Clinical, socio-economic, and psychological changes after temporal lobectomy for epilepsy.
To determine the effect of anterior temporal lobectomy, performed for the relief of epilepsy, on the lives of patients submitted to operation, 100 consecutive patients followed up for two to twelve years are reviewed, using a reliable social measure of pre-operative incapacity and post-operative outcome. The incidence of various pathological findings and the rate of seizure relief in this sample were consistent with those previously published from this unit, 47 per cent. showing mesial temporal sclerosis and 62 per cent. being largely relieved of epilepsy.

The social background of these patients was considerably disturbed: 40 per cent. had a family history of mental illness, 27 per cent. separated from at least one parent before the age of fifteen, 45 per cent. had experience of life in an institution, and 37 per cent. were unemployed pre-operatively.

At follow-up, 51 per cent. were of good social adjustment, 29 per cent. had usefully improved, but 12 per cent. deteriorated. The most consistently good effects were on working ability and inter-personal relationships rather than on use of leisure or sexual adjustment. Thirty-two per cent. were considered psychiatrically normal at follow-up, compared with 13 per cent. before operation.

A correlation analysis of 100 items was used to ascertain those related to the social measure, and their incidence was explored in four outcome groups. Those who improved were most relieved of epilepsy, those retaining good adjustment had the lowest rate of family mental illness, those who deteriorated had more late-onset epilepsy and were more intelligent, those who remained of poor adjustment were least relieved of epilepsy, and had high psychosis and psychopathy rates, an excess of lesions of no specific pathology; among them there was an excess of patients below the median IQ.

In the follow-up period 37 patients were at some time admitted to mental hospital, and 5 committed suicide.

The relevance of social outcome is discussed, the features associated with good and poor prognosis are outlined, and the role of the surgical procedure in determining outcome considered.