Kristina Malmgren, MD, PhD
Results from a long-term study of outcomes after epilepsy surgery in childhood demonstrated rates of high school graduation and full-time employment in seizure-free patients similar to that seen in the general population.
The long-term study included 203 patients who underwent epilepsy surgery between 1995 and 2012 at age 19 or younger. The Swedish National Epilepsy Surgery Register (SNESUR) was used to collecting patients’ preoperative data, information about type of surgery and complications, and 2-year follow-up data since 1990. The goal of the study was to compare long-term employment outcomes of patients who underwent childhood epilepsy surgery with the general population reference data.
Investigators recorded variables at baseline such as age at epilepsy onset, sex, time to epilepsy surgery (between onset and surgery), age at surgery, mean monthly seizure frequency during the year preceding surgery, and number of antiepileptic drugs.
At each follow-up, investigators recorded data on seizure outcome, employment outcome and educational attainment. Educational attainment was classified into 4 categories: special education (adapted schooling provided up to the age of 20 for individuals with intellectual’s disabilities), compulsory school (9 years), high school (3 years following the compulsory 9 years), and postsecondary education (university, college, or vocational education after high school). Investigators classified employment outcomes as full-time employment, part-time employment, ongoing studies, or reliance on benefits.
Of the 203 patients included in the study, 72 had follow-up 5 years post-surgery, 127 at 10 years, 105 at 15 years, and 42 at 20 years post-surgery. At each follow-up visit, the percent of patients with an IQ >70 and seizure-freedom were 66%, 64%, 62%, and 64%, respectively.
Attainment of a postsecondary education in seizure-free patients age >25 with a preoperative IQ >70 was achieved in 7/25 (28%; 95% CI ,10%-46%), 16/29 (55%; 95% CI, 37%-73%), and 8/13 (62%; 95% CI, 35%-88%) patients at the 10-, 15-, and 20-year follow-ups, respectively, compared to the general population (43%, 44%, and 44%, respectively).
At 5-year follow-up, 44% of patients with an IQ >70 were employed part-time or full-time. The rate of part-time or full-time employment increased at each 5-year follow-up, from 69% at 10 years, to 71% at 15 years, and 77% at 20-years. Among patients with a preoperative IQ <70, 55%, 19%, 25%, and 10% attained part-time or full-time employment, even with reliance on social benefits.
Investigators noted the significant increase in full-time employment rates for seizure-free patients compared to those who still experienced seizures. Employment in seizure-free patients with an IQ >70 was reported in 17/25 (68%; 95 CI, 50%-86%), 22/29 (76%; 95% CI, 60%—91%), and 8/ 13 (62%; 95% CI, 35%–88%) patients at the 10-, 15-, 20-year follow-ups compared to rates of 66%, 66%, and 68% in the general population,
Limitations of the study included the lack of information regarding wages, occupational complexity, extent of part-time work, or postoperative cognitive assessments.
“It is reasonable to believe that successful surgical intervention in childhood would allow patients to enter adulthood less hindered by their epilepsy, even though associated adverse cognitive, psychiatric, and social factors may still have an influence,” the investigators wrote. “As a consequence, pediatric patients could be expected to fare better in terms of long-term employment compared to patients operated later in life who in many cases have had intractable epilepsy all through adolescence and early adulthood.”
Reinholdson J, Olsson I, Edelvik tranberg A, Malmgren K. Long-term employment outcomes after epilepsy surgery in childhood. Neurology. 2020;94(2):e205-e216.doi:10.1212/WNL.0000000000008681