Prospective and longitudinal long-term employment outcomes after resective epilepsy surgery

Abstract

Objective: To investigate long-term employment outcomes after resective epilepsy surgery in a national population-based cohort of adults.

Methods: In the Swedish National Epilepsy Surgery Register, all adults who were operated with resective epilepsy surgery from 1995 to 2010 were identified. Two-year follow-up was available for 473/496, 5-year follow-up for 220/240, 10-year follow-up for 240/278, and 15-year follow-up for 85/109 patients.

Results: There were no significant changes in employment outcome over time at group level, but for those with full-time employment at baseline, 79%, 79%, 57%, and 47% of seizure-free patients were in full-time work at 2-, 5-, 10-, and 15-year follow-up, compared to patients with benefits at baseline, where 16%, 27%, 31%, and 33% of seizure-free patients worked full time at these time points (p = 0.018 at 10 years). More patients with full-time work had ability to drive, a family of their own, and higher educational status than patients in part-time work or on benefits. Univariate predictors for employment at long term were having employment preoperatively, higher education, favorable seizure outcome, male sex, and younger age at surgery. Multivariate predictors were having employment preoperatively, favorable seizure outcome, and younger age.

Conclusions: The best vocational outcomes occurred in seizure-free patients who were employed or students at baseline, which may reflect a higher general psychosocial level of function. Younger age also predicted better employment outcomes and it therefore seems plausible that early referral for surgery could contribute to better vocational outcomes.

Figure 1. Employment outcome after surgery related to baseline employment status and seizure outcome

Seizure-free = seizure-free the year before follow-up; sz reduction = reduction in seizure frequency compared with baseline.

Figure 2. Full-time employment for seizure-free patients and in the general population

Percentage with full-time employment in the general population and in seizure-free patients in different age groups. Numbers above bars represent number of patients in each group. Gen pop = general population.

Figure 3. Univariate analyses of predictors for employment

Forest plot of predictors for employment (full- or part-time) at 2, 5, 10, and 15 years after surgery. Retired patients were excluded from analyses. Age/10 years = age (per decade of life); Epi dur (per 10% of life) = epilepsy duration in percent of life length (increments of 10% units); neurol dysfunction = any neurologic dysfunction (including intellectual disability with a Full Scale IQ <70); OR = odds ratio; preop = preoperatively; ref = reference; szs = seizures.