Profiles of psychosocial outcome after epilepsy surgery: The role of personality

Abstract

PURPOSE: We have previously found that the developmental time frame of epilepsy onset influences adult personality traits and subsequent adjustment to intractable seizures. In the same cohort of patients we now investigate the influence of these factors on psychosocial outcome after surgical treatment. METHODS: Fifty-seven adult patients with focal epilepsy were prospectively assessed before and after surgery. Measures of psychosocial outcome included mood, health-related quality of life (HRQOL), and psychosocial adjustment, collected longitudinally at 1-, 3-, and 12-months after surgery. RESULTS: Patients with high neuroticism and low extraversion were predisposed to greater depression after surgery. More than 70% of patients with high neuroticism also reported disrupted family dynamics and difficulties adjusting to seizure freedom. The latter was associated with changes in self-identity that increased over time. Patients with epilepsy onset before or during the self-defining period of adolescence reported the greatest perceived self-change after surgery that had positive effects for HRQOL. DISCUSSION: Psychosocial outcome after epilepsy surgery appears intrinsically linked to a change in self and a transition from chronically sick to well. The development of personality traits and self-identity in the context of habitual seizures can impact psychosocial outcome and the extent of self-change reported after surgery, and paradoxically, can concur more beneficial effects.