Quality of life in young adults who underwent resective surgery for epilepsy in childhood.
ABSTRACT Purpose: This study investigated quality of life (QOL) in young adults who had undergone epilepsy surgery before the age of 16 years. The contribution to QOL of seizure status in the prior year, sex, number of antiepileptic drugs, and mood were evaluated. Methods: Sixty-nine young adults who had undergone surgery were subdivided into those who were seizure-free in the past year (n = 38) and those who had seizures (n = 31) in that time. A nonsurgical comparison group of young adults (n = 29) with childhood-onset medically intractable epilepsy was also studied. All groups completed measures of QOL and mood. Key Findings: After accounting for mood, sex, and number of antiepileptic drugs, the seizure-free group reported better cognitive and physical function and overall QOL, experienced less seizure worry, and had better self-perception. Mood was the most consistently predictive covariate, and was independently predictive of many aspects of QOL. Significance: Seizure freedom associated with surgery in childhood is associated with improved QOL in certain domains. Findings highlight the importance of mood in determining self-perception of QOL.
Full-textDOI: · Available from: Thomas J Snyder, Nov 13, 2014
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ABSTRACT: This study examined cognitive function in young adults who had epilepsy surgery in childhood. Thirty-seven individuals with medically intractable epilepsy with onset at 16 years or younger who had resective epilepsy surgery at least two years in the past (mean follow-up duration of 8.5 years) were assessed; of these, 13 had seizures within the year prior to the study, and the remainder had none. A comparison group of 16 individuals with childhood-onset intractable epilepsy who had not had surgery, all of whom had experienced at least one seizure in the past 12 months, was also included. The cognitive tests included measures of vocabulary, visuoconstructive ability, memory, and concept formation. Group differences were found only for the vocabulary and verbal memory tests, with the surgical group with seizures having the lowest performance. A subset of the surgical patients had preoperative data available on comparable tests, allowing for an examination of performance over time. Vocabulary scores were higher at follow-up, a finding which was present irrespective of seizure status. The results suggest that after epilepsy surgery in childhood or adolescence, few improvements in cognitive skills related to surgery or seizure outcome are to be expected.Epilepsy & Behavior 03/2014; 32:79–83. DOI:10.1016/j.yebeh.2014.01.006 · 2.06 Impact Factor
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ABSTRACT: Object Resection is a safe and effective treatment option for children with pharmacoresistant focal epilepsy, but some patients continue experience seizures after surgery. While most studies of pediatric epilepsy surgery focus on predictors of postoperative seizure outcome, these factors are often not modifiable, and the reasons for surgical failure may remain unclear. Methods The authors performed a retrospective cohort study of children and adolescents who received focal resective surgery for pharmacoresistant epilepsy. Both quantitative and qualitative analyses of factors associated with persistent postoperative seizures were conducted. Results Records were reviewed from 110 patients, ranging in age from 6 months to 19 years at the time of surgery, who underwent a total of 115 resections. At a mean 3.1-year follow-up, 76% of patients were free of disabling seizures (Engel Class I outcome). Seizure freedom was predicted by temporal lobe surgery compared with extratemporal resection, tumor or mesial temporal sclerosis compared with cortical dysplasia or other pathologies, and by a lower preoperative seizure frequency. Factors associated with persistent seizures (Engel Class II-IV outcome) included residual epileptogenic tissue adjacent to the resection cavity (40%), an additional epileptogenic zone distant from the resection cavity, and the presence of a hemispheric epilepsy syndrome. Conclusions While seizure outcomes in pediatric epilepsy surgery may be improved by the use of high-resolution neuroimaging and invasive electrographic studies, a more aggressive resection should be considered in certain patients, including hemispherectomy if a hemispheric epilepsy syndrome is suspected. Family counseling regarding treatment expectations is critical, and reoperation may be warranted in select cases.Journal of Neurosurgery Pediatrics 08/2014; 14(4):1-10. DOI:10.3171/2014.7.PEDS13658 · 1.37 Impact Factor
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ABSTRACT: Accurate estimators of key design metrics (power, area, delay, etc.) are increasingly required to achieve IC cost reductions in system-level through physical layout optimizations. At the same time, identifying physical or analytical models of design metrics has become very challenging due to interactions among many parameters that span technology, architecture and implementation. Metamodeling techniques can simplify this problem by deriving surrogate models from samples of actual implementation data. However, the use of metamodeling techniques in IC design estimation is still in its infancy, and practitioners need more systematic understanding. In this work, we study the accuracy of metamodeling techniques across several axes: (1) low- and high-dimensional estimation problems, (2) sampling strategies, (3) sample sizes, and (4) accuracy metrics. To help obtain more general conclusions, we study these axes for three very distinct chip design estimation problems: (1) area and power of networks-on-chip routers, (2) delay and output slew of standard cells under power delivery network noise, and (3) wirelength and buffer area of clock trees. Our results show that (1) adaptive sampling can effectively reduce the sample size required to derive surrogate models by up to 64% (or, increase estimation accuracy by up to 77%) compared with Latin hypercube sampling; (2) for low-dimensional problems, Gaussian process-based models can be 1.5x more accurate than tree-based models, whereas for high-dimensional problems, tree-based models can be up to 6x more accurate than Gaussian process-based models; and (3) a variant of weighted surrogate modeling , which we call hybrid surrogate modeling, can improve estimation accuracy by up to 3x. Finally, to aid architects, design teams, and CAD developers in selection of the appropriate metamodeling techniques, we propose guidelines based on the insights gained from our studies.Design, Automation & Test in Europe Conference & Exhibition (DATE), 2013; 01/2013