A patient with lifelong epilepsy visits their physician. After trying multiple medications, the symptoms persist. The patient weighs the risks and benefits of epilepsy surgery for the possibility of a seizure-free life. Although the physical symptoms may subside, there is no magic bullet to heal the mental strain of the neurological condition. Now, they must navigate a new life without the anchor of chronic illness and the burden of normality.
Kayela Arrotta, PhD, a neuropsychologist at Cleveland Clinic, told Becker’s the Readiness Brain Operation Optimization Training (REBOOT) program aims to bridge the gap between physical and mental health before, during and after epilepsy surgery. The goal: communicate the risks and benefits of surgery, identify behavioral health conditions, connect participants with services, provide peer support through a six-week program and follow up to encourage sustained progress.
“We know there’s a subset of patients that can be at risk for experiencing worsening depression and anxiety after surgery,” she said. “REBOOT aims to help with cognitive readiness in that emotional resilience. If we can put into place some really good strategies to help with our cognitive function ahead of time … then those changes are far less impactful on our day-to-day functioning.”
The virtual program consists of six one-hour sessions in which first patients complete an interview with Dr. Arrotta or another group leader to identify behavioral health needs. The program also integrates the use of standardized tests such as the GAD-7 and PHQ-4, she said.
“One of the biggest things that I hear patients say is that they kind of de-prioritize their mental health prior to epilepsy surgery, because they have this idea that surgery is going to fix everything,” Dr. Arrotta said. “We warn patients that this is a dangerous trap. I get it, it’s reasonable to think that way, but that’s not what we typically see with patients when we track them through that recovery process.”
A major focus is empowerment through education.
Four sessions of the program include peer-to-peer mentoring in which participants discuss cognitive compensatory strategies — such as tying a shoe, making a to-do list or keeping a calendar — and aspects of mental health strategies such as coping. These sessions also educate patients on how their mental health may shift after surgery, especially for those removing areas of the brain responsible for emotional regulation, such as the amygdala.
Throughout the program, patients set weekly goals allowing them to work on incorporating the cognitive, coping and brain health strategies into their everyday lives to create behavioral changes.
She said the potential of cognitive decline or mood changes can affect a person’s overall health.
“The better your mood is going into surgery, the better it’s going to be coming out of surgery, because we do know that preexisting mood symptoms is one of the biggest risk factors for worsening anxiety and depression after surgery,” Dr. Arrotta said.
After six weeks, patients complete a follow-up session to reinforce and expand on several types of coping strategies and continued education about mood risks.
Dr. Arrotta said leaders should always take a patient-centered approach and look beyond the initial problem to solve. If the patient has goals to pursue medical school or a high-demand job in which any cognitive decline may negatively impact their lives, mental and physical health is essential to pursuing a fulfilled life post-surgery.
“We have to consider the outcomes beyond the specific condition. What are the outcomes beyond seizure freedom and that includes things like cognitive impact, mental health impact, different aspects of being able to pursue their career goals and their other life goals?” she said. “So considering the patient as a whole and what’s going to be best and most appropriate from a treatment perspective in that larger context.”
