Epilepsy Surgery Improves Quality of Life – Results of a Questionnaire Study

Czech version

Authors: I. Doležalová ¹; E. Pešlová ²; M. Michnová ¹; T. Nečasová ³; J. Kočvarová ¹; K. Musilová ¹; I. Rektor ^1,4; M. Brázdil ^1,4
Authors‘ workplace: Centrum pro epilepsie Brno, I. neurologická klinika LF MU a FN u sv. Anny v Brně ¹; LF MU, Brno ²; Institut biostatistiky a analýz, LF MU, Brno ³; CEITEC – Středoevropský technologický institut, MU, Brno ⁴
Published in: Cesk Slov Neurol N 2016; 79/112(4): 430-439
Category: Short Communication

Overview

Aim:
Seizure-freedom is the traditional goal of epilepsy surgery. At presents, our attention is more and more concerned with the effects of epilepsy surgery on other aspects, mainly the impact of epilepsy surgery on employment status and quality of life.

Methods:
A questionnaire was designed for the purposes of our study; this questionnaire consists of 13 questions focusing on topics related to epilepsy surgery. These questions could be divided into four subfields: 1. demographic data and patients´ characteristics, 2. information related to surgery, 3. employment and social support, 4. subjective evaluation of surgery impact on the patient’s life.

Results:
Ninety-one respondents were included in the study – 56 men (61.5%) and 35 women (38.5%), who correctly completed the questionnaires. Fifty-nine patients (64.8%) were completely seizure-free after surgery. Before the surgery, 46 patients (50.5%) were employed, there was a mild increase in employment after surgery that did not reach statistical significance (p = 0.596). Half of the patients (49, 54%) reported an increase in quality of life after surgery. One question asked whether the patient would undergo the surgery again if he/she could change the past; 78 patients (85.7%) agreed they would.

Conclusion:
The majority of patients undergoing a surgery for drug-resistant epilepsy were seizure-free but only a minority managed subsequently to find an employment. Despite this, epilepsy surgery is assessed positively in the vast majority of patients, it provides them with an increase in quality of life and the majority would undergo the surgery again.

Key words:
epilepsy – drug-resistant – surgery – seizure-freedom – quality of life – employment after surgery – disability pension

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Sources

1. Tellez-Zenteno JF, Ronquillo LH, Wiebe S. Sudden unexpected death in epilepsy: evidence-based analysis of incidence and risk factors. Epilepsy Res 2005;65(1– 2):101– 15.

2. Tomson T, Beghi E, Sundqvist A, et al. Medical risks in epilepsy: a review with focus on physical injuries, mortality, traffic accidents and their prevention. Epilepsy Res 2004;60(1):1– 16.

3. Kwan P, Arzimanoglou A, Berg AT, et al. Definition of Drug Resistant Epilepsy: Consensus Proposal by the Ad Hoc Task Force of the ILAE Commission on Therapeutic Strategies. Aktuel Neurol 2010;37(8):372– 81. doi: 10.1111/ j.1528-1167.2009.02397.x.

4. Brázdil M. Proměny epileptochirurgie ve 21. století. Neurol Praxi 2015;16(2):77– 9.

5. Spencer S, Huh L. Outcomes of epilepsy surgery in adults and children. Lancet Neurology 2008;7(6):525– 37. doi: 10.1016/ S1474-4422(08)70109-1.

6. Kuba R, Brázdil M, Novák Z, et al. Dlouhodobá účinnost resekčních epileptochirurgických zákroků 5 let od operace. Neurol Praxi 2008;9(3):166– 70.

7. Kuba R, Brázdil M, Novák Z, et al. Kvalita života po resekční operaci pro farmakorezistentní epilepsii. Čes Slov Psychiat 2007;103:175– 83.

8. Katz A, Marks DA, McCarthy G, et al. Does interictal spiking change prior to seizures? Clin Neurophysiol 1992;79(2):153– 6.

9. Wiebe S, Blume WT, Girvin JP, et al. Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 2001;345(5): 311– 8.

10. Zarroli K, Tracy JI, Nei M, et al. Employment after anterior temporal lobectomy. Epilepsia 2011;52(5):925– 31. doi: 10.1111/ j.1528-1167.2011.03098.x.

11. Lendt M, Helmstaedter C, Elger CE. Pre- and postoperative socioeconomic development of 151 patients with focal epilepsies. Epilepsia 1997;38(12):1330– 7.

12. Reeves AL, So EL, Evans RW, et al. Factors associated with work outcome after anterior temporal lobectomy for intractable epilepsy. Epilepsia 1997;38(6):689– 95.

13. Asztely F, Ekstedt G, Rydenhag B, et al. Long-term follow-up of the first 70 operated adults in the Goteborg Epilepsy Surgery Series with respect to seizures, psychosocial outcome and use of antiepileptic drugs. J Neurol Neurosurg Psychiatry 2007;78(6):605– 9.

14. Sung C, Muller V, Jones JE, et al. Vocational rehabilitation service patterns and employment outcomes of people with epilepsy. Epilepsy Res 2014;108(8):1469– 79. doi: 10.1016/ j.eplepsyres.2014.06.016.

15. Capella ME. Inequities in the VR system: do they still exist? Rehabil Couns Bull 2002;45(3):143– 53.

16. Elsharkawy AE, May T, Thorbecke R, et al. Long-term outcome and determinants of quality of life after temporal lobe epilepsy surgery in adults. Epilepsy Res 2009;86(2– 3):191– 9. doi: 10.1016/ j.eplepsyres.2009.06.008.

17. Augustine EA, Novelly RA, Mattson RH, et al. Occupational adjustment following neurosurgical treatment of epilepsy. Ann of Neurol 1984;15(1):68– 72.

18. Sperling MR, Saykin AJ, Roberts FD, et al. Occupational outcome after temporal lobectomy for refractory epilepsy. Neurology 1995;45(5):970– 7.

19. Chin PS, Berg AT, Spencer SS, et al. Employment outcomes following resective epilepsy surgery. Epilepsia 2007;48(12):2253– 7.

20. Chin PS, Berg AT, Spencer SS, et al. Patient-perceived impact of resective epilepsy surgery. Neurology 2006;66(12):1882– 7.

21. Elsharkawy AE, Alabbasi AH, Pannek H, et al. Long-term outcome after temporal lobe epilepsy surgery in 434 consecutive adult patients. J Neurosurg 2009;110(6):1135– 46. doi: 10.3171/ 2008.6.JNS17613.

22. Kral T, von Lehe M, Podlogar M, et al. Focal cortical dysplasia: long-term seizure outcome after surgical treatment. J Neurol Neurosurg Psychiatry 2007;78(8):853– 6.

23. George L, Lyer RS, James R, et al. Employment outcome and satisfaction after anterior temporal lobectomy for refractory epilepsy: a developing country‘s perspective. Epilepsy Behav 2009;16(3):495– 500. doi: 10.1016/ j.yebeh.2009.08.020.

24. Thorbecke R, May TW, Koch-Stoecker S, et al. Effects of an inpatient rehabilitation program after temporal lobe epilepsy surgery and other factors on employment 2 years after epilepsy surgery. Epilepsia 2014;55(5):725– 33. doi: 10.1111/ epi.12573.

25. Wilson SJ, Bladin PF, Saling MM. Paradoxical results in the cure of chronic illness: the „burden of normality“ as exemplified following seizure surgery. Epilepsy Behav 2004;5(1):13– 21.

26. Seiam AH, Dhaliwal H, Wiebe S. Determinants of quality of life after epilepsy surgery: systematic review and evidence summary. Epilepsy Behav 2011;21(4):441– 5. doi: 10.1016/ j.yebeh.2011.05.005.

27. Meldolesi GN, Di Gennaro G, Quarato PP, et al. Changes in depression, anxiety, anger, and personality after resective surgery for drug-resistant temporal lobe epilepsy: a 2-year follow-up study. Epilepsy Res 2007;77(1):22– 30.

28. Cankurtaran ES, Ulug B, Saygi S, et al. Psychiatric morbidity, quality of life, and disability in mesial temporal lobe epilepsy patients before and after anterior temporal lobectomy. Epilepsy Behav 2005;7(1):116– 22.

29. Bjornaes H, Stabell KE, Heminghyt E, et al. Resective surgery for intractable focal epilepsy in patients with low IQ: predictors for seizure control and outcome with respect to seizures and neuropsychological and psychosocial functioning. Epilepsia 2004;45(2):131– 9.

30. Preiss J, Vojtěch Z. Kvalita života po resekční operaci pro farmakorezistentní epilepsii. Čes Slov Psychiat 2007;103(41):175– 83.

31. Maganti R, Rutecki P, Bell B, et al. Epilepsy surgery outcome among US veterans. Epilepsy Behav 2003;4(6):723– 8.

32. Rausch R, Kraemer S, Pietras CJ, et al. Early and late cognitive changes following temporal lobe surgery for epilepsy. Neurology 2003;60(6):951– 9.

33. Poochikian-Sarkissian S, Sidani S, Wennberg R, et al. Seizure freedom reduces illness intrusiveness and improves quality of life in epilepsy. Can J Neurol Sci 2008;35(3):280– 6.

34. Gilliam F, Kuzniecky R, Meador K, et al. Patient-oriented outcome assessment after temporal lobectomy for refractory epilepsy. Neurology 1999;53(4):687– 94.

35. Derry PA, McLachlan RS. Causal attributions for seizures – relation to preoperative psychological adjustment and postoperative psychosocial function in temporal-lobe epilepsy. J Epilepsy 1995;8(1):74– 82.

36. Wheelock I, Peterson C, Buchtel HA. Presurgery expectations, postsurgery satisfaction, and psychosocial adjustment after epilepsy surgery. Epilepsia 1998;39(5):487– 94.

37. Tanriverdi T, Olivier NP, Olivier A. Quality of life after extratemporal epilepsy surgery: a prospective clinical study. Clin Neurol Neurosur 2008;110(1):30– 7.

38. Aydemir N, Ozkara C, Canbeyli R, et al. Changes in quality of life and self-perspective related to surgery in patients with temporal lobe epilepsy. Epi Behav 2004;5(5):735– 42.

39. Chovaz CJ, McLachlan RS, Derry PA, et al. Psychosocial function following temporal lobectomy – influence of seizure control and learned helplessness. Seizure 1994;3(3):171– 6.

40. Wilson S, Bladin P, Saling M. The „burden of normality“: concepts of adjustment after surgery for seizures. J Neurol Neurosurg Psychiatry 2001;70(5):649– 56.

41. Wass CT, Rajala MM, Hughes JM, et al. Long-term follow-up of patients treated surgically for medically intractable epilepsy: results in 291 patients treated at Mayo Clinic Rochester between July 1972 and March 1985. Mayo Clin Proc 1996;71(11):1105– 13.