The "burden of normality": concepts of adjustment after surgery for seizures

Objectives-To conceptualise the process of adjustment provoked by the sudde n alleviation of chronic epilepsy by temporal lobectomy On being rendered s eizure free, the process of adjustment primarily depends on the patient's c apacity to discard roles associated with chronic epilepsy and to learn to b ecome well. This can involve a reconceptualisation of the patient's identit y from chronically ill, to "cured", and can give rise to a constellation of psychological, affective, behavioural, and sociological features character ised as the "burden of normality" Methods-This is a theoretical inquiry that documents the clinical phenomeno logy of the burden of normality by classifying its key psychological and ps ychosocial features. The model of adjustment is presented in the contest of previous outcome research on surgery for seizures, providing a conceptual Link between practice based rehabilitation measures of outcome and multidim ensional constructs, such as health related quality of life. Results-The model represents a process oriented, theoretical frame cr-ark f or comprehensively measuring outcome after life changing medical interventi ons. It has implications for clinical practice, including the identificatio n of preoperative predictors of outcome and informing appropriate managemen t and rehabilitation of patients. Conclusion-This model of outcome after temporal lobectomy may ultimately be applicable to the treatment of other chronic conditions.