Family interactions as targets for intervention to improve social adjustment after epilepsy surgery

Purpose: To identify family interactions associated with psychosocial outco me of epilepsy surgery, to design interventions to improve patient outcome. Methods: A cross-sectional, case series study of relations among observed f amily behavior and psychosocial outcome of 43 patients after temporal lobec tomy. Videotaped family behavior during family discussion tasks was rated f or predominant family affect, affective range, and support of patient auton omy. Multiple regression analyses tested the relation of observed family ch aracteristics to outcomes, controlling for seizure control and other psycho logical and disease characteristics. Results: Predominant family affect predicted patients' social adjustment in dependent of postoperative seizure status and other disease characteristics . The relation between predominant affect and social adjustment was stronge r among patients with persisting complex partial seizures (CPSs; r = -0.91) , versus patients with auras (r = -0.38) and seizure-free patients (r = -0. 28; multiple R = 0.71; p < 0.05). Families with a positive affective climat e supported patients' autonomy. Conclusions: Two potential targets were identified for family intervention to improve postsurgical social adjustment: (a) family interactions that sup port a predominantly positive affective climate, and (b) family interaction s that support patient autonomy. These findings are consistent with finding s in normal and other clinical populations. They identify specific interact ions that give rise to positive versus negative affective climate and suppo rt versus undermining of autonomy. These results lay the groundwork for int ervention studies targeting these specific family interactions. Such interv ention studies would clarify the direction of effect of the observed relati onships and would test the efficacy of family intervention for improving ps ychosocial outcomes for patients with epilepsy.