According to the results of a recently published prospective cohort study, drug-resistant epilepsy (DRE) who underwent epilepsy surgery had significant improvements in health-related quality of life (HRQOL) that occurred in the first year after surgery, with the greatest improvement. Occurs in the first 6 months after surgery. Improvement was stable in those who underwent surgery while those on medical therapy remained unchanged at 2-year follow-up.
Led by Elisa Widzaza, MD, PhD, pediatric neuroradiologist, The Hospital for Sick Children, the study recruited patients with DRE from 8 Canadian epilepsy centers who underwent surgery (n = 111) or continued medical therapy (n = 154). Compromise in 6 months, 1 year and 2 years. Data analyzed from May 2014 to December 2021 showed that surgical patients’ HRQOL was 3.0 (95% CI, –0.7 to 6.8) points higher at 6 months, 4.9 (95% CI, 0.7–9.1) points higher at 1-year, and 5.1 ( 95% CI, 0.7–6.8) points higher at 2-year follow-up compared with treated patients.
“Understanding the evolution of HRQOL after surgery compared to medical therapy is important in counseling children and parents and will contribute to informed decision-making about treatment options,” concluded Widzaja et al. “Epilepsy surgery leads to improvements in seizure freedom and HRQL in children, with downstream effects such as better educational and vocational achievement and reduced health care resource utilization and health care costs. Our study provides objective evidence to justify the high cost. Surgery and To improve access to surgery.”
HRQOL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55, an assessment that includes 4 domains of physical, cognitive, emotional, and social function. In the study, the mean age of the patient group at baseline was 11.0 (SD, 4.1) and more than half (56%) had daily or weekly seizures. Entering the study, patients selected for surgery were more likely to have frequent seizures, unilateral temporal seizures, or extratemporal seizures, while medical patients were more likely to have bilateral, multilobar, or unknown seizure focus.
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In addition to greater HRQOL scores observed at follow-ups, linear mixed models revealed that higher HRQOL was associated with older age of seizure onset, less antiseizure medication, and greater family resources at baseline. In sensitivity analyses, results were similar, with improvements in social functioning that occurred 6 months and 1 year after surgery remaining stable 2 years after the procedure. There were no significant differences in cognitive, mental and physical functioning between surgical and medical patients.
Additional results from a sensitivity analysis revealed that 72% of children who underwent surgery were seizure free at 2 years, compared with 33% of those with medical therapy. Notably, patients who were seizure-free reported significantly higher HRQOL than patients who were not seizure-free at follow-up, regardless of surgical status.
In the study limitations section, the investigators wrote, “To our knowledge, this is the largest multicenter study evaluating the trajectory of HRQOL after pediatric epilepsy surgery compared with medical therapy. Although some clinical characteristics of surgery and treatment differed. For patients at baseline, we analyzed HRQOL. We adjusted extensively for variables that were reported to influence who. In addition, the 2 groups did not differ in their HRQOL at baseline, which is one of the most important predictors of HRQOL at follow-up.”