Article

Quality of life in young adults who underwent resective surgery for epilepsy in childhood

Division of Neurology, The Hospital for Sick Children, Toronto, Ontario Canada School of Social Work, McGill University, Montreal, Quebec, Canada Department of Psychology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada Department of Nursing, Brock University, St. Catharines, Ontario Canada Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada Department of Psychiatry, University of Alberta Hospital, Edmonton, Alberta, Canada Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada.
Epilepsia (Impact Factor: 4.57). 07/2012; 53(9):1577-1586. DOI: 10.1111/j.1528-1167.2012.03594.x
Source: PubMed

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.

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Available from: Thomas J Snyder, Nov 13, 2014
    • "It will also be useful to compare parental HRQoL and parental emotional symptoms in parents whose children undergo surgery versus those where surgery is not considered an option. There is increasing evidence that pediatric epilepsy surgery can have a positive impact on child outcomes with respect to cognition [32], quality of life [33], and parental stress [34]. It will be important to also include parent HRQoL and emotional symptoms as outcome measures when considering the impact of epilepsy surgery on the family. "
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    ABSTRACT: Purpose: The purpose of this study was to assess and compare health-related quality of life (HRQoL) and emotional well-being in mothers and fathers of children with drug-resistant epilepsy, referred for presurgical evaluation in Sweden. Methods: Mothers (n=117) and fathers (n=102) of 122 children (0-18years) completed the generic 36-item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Mothers' and fathers' SF-36 scores were compared with age-adjusted Swedish population values using the independent t-tests. Differences in the proportions of mothers vs. fathers classified as 'noncases' or 'possible/probable' clinical cases of anxiety (HADS-A) and depression (HADS-D), respectively, were assessed with the chi-square test. Parents' HADS scores were also compared using independent t-tests. Results: Mothers had significantly lower scores compared with norms on 6 of the 8 SF-36 domains (p<0.01), while fathers had significantly lower scores on 4 of the domains (p<0.01). Mothers had significantly lower scores than fathers on 4 of the SF-36 domains (p<0.05). Significantly more mothers than fathers scored below the population mean for the SF-36 Mental Component Summary score. A significantly larger proportion of mothers than fathers had 'possible/probable' anxiety (52% vs. 38%) but not depression (30% vs. 22%). Mothers had significantly worse scores than fathers on HADS-A (p<0.01) but not on HADS-D. Conclusion: Mothers and fathers of children with drug-resistant epilepsy have diminished HRQoL compared with population norms. Symptoms of anxiety appear to be more common than symptoms of depression. Mothers experienced higher levels of anxiety, but not depression, than fathers and scored lower than fathers on vitality, mental health, and Mental Component Summary of the SF-36. There is a need to identify contributory factors and interventions to ameliorate these difficulties.
    No preview · Article · Oct 2015 · Epilepsy & Behavior
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    • "In medically-refractory epilepsy, localization and surgical resection of the epileptogenic zone leads to seizure freedom in $60–80% of patients with mesial temporal lobe epilepsy (MTLE) and about one-half of individuals with focal neocortical epilepsy (FNE) (Spencer and Huh, 2008; Englot et al., 2013). This leaves substantial room for improvement in surgical outcomes, as seizure freedom is the single greatest predictor of qualityof-life in epilepsy (Macrodimitris et al., 2011; Elliott et al., 2012). Failures in the surgical treatment of epilepsy stem in part from an incomplete understanding of epileptic brain networks (Engel et al., 2013), for most cases of failed epilepsy surgery involve incomplete delineation and resection of the epileptogenic zone from which seizures originate (Englot et al., 2014a, b). "
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    ABSTRACT: Intractable focal epilepsy is a devastating disorder with profound effects on cognition and quality of life. Epilepsy surgery can lead to seizure freedom in patients with focal epilepsy; however, sometimes it fails owing to an incomplete delineation of the epileptogenic zone (EZ). Brain networks in epilepsy can be studied with resting-state functional connectivity (RSFC) analysis, yet previous investigations using functional MRI or electrocorticography have produced inconsistent results. Magnetoencephalography (MEG) allows noninvasive whole-brain recordings, and can be used to study both long-range network disturbances in focal epilepsy and regional connectivity at the EZ. In MEG recordings from presurgical epilepsy patients, we examined: (1) global functional connectivity maps in patients vs controls, and (2) regional functional connectivity maps at the region of resection, compared with the homotopic nonepileptogenic region in the contralateral hemisphere. Sixty-one patients were studied, including 30 with mesial temporal lobe epilepsy and 31 with focal neocortical epilepsy. Compared with a group of 31 controls, epilepsy patients had decreased RSFC in widespread regions, including perisylvian, posterior temporoparietal, and orbitofrontal cortices (P < .01, false discovery rate-corrected). Decreased mean global connectivity was related to longer duration of epilepsy and higher frequency of consciousness-impairing seizures (P < .01, linear regression). Furthermore, patients with increased regional connectivity within the resection site (n = 24) were more likely to achieve postoperative seizure freedom (87.5% with Engel I outcome) than those with neutral (n = 15, 64.3% seizure free) or decreased (n = 23, 47.8% seizure free) regional connectivity (P < .02, χ). Widespread global decreases in functional connectivity are observed in patients with focal epilepsy and may reflect deleterious long-term effects of recurrent seizures. Furthermore, enhanced regional functional connectivity at the area of resection may help predict seizure outcome and aid surgical planning.
    Full-text · Article · Aug 2015 · Neurosurgery
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    • "In medically-refractory epilepsy, localization and surgical resection of the epileptogenic zone leads to seizure freedom in $60–80% of patients with mesial temporal lobe epilepsy (MTLE) and about one-half of individuals with focal neocortical epilepsy (FNE) (Spencer and Huh, 2008; Englot et al., 2013). This leaves substantial room for improvement in surgical outcomes, as seizure freedom is the single greatest predictor of qualityof-life in epilepsy (Macrodimitris et al., 2011; Elliott et al., 2012). Failures in the surgical treatment of epilepsy stem in part from an incomplete understanding of epileptic brain networks (Engel et al., 2013), for most cases of failed epilepsy surgery involve incomplete delineation and resection of the epileptogenic zone from which seizures originate (Englot et al., 2014a, b). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Intractable focal epilepsy is a devastating disorder with profound effects on cognition and quality of life. Epilepsy surgery can lead to seizure freedom in patients with focal epilepsy; however, sometimes it fails due to an incomplete delineation of the epileptogenic zone. Brain networks in epilepsy can be studied with resting-state functional connectivity analysis, yet previous investigations using functional magnetic resonance imaging or electrocorticography have produced inconsistent results. Magnetoencephalography allows non-invasive whole-brain recordings, and can be used to study both long-range network disturbances in focal epilepsy and regional connectivity at the epileptogenic zone. In magnetoencephalography recordings from presurgical epilepsy patients, we examined: (i) global functional connectivity maps in patients versus controls; and (ii) regional functional connectivity maps at the region of resection, compared to the homotopic non-epileptogenic region in the contralateral hemisphere. Sixty-one patients were studied, including 30 with mesial temporal lobe epilepsy and 31 with focal neocortical epilepsy. Compared with a group of 31 controls, patients with epilepsy had decreased resting-state functional connectivity in widespread regions, including perisylvian, posterior temporo-parietal, and orbitofrontal cortices (P < 0.01, t-test). Decreased mean global connectivity was related to longer duration of epilepsy and higher frequency of consciousness-impairing seizures (P < 0.01, linear regression). Furthermore, patients with increased regional connectivity within the resection site (n = 24) were more likely to achieve seizure postoperative seizure freedom (87.5% with Engel I outcome) than those with neutral (n = 15, 64.3% seizure free) or decreased (n = 23, 47.8% seizure free) regional connectivity (P < 0.02, chi-square). Widespread global decreases in functional connectivity are observed in patients with focal epilepsy, and may reflect deleterious long-term effects of recurrent seizures. Furthermore, enhanced regional functional connectivity at the area of resection may help predict seizure outcome and aid surgical planning. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    Full-text · Article · May 2015 · Brain
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