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

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.     

Infarction After Surgery for Focal Epilepsy: Manipulation Hemiplegia Revisited

The success of surgery for seizure focus resection depends on postoperative reduction or disappearance in number of seizures, improvement in psychosocial functioning, and low morbidity and mortality. Permanent neurologic sequelae are most often not discussed in this context. Deficits more than a superior quadrantanopsia are not expected after temporal lobectomy. Four cases of ischemic stroke after seizure focus resection, each distant from the site of tissue removal, are reported. These are the first such radiologically documented reports of "manipulation hemiplegia." The permanent neurologic deficits are not attributed to resected tissue or edema.     

Mortality in a Consecutive Cohort of 248 Adolescents and Adults Who Underwent Diagnostic Evaluation for Epilepsy Surgery

Summary: A cohort analytic study of a broad set of outcomes was performed in a consecutive series of 248 adults and adolescents who underwent evaluation for surgery for intractable epilepsy at the University of California, Los Angeles (UCLA), U.S.A. from 1974 to 1990. In the analysis, 202 were designated as "surgery" patients and 46 were assigned to a "nonsurgery" group, based primarily on whether surgery for a localized surgical region was undertaken. Follow-up at an average of 6 years revealed that 14 (7%) of the surgery and 9 (20%) of the non- surgery group had died (p < 0.01). Results were similar after adjusting for baseline differences between groups. These multivariate models also showed that female gender was significantly associated with lower mortality. A significantly higher proportion of the deceased experienced two or more seizures over the latest year of follow-up compared with survivors (p < 0.01). Specific causes of death remain to be determined.     

Empirical Techniques for Determining the Reliability, Magnitude, and Pattern of Neuropsychological Change After Epilepsy Surgery

Summary: Purpose : We assessed test-retest neuropsychological performance in patients with complex partial seizures to derive reliable change indices (RCIs) and regression-based norms for change, indices that may be helpful in assessing cognitive outcome after anterior temporal lobectomy.
Methods : Forty patients with complex partial seizures (CPS) who did not undergo epilepsy surgery were administered a comprehensive neuropsychological battery on two. occasions. Their test-retest data were used to compute both RCIs and regression-based norms for change for each neuropsychological index. RCIs corrected for practice effects provide a confidence interval (CI) indicating the degree of performance change required to exceed the variability attributable to sources of error (e.g., practice, test-retest reliability). Regression-based norms for change also correct for several sources of measurement measurement error and examine observed versus expected test-retest changes on a common metric, thereby facilitating determination of the degree and relative magnitude of change across cognitive domains.
Results : Mean changes in test-retest performance were generally modest, but were evident across several test measures. Our data indicate a considerable degree of individual variability in test-retest Performance.
Conclusions : RCIs and regression-based norms are complementary indexes and can be particularly useful in examining the test-retest performance of individual patients who undergo epilepsy surgery as well as in the more general investigation of cognitive outcome after epilepsy surgery.     

Surgery for epilepsy due to cortical malformations: ten-year follow-up

Children with malformations of cortical development represent a significant proportion of pediatric epilepsy surgery candidates. From a cohort of 40 children operated on between 1980 and 1992 with malformation of cortical development, 38 were alive and had data 10 years after surgery. Age at surgery ranged from 6 months to 18 years (mean, 9.6 years). Thirty-six had partial seizures, and two had infantile spasms; 20 were nonlesional. Pathologic diagnoses were cortical dysplasia (n = 31) and developmental tumor (n = 7). At 10-year follow-up, 15 (40%) were seizure free, 10 (26%) had >90% seizure reduction, and 13 (34%) were improved or unchanged. Children seizure free at two-year follow-up were likely to remain seizure free. Ten-year seizure freedom was 72% in children with developmental tumors and 32% in the cortical dysplasia group. Complete resection was statistically significant for favorable outcome, and no patient with an incomplete resection was seizure free.     

Development of a Novel Scale to Assess Life Fulfilment as Part of the Further Refinement of a Quality-of-Life Model for Epilepsy

Summary: We have been involved in developing a health-related quality-of-life model for use as an outcome measure in epilepsy. As part of the further development of this model, we have developed a measure of life fulfilment. This scale is based on methods previously described by Krupinski in 1980. The value of Krupinski's approach is the opportunity for patients to weight the numerous aspects of their quality of life and assess the discrepancy between their actual and desired circumstances. The life fulfilment scale has been shown to be reliable (α= 0.7) and valid. The scale is currently being applied to several clinical studies in epilepsy. We believe that the scale provides a valuable contribution to our health-related quality-of-life model.     

Experimental Examination and Social Validation of a Microswitch Intervention to Improve Choice-Making and Activity Engagement for Six Girls with Rett Syndrome

ABSTRACT

Background: The use of assistive technology, specifically microswitches, with children with RTT has been shown to effectively moderate the impact of their disability on their quality of life^? by facilitating access to meaningful leisure and other activities.

Objectives: This study aimed to evaluate the effectiveness of a microswitch intervention on increased choice making, engagement in a targeted sorting activity, and indices of happiness, and decreased stereotypic behaviors for six girls with Rett syndrome. Targeted dependent variables were also assessed at six months post-intervention. Following the intervention study, 90 external raters completed a social validation procedure.

Method: An ABABAB experimental sequence was implemented for each participant with a cross-over effect. A social validation assessment involving 90 external raters was carried out.

Results: Data emphasized an improved performance for each participants involved (i.e., adaptive responses). Five participants showed a capacity of independent choice. One participant seemed to be closely linked to the position of the container. Social raters favorably endorsed the use of the program since they positively evaluated the use of the technology on all the dimensions investigated.

Conclusion: A microswitch intervention may improve choice making and activity engagement for children with Rett syndrome. Further research is needed on the development of more sophisticated forms of individualized technological options to improve opportunities for enhanced engagement and choice-making for individuals with RTT.