Quality of Life after Successful Epilepsy Surgery: Evaluation by Occupational Achievement and Income Acquisition
Chaichon Locharernkul MD*, Buranee Kanchanatawan MD**, Krishnapundha Bunyaratavej MD***, Teeradej Srikijvilaikul MD***, Tayard Deesudchit MD****, Supatporn Tepmongkol MD*****, Sukalaya Lertlum, MD*****, Lawan Tuchinda, MD******, Chanop Shoungshotti, MD*******, Pradit Ounpak*
Affiliation : * Department of Medicine, **Department of Psychiatry, ***Department of Surgery, **** Department of Pediatric, ***** Department of Radiology, ****** Department of Anesthesiology, ******* Department of Pathology, Faculty of Medicine, Chulalongkorn University and Chulalongkorn Comprehensive Epilepsy Program (CCEP) under the patronage of Professor Doctor HRH Princess Chulabhorn, King Chulalongkorn Memorial Hospital, Thai Red Cross Society
Objectives : A comprehensive epilepsy surgery program has been developed at Chulalongkorn University Hospital, Thai-
land to reach an international standard level, rendering patients good surgical outcomes comparable to developed
countries. After successful operation, seizure free patients have become independent, self earning or employed. However,
quality of life (QOL) in terms of occupational achievement and income acquisition after epilepsy surgery has never been
studied. These indicators reflect the ultimate QOL in the aspects of actual independency, intact brain functions, mental
health and psycho-social interactions. The authors therefore conduct the study on improvement of QOL after successful
epilepsy surgery using these parameters.
Materials and Methods : One hundred and eleven intractable epilepsy who have become seizure free to worthwhile improved
(Engel class I to III) after standard presurgical evaluation and epilepsy surgery from January 2002 to December 2004
were evaluated. The patients were followed up for 3 years. The occupational status and incomes were categorized
according to the ranking of the patients’ functioning levels. The pre and post surgery work abilities, employment and
incomes were interviewed and compared. Mc Nemar test and paired t-test were used for statistical analyses.
Results : The average age of the 111 adults (54 males and 57 females) was 33.7± 9.2 years. Eighty two percent of the patients
had temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS) and underwent standard anterior temporal
lobectomy. The rest had tumors, cortical dysplasia or scar and received lesionectomy or cortical resection assisted by
intra-operative or intra-cranial EEG. The overall seizure free rate is 83.8 %. The occupational status of the subjects was
shown to improve significantly after surgery from unemployed to higher categories of professional achievement (p <
0.001). The number of unemployed and no income individuals decreased from 66 to 25 cases (62.1 % reduction rate) after
surgery (p < 0.001). Reciprocally, the number of persons who achieved professional jobs with regular incomes or salaries
increase from 30 to 53 cases (43.4 % increasing rate) (p < 0.001). The patients who have not acquired any income
increment showed improvement in working ability after epilepsy surgery. The average annual incomes per capita shows the
increasing rate of 45.08 %, from 55,657.85 Baht (approximately US$ 1,390) to 80,748.15 Baht (approximately US$
2,018), with strong statistical significance (p < 0.001). The improvement is best seen in seizure free than in non-seizure free
subjects.
Conclusion : The present study, to the authors’ knowledge, is the first to use work abilities, professional achievement and
income acquisition to assess the ultimate QOL after epilepsy surgery. Most subjects have been shown to significantly
improve their postoperative lives in terms of occupational accomplishment and income increment, especially in seizure free
individuals. The need for expansion of epilepsy surgery is emphasized.
Keywords : QOL, Epilepsy surgery, Occupation, Income, MTLE
