resection was the most common type of surgery. Nonresective procedures and neurologic deficits were more prevalent in patients with low IQ.

Seventy-two patients were followed up at five years post-surgery, 127 after 10 years, 105 after 15 years, and 42 at 20 years.

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, and both educational attainment and rates of full-time employment were similar to the general population.

A majority of patients with an IQ of at least 70 had attained at least a high school education five years after surgery. By contrast, a majority of patients with an IQ <70 had attended special education and were dependent on social benefits.

Higher age at surgery was associated with greater chances of employment at the 10- and 15-year follow-ups. At the 20-year follow-up, being seizure-free was a positive predictor of employment.

However, having >30 seizures/month at baseline was negatively associated with employment at the 15-year follow-up.

Dr. Reinholdson said, "There may be a reluctance among clinicians to refer patients for epilepsy surgery (and) a corresponding hesitancy among children and their parents to ultimately opt for a surgical procedure. We therefore think that this study is helpful for counselling patients and parents."

"A key point for clinicians is that the referral of children with drug resistant epilepsy for presurgical evaluation should be considered early," he added.

Several US epileptologists commented to Reuters Health by email.

Dr. Daniel J. Correa, of the Montefiore Health System and Albert Einstein College of Medicine in New York City, said, "Some clinicians may have concerns about affecting intellectual development with an epilepsy surgery in a child or young adult. However, most epilepsy specialists agree that reducing the burden of seizures, or curing the epilepsy, is the best option for a child."

Like Dr. Reinholdson, he noted, "This study underscores the need for early evaluation of children living with epilepsy that cannot be controlled by two medications. For children and adults whose seizures are not responsive to two medication trials, we need to make every attempt to see if they have an option for an epilepsy surgery."

"There are many types of resective and non-resective surgeries that are tailored to each person's situation," he added. "It's possible that the earlier seizure freedom is achieved, the greater the chance that person has to develop in the future."

Dr. David Burdette, epilepsy section chief at Spectrum Health in Grand Rapids, Michigan, commented, "Surgery is a big step for patients, their families and caregivers, and their treating providers. Nevertheless, epilepsy surgery offers a potential cure for epilepsy, and this employability data will prove very helpful in building the case for epilepsy surgery while allaying fears about the ability to function after surgery."

Nonetheless, he noted, "Epilepsy surgery is not without risks, so this decision should be made in conjunction with an epileptologist at a National Association of Epilepsy Centers Level IV epilepsy program."

"In addition to offering greater opportunities in the area of employability, epilepsy surgery - with the subsequent reductions in seizure burden - results in improvement in mood, greater willingness to engage in and seek social interaction, and significantly reduced rates of SUDEP (sudden unexpected death in epilepsy)," he said. "All of these improvements work together to result in a healthier, happier individual."

SOURCE: http://bit.ly/2sGDfJE Neurology, online December 3, 2019.