Executive dysfunction and employment in epilepsy

Lisa E Hauger; Christoph Helmstaedter; Morten I Lossius; Kristin Å Alfstad; Ellen Molteberg; Halvor Torgersen; Annette H Skogan

doi:10.1002/epi.70165

Executive dysfunction and employment in epilepsy

Epilepsia. 2026 Mar 7. doi: 10.1002/epi.70165. Online ahead of print.

Authors

Lisa E Hauger^{1

2}, Christoph Helmstaedter³, Morten I Lossius^{1

2

4}, Kristin Å Alfstad^{1

2}, Ellen Molteberg^{1

2}, Halvor Torgersen^{1

2}, Annette H Skogan^{1

2

5}

Affiliations

¹ Division for Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Nydalen, Norway.
² Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Oslo, Norway.
³ Department of Epileptology, University Hospital Bonn, Bonn, Germany.
⁴ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁵ Department of Psychology, University of Oslo, Oslo, Norway.

PMID: 41793274
DOI: 10.1002/epi.70165

Abstract

Objective: 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.

Methods: 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).

Results: 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.

Significance: 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.

Keywords: DRE; EpiTrack; employment; executive function; mental health.

Grants and funding

334239/The Norwegian Epilepsy Association / Epilepsiforbundet