Edelvik Anna, Flink Roland, Malmgren Kristina
From the Department of Clinical Neuroscience and Rehabilitation (A.E., K.M.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Clinical Neurophysiology (R.F.), Uppsala University Hospital, Sweden.
Neurology. 2015 Oct 27;85(17):1482-90. doi: 10.1212/WNL.0000000000002069. Epub 2015 Sep 25.
To investigate long-term employment outcomes after resective epilepsy surgery in a national population-based cohort of adults.
In the Swedish National Epilepsy Surgery Register, all adults who were operated with resective epilepsy surgery from 1995 to 2010 were identified. Two-year follow-up was available for 473/496, 5-year follow-up for 220/240, 10-year follow-up for 240/278, and 15-year follow-up for 85/109 patients.
There were no significant changes in employment outcome over time at group level, but for those with full-time employment at baseline, 79%, 79%, 57%, and 47% of seizure-free patients were in full-time work at 2-, 5-, 10-, and 15-year follow-up, compared to patients with benefits at baseline, where 16%, 27%, 31%, and 33% of seizure-free patients worked full time at these time points (p = 0.018 at 10 years). More patients with full-time work had ability to drive, a family of their own, and higher educational status than patients in part-time work or on benefits. Univariate predictors for employment at long term were having employment preoperatively, higher education, favorable seizure outcome, male sex, and younger age at surgery. Multivariate predictors were having employment preoperatively, favorable seizure outcome, and younger age.
The best vocational outcomes occurred in seizure-free patients who were employed or students at baseline, which may reflect a higher general psychosocial level of function. Younger age also predicted better employment outcomes and it therefore seems plausible that early referral for surgery could contribute to better vocational outcomes.
在全国基于人群的成年队列中调查切除性癫痫手术后的长期就业结局。
在瑞典国家癫痫手术登记处，确定了1995年至2010年接受切除性癫痫手术的所有成年人。473/496例患者有2年随访数据，220/240例患者有5年随访数据，240/278例患者有10年随访数据，85/109例患者有15年随访数据。
在组水平上，就业结局随时间没有显著变化，但对于基线时全职工作的患者，无癫痫发作的患者在2年、5年、10年和15年随访时分别有79%、79%、57%和47%仍在全职工作，而基线时领取福利的患者，无癫痫发作的患者在这些时间点全职工作的比例分别为16%、27%、31%和33%（10年时p = 0.018）。与从事兼职工作或领取福利的患者相比，更多全职工作的患者有驾驶能力、自己的家庭且教育程度更高。长期就业的单因素预测因素包括术前就业、高等教育、良好的癫痫发作结局、男性性别和手术时年龄较小。多因素预测因素为术前就业、良好的癫痫发作结局和年龄较小。
最佳职业结局出现在基线时就业或为学生且无癫痫发作的患者中，这可能反映了更高的总体心理社会功能水平。年龄较小也预示着更好的就业结局，因此早期转诊进行手术似乎有可能带来更好的职业结局。
