OCCUPATIONAL OUTCOME AFTER TEMPORAL LOBECTOMY FOR REFRACTORY EPILEPSY

We evaluated employment after temporal lobectomy for refractory epilep sy in 86 patients (3.5 to 8 years of follow-up). Seventy-three patient s qualified for the work force before and after surgery. Unemployment rates declined after surgery (18 patients [25%] unemployed before surg ery, eight patients [11%] unemployed after surgery), and underemployme nt also tended to diminish. Improvement in occupational status related strongly to the degree of postoperative seizure relief. Seizure-free patients fared better (no unemployment, little underemployment) than p atients with some seizure-free years and some years with seizures afte r surgery, whose high underemployment level persisted. Patients with s eizures in each year after surgery fared worst (despite reduced seizur e frequency), with increased unemployment after surgery. Age at surger y also influenced vocational outcome in patients who were unemployed b efore surgery. Historical, educational, cognitive, and behavioral meas ures did not correlate with vocational outcome. Employment gains came slowly; unemployed patients took up to 6 years to obtain work after su rgery. Of 13 students at the time of surgery, 11 have graduated and ni ne are now employed. We conclude that seizures play a large role in li miting employment, and that by alleviating seizures, temporal lobectom y improves employability in people with refractory epilepsy. Surgery t hereby provides benefit to individuals with epilepsy by increasing fin ancial independence and to society by reducing unemployment.