Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Epilepsia. 2011 May;52(5):925-31. doi: 10.1111/j.1528-1167.2011.03098.x.
To explore the effect of anterior temporal lobectomy on employment and define demographic and clinical predictors of postoperative employment in a large cohort with a prolonged observational period.
Subjects had an anterior temporal lobectomy for refractory epilepsy. All had an assessment period of 4 years or more with documentation of demographic factors, employment status, and seizure frequency prospectively registered in a database at surgery and at each contact after surgery. McNemar chi-square and a Wilcoxon matched pairs test were used to compare employment status before and after surgery. A multiple logistic regression assessed independent predictors of postoperative employment status based on preoperative employment status.
Three hundred sixty-nine patients were evaluated. Employment levels were higher and unemployment levels were lower after surgery (McNemar χ(2) = 3.96; p = 0.047). Working before surgery (Wald's χ(2) = 22.69, p < 0.0001) and having a greater percent of seizure-free years (Wald's χ(2) = 34.43, p < 0.0001) were associated with being employed after surgery. Of 131 patients who were unemployed or homemakers before surgery, 67 (51.1%) became employed postoperatively, with a younger age at surgery, a younger age of epilepsy onset, and driving a motor vehicle associated with gaining employment. Of 172 patients who were working at baseline, 27 (15.7%) became unemployed or homemakers after surgery. Gender was the only variable associated with loss of employment, with women being more likely to become homemakers (χ(2) = 14.98, d.f.= 6, p = 0.02). Most students were working after surgery, with seizure control influencing outcome.
Anterior temporal lobectomy is followed by reduced unemployment and underemployment, with elimination of seizures, relative youth, and operating a motor vehicle serving as the main driving forces for improvement. This is important information for patients and physicians who contemplate surgery as it helps define reasonable expectations, and provides further objective evidence for benefits beyond purely medical outcomes after epilepsy surgery.
探讨前颞叶切除术对就业的影响，并确定在一个大样本中，术后就业的人口统计学和临床预测因素，该样本具有较长的观察期。
研究对象接受了难治性癫痫的前颞叶切除术。所有患者的评估期均超过 4 年，在手术时和术后每次接触时，前瞻性地记录了人口统计学因素、就业状况和癫痫发作频率。采用 McNemar 卡方检验和 Wilcoxon 配对检验比较手术前后的就业状况。基于术前就业状况，采用多元逻辑回归评估术后就业状况的独立预测因素。
共评估了 369 例患者。术后的就业水平较高，失业水平较低（McNemar χ(2) = 3.96；p = 0.047）。手术前就业（Wald's χ(2) = 22.69，p < 0.0001）和有更多的无癫痫发作年数（Wald's χ(2) = 34.43，p < 0.0001）与术后就业相关。在术前失业或家庭主妇的 131 例患者中，有 67 例（51.1%）术后就业，手术年龄较小、癫痫发作年龄较小以及驾驶机动车与获得就业相关。在基线时工作的 172 例患者中，有 27 例（15.7%）术后失业或成为家庭主妇。性别是唯一与失业相关的变量，女性更有可能成为家庭主妇（χ(2) = 14.98，df= 6，p = 0.02）。大多数学生术后都在工作，癫痫控制影响结局。
前颞叶切除术可减少失业和就业不足，消除癫痫发作，相对年轻，操作机动车是改善的主要驱动力。这对于考虑手术的患者和医生来说是重要的信息，因为它有助于定义合理的预期，并为癫痫手术后除了纯粹的医疗结果之外的益处提供进一步的客观证据。
