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NEUROLOGY 2006;66:1882-1887
© 2006 American Academy of Neurology

Patient-perceived impact of resective epilepsy surgery

P. S. Chin, MD, MSHS, A. T. Berg, PhD, S. S. Spencer, MD, M. L. Lee, PhD, S. Shinnar, MD, PhD, M. R. Sperling, MD, J. T. Langfitt, PhD, T. S. Walczak, MD, S. V. Pacia, MD, C. W. Bazil, MD, PhD, S. Vassar, MS and B. G. Vickrey, MD, MPH

From the Robert Wood Johnson Clinical Scholars Program (P.S.C.), Departments of Neurology and Medicine at UCLA and the Greater Los Angeles VA Health Care System, Los Angeles, CA; BIOS (A.T.B.), NIU, Dekalb, IL; Department of Neurology (S.S.S.), Yale University School of Medicine, New Haven, CT; Department of Biostatistics (M.L.L.), UCLA and the Center for the Study of Healthcare Provider Behavior, HSR&D Field Program, VA Medical Center (152), Sepulveda, CA; Departments of Neurology and Pediatrics (S.S.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (M.R.S.), Thomas Jefferson University Medical School, Philadelphia, PA; Department of Neurology (J.T.L.), University of Rochester, Rochester, NY; Minnesota Comprehensive Epilepsy Program (T.S.W.), Minneapolis, MN; Department of Neurology (S.V.P.), New York University, New York, NY; Department of Neurology (C.W.B.), Columbia University Medical School, New York, NY; Department of Neurology (S.V.), UCLA, Los Angeles, CA; Department of Neurology (B.G.V.), UCLA and the Greater Los Angeles VA Health Care System, Los Angeles, CA.

Address correspondence and reprint requests to Dr. Peter Chin, Health Economics and Outcomes Research, Genentech, Inc., 1 DNA Way, MS 241A, South San Francisco, CA 94080; e-mail: neuroepi{at}yahoo.com

Objective: To evaluate the patient-perceived impact of resective epilepsy surgery, a key outcome to consider in evaluating such a highly invasive, elective procedure.

Methods: Impact measures obtained from 396 patients in a multicenter cohort study of resective epilepsy surgery included (1) willingness to undergo surgery if that decision could be made again and (2) the overall impact of surgery on the patient’s life. Predictors of impact were analyzed using multivariate ordinal logistic regression.

Results: Of study participants, 73.8%, 77.4%, and 75.5% would definitely undergo surgery again and 78.2%, 80.2%, and 79.1% reported a very strong or strong positive overall impact of surgery at 3, 12, and 24 months. Multivariate ordinal logistic regression showed that seizure freedom predicted more positive perceptions at 3, 12, and 24 months (all p < 0.04). Becoming employed was uniquely associated with willingness to undergo surgery again and with overall impact at 24 months (all p < 0.05), but only a net 7% of the cohort improved their employment status. Right-sided resection (at 12 and 24 months, p < 0.005) and female gender (at 3 and 12 months, p = 0.006) were each positively associated with perceived overall impact.

Conclusions: Most epilepsy surgery patients report a positive overall impact of the procedure on their lives and a high willingness to undergo surgery again if that choice could be made. Seizure-free individuals express consistently more positive perceptions of the procedure. Findings suggest that it is important to make early efforts to reintegrate epilepsy surgery patients into employment.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the June 27 issue to find the title link for this article.

Supported by NIH NINDS RO1 32375-06 and the Robert Wood Johnson Foundation.

The views expressed in this article do not necessarily reflect those of the Robert Wood Johnson Foundation.

Disclosure: The authors report no conflicts of interest.

Received July 14, 2005. Accepted in final form March 10, 2006.






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