Predictive coding: A contemporary view on the burden of normality and forced normalization in individuals undergoing epilepsy surgery |
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| Institution: | 1. Krembil Research Institute, Toronto Western Hospital (TWH), Toronto, ON, Canada;2. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada;3. Division of Neurology, Departments of Medicine, Paediatrics and Pharmacology, University of Toronto, Toronto, ON, Canada;4. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada;5. Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada;1. Epilepsy Center, University of Freiburg, Breisacher Strasse 64, 79106 Freiburg, Germany;2. Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Hauptstraße 8, 79104 Freiburg, Germany;3. Department of Psychotherapeutic Neurology, Kliniken Schmieder Gailingen, Auf dem Berg, 78262, Gailingen, Germany;1. Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy;2. Department of Neurology, University of Florence, Florence, Italy;1. Agenzia Regionale di Sanità, Regione Toscana, Firenze, Italy;2. Unit of Neurology, Department of Medicine, Usl centro Toscana Health Authority, Prato, Italy |
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| Abstract: | Following epilepsy surgery, a good psychosocial outcome is not necessarily contingent on a good seizure outcome. Increasingly, it is believed that “successful” surgery is a combination of both an acceptable and expected seizure status as well as the individual's perception of improvements in quality of life (QOL). The factors that create this optimal outcome remain an ongoing area of research in the epilepsy community. That being said, there have been some major breakthroughs in observing and understanding poor outcomes seen in a subset of postoperative patients with epilepsy. Characteristics of burden of normality and forced normalization are two phenomena that have been evident in cases of poor postoperative outcomes. In this review, we provide a summary of research and concepts used to explain these poor QOL outcomes for a seemingly successful surgery and suggest a contemporary view in understanding the mechanism of forced normalization through understanding the brain as a predictive organ. Using such a predictive coding model together with recommendations of other studies, we suggest the crucial need for a preoperative intervention addressing patient predictions and expectations to optimize on the benefits achievable through epilepsy surgery. |
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