Abstracts

Rationale: 57 participants (surgical: M age = 31.3 years, SD = 8.9) who underwent ATL and completed 5- and 10-year follow-up interviews; 41 participants also completed a 15-year follow-up interview. 18 TLE individuals who did not undergo ATL (medically-managed control group: M age = 34.7 years, SD = 10.3) were followed at 5- and 10-years; 9 participants were available for interview at 15-year follow-up. Assessment of psychosocial status focused on full-time employment, driving, independent living, and financial independence. Methods: 57 participants (surgical group: M age = 31.3 years, SD = 8.9) who underwent ATL and completed 5- and 10-year follow-up interviews; 41 participants also completed a 15-year follow-up interview. 18 TLE individuals who did not undergo ATL (medically-managed control group: M age = 34.7 years, SD = 10.3) were followed at 5- and 10-years; 9 participants were available for interview at 15-year follow-up. Assessment of psychosocial status focused on full-time employment, driving, independent living, and financial independence. Results: At 5-years post-surgery, surgical participants were more likely to be living independently (p < 0.001) and driving (p = 0.004) than were their medically-managed counterparts. Additionally, surgical participants were more likely to be financially independent (p = 0.032) and have full-time employment (p = 0.025). The same was true at 10-year follow-up: independent living (p = 0.022); driving (p = 0.003); financial independence (p = 0.003); full-time employment (p = 0.037). At 15-years post-surgery, surgical participants were more likely to be living independently (p = 0.014) and driving (p = 0.020) than were medically-managed controls. There was a trend noted between the groups on financial independence (p = 0.065) but no significant difference for full-time employment rates (p = 0.209). Within-group analyses showed that the surgical participants made significant gains in ability to live independently and drive from pre-surgery to 5-years post-surgery, and these gains were maintained across both 10- and 15-year follow-ups (all p's < 0.05). Non-significant gains were seen relative to baseline rates of full-time employment and financial independence. At the 15-year follow-up 68% of the sample was seizure free in the previous 12 months compared to 11% in the medically managed group (p = 0.0001), and 47% of those in the surgery group had no seizures or auras since surgery. Additionally, 37% of the surgical group was no longer taking medications compared to 11% in the medically-managed group. Conclusions: Individuals undergoing ATL demonstrated improvement across several psychosocial domains relative to a medically-managed group. Within-group gains were observed in rates of independent living and driving across all follow-up intervals with smaller gains maintained in financial independence and full time employment. By examining these psychosocial outcomes, and by the inclusion of a control group, these data show the persisting benefit of ATL beyond decreases in seizure frequency and severity.