THE ADJUSTMENT TO LIVING WITHOUT EPILEPSY

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Abstract
Five patients with medically uncontrollable temporal lobe epilepsy and interictal psychiatric difficulties, in whom seizures were arrested permanently or temporarily by neurosurgical intervention, were investigated in detail neurologically, electroencephalographically and psychiatrically to elucidate some of the mechanisms of the protracted psychiatric course after operation. In 4 patients, the psychiatric observations after "ablation" of the seizure showed that the latter had contributed as a significant positive factor to the patient''s intrapsychic and interpersonal adjustment. Outcome after surgery for temporal lobe epilepsy is dependent not only on the nature and site of the lesion, on the skill of the electroencephalog-rapher and surgeon, but on the patient himself, his family and their psychic resources. For optimal behavioral recovery in the patient made seizure-free by operation, these resources should be assessed preoperatively. For those patients in whom the illness fulfills a significant adaptive role, a tightly coordinated program of psychiatric supervision and vocational rehabilitation should be organized for the postoperative period. Postoperative rehabilitation of the patient relieved of psy-chomotor epilepsy requires a reversal of the usual concept of rehabilitation in that such patients must learn to live without the help of an accustomed handicap.