Educational and Employment Outcomes Following Epilepsy Surgery in Childhood

Abstract

Childhood-onset epilepsy is associated with educational under-attainment and underemployment. In some children, surgical intervention may be offered as treatment for medication-resistant seizures. Successful treatment may halt seizure-related cognitive and academic deterioration, providing opportunity for greater success in school and work. This chapter examines published research on four Indicators of educational and employment outcomes after epilepsy surgery in childhood (surgery age ≤ 18): (1) special educational provision (2) qualifications attained, (3) unemployment, and (4) financial independence. Few reports are available: research to date describes outcomes after temporal lobe surgery, hemispherectomy, and mixed surgical cohorts (resective and palliative surgeries). Better long-term outcomes across all four indicators are seen for patients who are seizure free postsurgically, and better outcome is associated with shorter lifetime duration of epilepsy. Long-term postsurgical employment outcomes in children are reported as superior to those of adults. Findings indicate that early surgery leading to seizure cessation may promote outcome. However, few studies compare outcomes of surgery with continued pharmacotherapy. Lack of longitudinal data makes it difficult to preclude that superior seizure and psychosocial outcomes simply reflect better presurgical function. More generally, duration of follow-up is often too brief to capture outcomes of epilepsy surgery in children, in whom these are continuing to emerge.