''If I didn't have epilepsy'': Patient expectations of epilepsy surgery

Although reduction of seizures is the primary aim of epilepsy surgery, patients who undergo elective temporal lobe surgery for the relief of medically intractable epilepsy often hope that a successful surgical outcome will result in broader changes in their lifestyle. The reasons given for proceeding to surgery often include assumptions about the consequences of becoming seizure-free. We describe the application of a rating scale to assess the expectations of presurgical epilepsy candidates. Seventy patients in the presurgical epilepsy program at the National Hospital for Neurology & Neurosurgery, London, were asked to rate themselves on 20 descriptive scales covering personality, cognitive, and emotional dimensions. They were also asked to rate how they believed they would be if the surgery were successful and their seizures ceased. An analysis of their responses showed that the patients were expecting significant positive changes in many dimensions postoperatively. Many of these expectations do not compare with the psychosocial changes that have been associated with temporal lobectomy in the literature or those reported by 32 patients who had been followed up for 1 year postoperatively. We conclude that these implicit assumptions need to be identified and addressed preoperatively so that the candidate can make a truly informed decision regarding a surgical option.