Abstract
Ph.D.
Epilepsy is a multidimensional disorder that extends beyond the medical implications to impact
nearly every aspect of the person's life, as well as the lives of the people in the surrounding
environment. Intractable epilepsy has a poor prognosis with possible worsening of seizures and
cognitive decline over time. Anterior temporal lobe surgery for epilepsy provides an opportunity for
the alleviation of seizures; however there are potential risks, to memory in particular. Research on
surgery outcome thus far has evaluated outcome from a linear paradigm and has studied impact of
surgery on isolated areas of function, the results derived from this have been largely inconsistent. So
far, there has been very little research that focuses on the person as a whole, and as yet there has
been no integrated approach to studying surgical outcome.
The aim of the current study was therefore to investigate the impact of anterior temporal lobe
surgery, specifically the symptomatic and functional surgical outcomes, in an integrated and holistic
manner. This was done in accordance with the paradigm of complex systems theory as a critique of
the previous literature in this field, and to gain a more holistic understanding of surgical outcome. A
combination of methodologies was employed in order to achieve this.
The sample consisted of male (n=10) and female (n=24) patients with intractable epilepsy
undergoing left-sided (n=13) and right-sided (n=21) temporal lobe surgery at the Milpark Hospital
Johannesburg between the ages of 14 and 58 (mean = 39 years), over a period of seven years. A
pretest-posttest design was employed to obtain quantitative data (n=34). Post surgical assessments
were conducted up to seven years post surgery (mean=3.6 years). Pre and post surgery assessment
included neurocognitive functioning, particularly memory and language functions, by means of the
Rey Complex Figure Test, Wechsler Memory Scale-Ill, and Controlled Oral Word Association Test; as
well as emotional functioning, particularly depression and anxiety, by means of the Beck Depression
lnventory-11 and Beck Anxiety lnventory-11. The quantitative data was subjected to statistical analysis
of the sample as a whole, as well as gender and side of surgery comparisons, and included tests of
normality of distribution of the data; the paired samples t-test; the independent samples t-test; the
Wilcoxon Signed Ranks test; the Mann-Whitney U test; and the Wilks' Lambda test.
A semi-structured interview was also conducted (n=30) in order to obtain qualitative data on the
functional (psychosocial) aspects of outcome. The interview included an assessment of
postoperative seizure outcome; changes in daily activity functions; the client's report on positive and
negative outcomes of surgery; quality of life changes and satisfaction with surgery. The qualitative
data was analysed using the methods of open coding and axial coding.
The results for neuropsychological function reflected known lateralization effects with memory
showing auditory-verbal memory deficits after left-sided surgery; and visual (figural) memory deficits
after right-sided surgery. Gender differences reflected known neuropsychological differences with
female superiority in verbal fluency and a male advantage on visual-spatial tasks. Importantly, there
was no relationship between neuropsychological deficit and decrements in daily activity functions,
emotional functioning or quality of life. This indicates little impact of neuropsychological deficit post
surgery and may be an indication of the effectiveness of the preoperative screening procedures. The
results for emotional functioning showed a statistically significant improvement in the
'moderate/severe' depression and anxiety groups from pre to post surgery. This indicates a
substantial improvement in both depression and anxiety for this severity group.
The qualitative results showed that surgery rendered 74% of the sample seizure free, 15% showing
worthwhile improvement, and 11% no change or worse seizures. Seizure outcome however did not
determine quality of life changes, even those with some improvement or no change still reported an
improvement in quality of life post surgically. The functional outcomes showed little postoperative
change in daily activity functions (driving, occupational functioning and marital status) but still a
reported improvement in quality of life. There were far more reports on perceived positive than
negative outcomes. The most positive benefit of surgery, as reported by participants, was that of
increased feelings of control, decreased helplessness, and less anxiety and worry of having seizures.
The overwhelming majority of participants reported improved quality of life (90%) and satisfaction
with surgery (93%).