Executive dysfunction and employment in epilepsy

Executive dysfunction, affective symptoms, and unemployment are prevalent in patients with epilepsy, yet the relation between these variables remains poorly understood. The present study examined: (1) The relationship between epilepsy-related variables, affective symptoms, and executive functions (EFs); and (2) how these variables may be associated with participation in employment or education.

Retrospective study including 559 patients admitted to the Norwegian National Centre for Epilepsy. EFs was assessed using EpiTrack, and affective symptoms were evaluated with the 7-item Generalized Anxiety Disorder (GAD-7) and Neurological Disorders Depression Inventory for Epilepsy (NDDI-E).

Impaired EFs were observed in half of the patients, and were associated with a higher antiseizure medication (ASM) load, even after adjusting for variables related to disease severity. Approximately 36% of the patients reported symptoms indicating major depression and 19% reported symptoms indicating generalized anxiety. Half of the sample was unemployed, and these patients showed poorer EFs than those engaged in employment or education (F(3, 530) = 12.29, p < .001, ηp² = .07), with no group differences in seizure frequency, anxiety, or depressive symptoms.

In patients at a tertiary epilepsy center, executive dysfunction is prevalent along with heightened symptoms of depression and anxiety. Executive dysfunction is associated with a higher ASM load as well as increased likelihood of unemployment. Our findings suggest that job retention may depend on more than the burden of epilepsy alone, with executive functioning playing a critical role. These findings emphasize the importance of monitoring EF during treatment adjustments and support minimizing total ASM load whenever possible to promote better functional outcomes.