Sarah Wilson, PhD

“We need to get patients ready for surgery. It’s kind of like pre-hab, pre-habilitation. Many patients come into surgery with unreasonably high expectations. ‘I’m going to have the surgery, my seizures are going to be fixed, and then I’m going to be fine. I’m going to have an amazing life’…Some of these expectations, really—we now know&mdash;are quite unrealistic.”

While epilepsy surgeries can offer patients essentially a new chance at a seizure-free life, patients often underestimate the challenges to adjusting to such a drastic change. In an attempt to understand the long-term impacts that epilepsy surgery can have in the social aspects of patients’ lives, Sarah Wilson, PhD, and colleagues began to map these outcomes over a ≥15-year period.

The clinical neuropsychologist, and head, School of Psychological Sciences, University of Melbourne, spoke to 

, June 22-26, in Bangkok, Thailand, about this work. She noted how patients can have autonomy challenges, issues with work-life adjustments, and changes in family dynamics, all of which are vital to the long-term success of the patient.

Wilson shared insight into how this can be addressed, and what steps need to be taken to educate patients on the long-term nature of the process and support them through it.

Coleman H, McIntosh A, Wilson S. Living with epilepsy: patient perceptions of their epilepsy and its treatment 15 to 20 years after epilepsy surgery. Presented at: 2019 International Epilepsy Congress. June 22-26, 2019; Bangkok, Thailand. P348.

Videos

The clinical neuropsychologist and head of the School of Psychological Sciences at the University of Melbourne discussed the results of a study she and colleagues conducted in which they mapped the long-term social outcomes of patient post-epilepsy surgery.

Sarah Wilson, PhD: Long-Term Social Outcomes of Epilepsy Surgery

“It’s a complex set of issues that we’re helping the patient, and the family, navigate. We know from the work we’ve done looking at post-operative adjustment, family dynamics and carer roles, all those things change as well, and they’re equally as important to the success and the outcome of the patient.”

When it comes to the post-operative management of patients with epilepsy, much and more goes into their care. As Sarah Wilson, PhD, clinical neuropsychologist, and head, School of Psychological Sciences, University of Melbourne, has pointed out, the processes are not that dissimilar to the rehabilitation of patients who have had a stroke in terms of taking a team-based approach.

The adjustments after resective surgery for individuals with epilepsy can include the experience of cognitive and memory challenges, and the neurorehabilitation process can often include a multidisciplinary team to ensure that patient outcomes are the best possible. Wilson spoke to 

, June 22-26, in Bangkok, Thailand, about what this can include.

She detailed the impact that this can have on family dynamics and carer roles for the patient, and how this transition into a well state from a state of illness may need to be addressed psychosocially in addition to any possible brain changes that have occurred.

The clinical neuropsychologist and head of the School of Psychological Sciences at the University of Melbourne detailed how the transition from states of illness to wellness after epilepsy surgery can result not just in brain changes, but psychosocial challenges for patients.

Sarah Wilson, PhD: Managing Post-Operative Patients With Epilepsy

“If you think about epilepsy surgery, [patients have] been chronically unwell. They have a procedure, and it renders them suddenly better. That’s sometimes described by patients as transformative, so they have this sense of ‘the new me,’ and ‘who am I, now that I don’t have epilepsy?’” 

When patients with epilepsy undergo resective surgery for their epilepsy, they often undergo a number of cognitive and psychological processes post-surgery, and while these can present differently, they have introduced a need for neurorehabilitation. Specifically, this rehabilitation process needs to focus on retraining of the brain in a number of facets.

 spoke with Sarah Wilson, PhD, clinical neuropsychologist, and head, School of Psychological Sciences, University of Melbourne, about this process. Wilson detailed how much of this rehabilitation is focused on “the burden of normalcy”—essentially providing patients the psychosocial skillsets and cognitive support they need to prepare for a post-epilepsy life.

Wilson spoke about the ideally assembled team and length of time for this sort of rehab, what physicians need to provide to help patients through this adjustment period, and &shy;&shy;how to address possible challenges with changes in mood.

The clinical neuropsychologist and head of the School of Psychological Sciences at the University of Melbourne spoke about what physicians need to provide to help patients through the adjustment period after epilepsy surgery.

Sarah Wilson, PhD: The Burden of Normality Post-Epilepsy Surgery

“We know that immediately after the surgery, the dynamic changes taking place in the brain and the recovery process that’s going on—which is understood in the context of neuroplasticity&mdash;means that we don’t always get a reliable or accurate picture early post-surgery. We need to do assessments longitudinally and we need to look over the longer term, which might be 5 or more years after surgery.”

When patients with epilepsy are refractory to antiepileptic therapy, there are several options for physicians and their patients to take, one of which is resective surgery. Of those surgeries, the most common is anterior temporal lobectomy, which is where the majority of research into risk factors and challenges has been done.

For Sarah Wilson, PhD, clinical neuropsychologist, and head, School of Psychological Sciences, University of Melbourne, the concern within this group of surgeries is focused on the long-term risks related to memory, and in some patients, language. She noted that immediately post-surgery, the long-term outlook is difficult to judge, and so long-term assessments of these patients need to be made. One of the ways to do this as well as lower the risk of challenges is to utilize neurorehabilitation.

To find out more about these neurorehabilitation methods and what has been done thus far,

, June 22-26, in Bangkok, Thailand. While these are in their early stages, Wilson noted that there has been some interesting work done in neuroplasticity to attempt to discern if the brain can be re-trained, so to speak, to address these issues after surgery.

The clinical neuropsychologist and head of the School of Psychological Sciences at the University of Melbourne discussed the early-stage research into neurorehabilitation post-epilepsy surgery, and the promise it might hold to address surgery’s long-term risks.

Sarah Wilson, PhD

Articles

Sarah Wilson, PhD: Long-Term Social Outcomes of Epilepsy Surgery

Sarah Wilson, PhD: Managing Post-Operative Patients With Epilepsy

Sarah Wilson, PhD: The Burden of Normality Post-Epilepsy Surgery

Sarah Wilson, PhD: The Promise of Neurorehabilitation After Epilepsy Surgery