Occupational and Marital Status of Patients with Epilepsy

Abstract

Purpose: The improvement of the quality of life (QOL) in adult patients with epilepsy is now widely accepted as a very important goal of therapy. In this study, we focused our attention on the occupational and marital status of the patients with epilepsy and tried to clarify the clinical factors impeding improvement of the QOL in adults with epilepsy. Methods: We examined the medical and social conditions of the adults who did not have severe mental retardation and had been treated at Hirosaki University Hospital for >5 years by the end of 1996. The subjects of this study were 288 patients (146 men and 142 women). Their ages at the end of 1996 ranged between 20 and 60 years, and the mean age was 39.2 years in the men and 38.3 years in the women. We interviewed the patients or their family members or both and examined their case records for information about their social status and medical condition. Results: We classified the type of epilepsy of the subjects. Sixty‐five patients had idiopathic generalized epilepsy, and 215 had symptomatic localization‐related epilepsy including 82 with temporal lobe epilepsy and 133 with extratemporal lobe epilepsy. Eight patients had unclassified epilepsies. Their seizure frequencies during the least 3 years were classified as follows: seizure free (163 cases), less than yearly (17 cases), yearly (70 cases), monthly (27 cases), weekly (nine cases). and daily (two cases). Forty‐two (15%) of the subjects had neuropsychiatric complications such as personality changes, psychotic states, and mild mental retardation. We investigated the occupational status of the subjects and found that 169 (114 men and 55 women) had permanent jobs, 24 (10 men and 14 women) had irregular jobs, 45 (20 men and 25 women) were unemployed, 44 women were housewives, and six (two men and four women) were students. The proportion of the patients whose seizures were uncontrolled at the time of this study was 32% (54 of 169) in the group having permanent jobs, and 80% (36 of 45) in the unemployed group. There was a significant correlation between the present seizure frequency and current occupational status by the X2 test (p < 0.01). Forty‐one cases (32 men and nine women) resigned voluntarily or were dismissed from their jobs because of their epileptic seizures, and 14 (34%) of the 41 cases were unemployed at the time of this study. Sixteen (9%) of the 169 cases who had permanent jobs had neuropsychiatric complications, and 12 (27%) of the 45 unemployed had neuropsychiatric complications. A significant correlation was indicated between presence of neuropsychiatric complications and occupational status (p < 0.01). As to marital status, 62 (42%) men and 68 (48%) women were married throughout the time of this study. Thirty cases (13 men and 17 women) had experienced divorce. Twenty (67%) of the 30 cases had seizures at the time of divorce and nine (30%) had neuropsychiatric complications. Seven cases (two men and five women) had divorced because of having epilepsy or epileptic seizures. Six (86%) of the seven cases had not informed their spouses that they had epilepsy. Conclusions: In this study, we determined that epileptic seizures and neuropsychiatric complications have negative effects on social status. We emphasize that both seizures and neuropsychiatric complications should be carefully managed to improve the QOL in adult patients with epilepsy. A more aggressive therapy, such as treatment with new antiepileptic drugs and surgical treatment, should be considered when poor social prognosis is anticipated.