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Sharma S, Nehra A, Pandey S, Tripathi M, Srivastava A, Padma MV, Garg A, Pandey RM, Chandra S, Tripathi M. Neuropsychological Rehabilitation for Epilepsy in India: Looking Beyond the Basics. Epilepsy Behav 2024; 153:109703. [PMID: 38452517 DOI: 10.1016/j.yebeh.2024.109703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Neuropsychological Rehabilitation (NR) helps manage cognitive deficits in epilepsy. As internationally developed programs have limited applicability to resource-limited countries, we developed a program to bridge this gap. This 6-week caregiver-assisted, culturally suitable program has components of (1) psychoeducation, (2) compensatory training, and, (3) cognitive retraining and is called EMPOWER (Indigenized Home Based Attention and Memory Rehabilitation Program for Adult Patients with Drug Refractory Epilepsy). Its efficacy needs to be determined. METHODS We carried out an open-label parallel randomized controlled trial. Adults aged 18-45 years with Drug Refractory Epilepsy (DRE), fluency in Hindi and or English, with impaired attention or memory (n = 28) were randomized to Intervention Group (IG) and Control Group (CG). The primary outcomes were objective memory (Auditory Verbal Learning Test), patient and caregiver reported everyday memory difficulties (Everyday Memory Questionnaire-Revised), number of memory aids in use, depression (Hamilton Depression Rating Scale), anxiety (Hamilton Anxiety Rating Scale) and quality of life (Quality of Life in Epilepsy-31). Intention to treat was carried out for group analysis. In the absence of norms necessary for computing Reliable Change Indices (RCIs), a cut-off of +1.0 Standard Deviation (SD) was utilized to identify clinically meaningful changes in the individual analysis of objective memory. A cut-off of 11.8 points was used for quality of life. Feedback and program evaluation responses were noted. RESULTS The majority of the sample comprised DRE patients with temporal lobe epilepsy who had undergone epilepsy surgery. Group analysis indicated improved learning (p = 0.013), immediate recall (p = 0.001), delayed recall (p < 0.001), long-term retention (p = 0.031), patient-reported everyday memory (p < 0.001), caregiver-reported everyday memory (p < 0.001), anxiety (p = 0.039) and total quality of life (p < 0.001). Individual analysis showed improvement in 50 %, 64 %, 71 %, 57 %, and 64 % of patients on learning, immediate recall, delayed recall, long-term retention, and total quality of life respectively. Despite improvements, themes indicative of a lack of awareness and understanding of cognitive deficits were identified. Overall, the program was rated favorably by patients and caregivers alike. CONCLUSION NR shows promise for patients with DRE, however larger studies are warranted. The role of cognition in epilepsy needs to be introduced at the time of diagnosis to help lay the foundation for education and acceptance.
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Affiliation(s)
- Shivani Sharma
- Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Nehra
- Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Hohmann L, Bien CG, Holtkamp M, Grewe P. German questionnaires assessing quality of life and psycho-social status in people with epilepsy: Reliable change and intercorrelations. Epilepsy Behav 2024; 150:109554. [PMID: 38041998 DOI: 10.1016/j.yebeh.2023.109554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES People with epilepsy (PWE) not only suffer from seizures but also from various psycho-social issues containing facets such as social functioning, anxiety, depression or stigmatization, and consequently quality of life. (1) Assessing reliable change of these issues is crucial to evaluate their course and potential treatment effects. As most psycho-social self-report questionnaires have been validated in separate samples, their clinical-socio-demographic differences may limit the comparability and generalizability of the scales' internal consistency, which is important for the reliable change index (RCI). Using a co-normalized approach, we provide the internal consistency and RCIs for a large set of questionnaires targeting quality of life (QOLIE-31-P), depressive symptoms (NDDI-E), anxiety (GAD-7), seizure severity (LSSS), subjective antiseizure medication adverse events (LAEP), stigma, epilepsy-related fear, and restrictions in daily life (PESOS), and subjective cognition (FLei). As for some German versions of these measures, psychometric data is still missing, we also add important information for the German language area. (2) In addition, knowledge about intercorrelations of these constructs is needed to shape questionnaire usage and treatment approaches. We thus investigate associations of these scales and compare weighted and unweighted subscales of the QOLIE-31-P. METHODS In our prospective study, 202 adult in-patients of the Epilepsy-Center Berlin-Brandenburg with a reliable diagnosis of epilepsy filled out a set of self-report questionnaires between 03/2018 and 03/2021. We calculated Cronbach's α, RCIs, and bivariate intercorrelations and compared the respective correlations of weighted and unweighted scales of the QOLIE-31-P. RESULTS For most of the scales, good to excellent internal consistency was identified. Furthermore, we found intercorrelations in the expected directions with strong links between scales assessing similar constructs (e.g., QOLIE-31-P Cognition and FLei), but weak relationships between measures for different constructs (e.g., QOLIE-31-P Seizure worry and FLei). The QOLIE-31-P Total score was highly correlated with most of the other scales. Some differences regarding their correlational patterns for weighted and unweighted QOLIE-31-P scales were identified. CONCLUSIONS Psycho-social constructs share a large amount of common variance, but still can be separated from each other. The QOLIE-31-P Total score represents an adequate measure of general psycho-social burden.
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Affiliation(s)
- Louisa Hohmann
- Department of Neurology, Berlin-Brandenburg Epilepsy Center, Charité-Universitätsmedizin Berlin, corporate member of Free University and Humboldt University of Berlin, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Queen Elisabeth Herzberge Protestant Hospital, Berlin, Germany.
| | - Christian G Bien
- Department of Epileptology, Mara Hospital (Bethel Epilepsy Center), Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Martin Holtkamp
- Department of Neurology, Berlin-Brandenburg Epilepsy Center, Charité-Universitätsmedizin Berlin, corporate member of Free University and Humboldt University of Berlin, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Queen Elisabeth Herzberge Protestant Hospital, Berlin, Germany
| | - Philip Grewe
- Department of Epileptology, Mara Hospital (Bethel Epilepsy Center), Medical School OWL, Bielefeld University, Bielefeld, Germany; Neuropsychology and Epilepsy Research, Medical School OWL, Bielefeld University, Bielefeld, Germany
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Shukla G, Nandal N, Afsar M, Gupta A, Agarwal P, Singh MB, Srivastava A, Suri A. Comprehensive Outcome Assessment and Quality of Life Following Epilepsy Surgery. Can J Neurol Sci 2023:1-8. [PMID: 37932896 DOI: 10.1017/cjn.2023.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND Seizure freedom without deficits is the primary goal for epilepsy surgery. However, patients with medically refractory epilepsy commonly suffer from many co-morbidities related to mood, cognition, and sleep as well as social problems and resultant stigma. While epilepsy surgery literature does describe quality of life (QOL) and neuropsychological outcomes, there is a paucity of information on various common non-seizure outcomes, especially pertaining to mood, sleep, cognition, and social aspects. The objective of this study was to evaluate the role of various non-seizure parameters on post-epilepsy surgery QOL. METHODS Consecutive adult patients operated for refractory epilepsy at least 1 year prior to initiation of this study were included and classified as seizure-free (group 1) or non-seizure-free (group 2). QOL was assessed using the QOLIE-31 instrument; patients with a T score less than 40 were categorized as "poor QOL." Non-seizure parameters assessed were cognition, mood disturbances, social improvement, social stigma, and sleep disturbances. Categorization into "good" and "poor" outcome subgroups on each item was carried out by dichotomization of scores. RESULTS Thirty-seven patients (16 F) [mean age 23.5 ± 5.6 years] were evaluated; 26 were seizure-free (group 1). In this group, impaired memory, lower language scores, depression, not having been employed, not receiving education prior to surgery, and experiencing social stigma were factors significantly associated with poor QOL. In group 2, all patients had poor QOL scores. CONCLUSION Non-seizure factors related to common epilepsy co-morbidities and social issues are highly prevalent among seizure-free patients reporting poor QOL after epilepsy surgery.
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Affiliation(s)
- Garima Shukla
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
- Currently at Division of Neurology, Department of Neurology, Queen's University, Kingston, ON, Canada
| | - Neha Nandal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
- Currently at Toowoomba Base Hospital, Queensland, Australia
| | - Mohammed Afsar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
- Currently at Department of Psychology, Christ University, Ghaziabad, India
| | - Anupama Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
- Currently at Center for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
- Currently at Department of Neurology, Santokba Durlabhji Memorial Hospital cum Medical Research Institute, Jaipur, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Všianský V, Brázdil M, Rektor I, Doležalová I, Kočvarová J, Strýček O, Hemza J, Chrastina J, Brichtová E, Horák O, Mužlayová P, Hermanová M, Hendrych M, Pail M. Twenty-five years of epilepsy surgery at a Central European comprehensive epilepsy center-Trends in intervention delay and outcomes. Epilepsia Open 2023; 8:991-1001. [PMID: 37259787 PMCID: PMC10472383 DOI: 10.1002/epi4.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE We analyzed trends in patients' characteristics, outcomes, and waiting times over the last 25 years at our epilepsy surgery center situated in Central Europe to highlight possible areas of improvement in our care for patients with drug-resistant epilepsy. METHODS A total of 704 patients who underwent surgery at the Brno Epilepsy Center were included in the study, 71 of those were children. Patients were separated into three time periods, 1996-2000 (n = 95), 2001-2010 (n = 295) and 2011-2022 (n = 314) based on first evaluation at the center. RESULTS The average duration of epilepsy before surgery in adults remained high over the last 25 years (20.1 years from 1996 to 2000, 21.3 from 2001 to 2010, and 21.3 from 2011 to 2020, P = 0.718). There has been a decrease in rate of surgeries for temporal lobe epilepsy in the most recent time period (67%-70%-52%, P < 0.001). Correspondingly, extratemporal resections have become more frequent with a significant increase in surgeries for focal cortical dysplasia (2%-8%-19%, P < 0.001). For resections, better outcomes (ILAE scores 1a-2) have been achieved in extratemporal lesional (0%-21%-61%, P = 0.01, at least 2-year follow-up) patients. In temporal lesional patients, outcomes remained unchanged (at least 77% success rate). A longer duration of epilepsy predicted a less favorable outcome for resective procedures (P = 0.024) in patients with disease duration of less than 25 years. SIGNIFICANCE The spectrum of epilepsy surgery is shifting toward nonlesional and extratemporal cases. While success rates of extratemporal resections at our center are getting better, the average duration of epilepsy before surgical intervention is still very long and is not improving. This underscores the need for stronger collaboration between epileptologists and outpatient neurologists to ensure prompt and effective treatment for patients with drug-resistant epilepsy.
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Affiliation(s)
- Vít Všianský
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Milan Brázdil
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Ivan Rektor
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Irena Doležalová
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Jitka Kočvarová
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Ondřej Strýček
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Jan Hemza
- Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Jan Chrastina
- Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Eva Brichtová
- Brno Epilepsy Center, Department of Neurosurgery, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Ondřej Horák
- Brno Epilepsy Center, Department of Pediatric Neurology, Brno University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Patrícia Mužlayová
- Brno Epilepsy Center, Department of Pediatric Neurology, Brno University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
| | - Markéta Hermanová
- Department of Pathology, St. Anne's University Hospital, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Michal Hendrych
- Department of Pathology, St. Anne's University Hospital, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Martin Pail
- Brno Epilepsy Center, Department of Neurology, St. Anne's University Hospital, Faculty of MedicineMasaryk University, Member of the ERN EpiCAREBrnoCzech Republic
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Tran VD, Nguyen BT, Van Dong H, Nguyen TA, Nguyen PX, Van Vu H, Chu HT. Microsurgery for drug resistance epilepsy due to temporal lobe lesions in a resource limited condition: a cross-sectional study. Ann Med Surg (Lond) 2023; 85:3852-3857. [PMID: 37554863 PMCID: PMC10406011 DOI: 10.1097/ms9.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/15/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Epilepsy is a prevalent neurological condition that affects individuals of all ages and genders worldwide. Surgical intervention for drug-resistant epilepsy has been found to improve quality of life, with patient independence being of utmost importance. METHODS The study was a retrospective and prospective cross-sectional study of 35 cases of drug-resistant temporal lobe epilepsy. All patients were operated on by the primary author between May 2018 and September 2022. The study evaluated various factors including clinical characteristics, electroencephalogram, magnetic resonance imaging, surgical outcomes, and histopathology. RESULTS The success rate of the surgeries (74.3%) is similar to those reported in high-income countries. 51.4% underwent selective amygdalohippocampectomy for cases that localized to the mesial temporal lobe. Lateral/neocortical lesions underwent lesionectomy (48.6%). Our study found a complication rate of 17.1%: meningitis (8.5%), trainset focal paralysis (2.9%), and soft tissue infection (5.7%). There were no mortalities. CONCLUSIONS The article showcases an international collaborative effort that demonstrates the possibility of providing highly effective and safe surgical care for temporal lobe epilepsy even in low-resource environments. The authors hope that this model can be replicated in other areas with similar resource limitations.
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Affiliation(s)
- Van Dinh Tran
- Vietnam Military Medical University, Hanoi, Vietnam
- Neurosurgery Center of Vietduc University Hospital, Hanoi, Vietnam
| | | | - He Van Dong
- Neurosurgery Center of Vietduc University Hospital, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- Neurosurgery Center of Vietduc University Hospital, Hanoi, Vietnam
| | | | - Hoe Van Vu
- Vietnam Military Medical University, Hanoi, Vietnam
| | - Hung Thanh Chu
- Neurosurgery Center of Vietduc University Hospital, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
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Kellenaers JTF, Rijkers K, van Mastrigt GAPG, Schijns OEMG, Hoogland G, Dings J, van Kuijk S, Vlooswijk MCG, Wagner LGL, Idema S, van Straaten IECW, van der Salm SMA, Majoie MHJM. Resective Epilepsy Surgery, QUality of life and Economic evaluation (RESQUE): the change in quality of life after resective epilepsy surgery-protocol for a multicentre, prospective cohort study. BMJ Open 2023; 13:e064263. [PMID: 37407053 DOI: 10.1136/bmjopen-2022-064263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Resective epilepsy surgery is often seen as a last resort when treating drug-resistant epilepsy. Positive results on quality of life (QoL) and economic benefits after surgery argue for a less restrictive attitude towards epilepsy surgery for drug-resistant epilepsy. QoL and economic benefits are country-dependent. The objective of the Resective Epilepsy Surgery, QUality of life and Economic evaluation (RESQUE) trial is to evaluate the change in QoL before and after epilepsy surgery in Dutch people with drug-resistant epilepsy. The results will form part of an economic evaluation of epilepsy surgery in people with epilepsy (PWE) in The Netherlands. METHODS AND ANALYSIS A longitudinal prospective multicentre cohort study involving 100 PWE undergoing epilepsy surgery between 2019 and 2025 is being performed in three Dutch academic hospitals. Excluded are PWE who have a lower level of intelligence (TIQ<70) or who do not master the Dutch language. Before surgery and 3, 6, 12 and 24 months after surgery, PWE receive validated online questionnaires (QOLIE-31, EQ-5D, iMCQ and iPCQ) on QoL, cost of care, expectations and satisfaction. Primary outcome is the change in QoL. Secondary outcomes are change in generic QoL, seizure reduction (International League Against Epilepsy Outcome Classification), medical consumption, productivity, the correlation between QoL and seizure reduction and expectation of and satisfaction with the surgery. ETHICS AND DISSEMINATION The study design has been approved by the Medical Ethics Review Committee (METC) of Maastricht UMC+ (2019-1134) and the Amsterdam UMC (vu). At the time of writing, UMC Utrecht is in the process of considering approval. The study will be conducted according to the Dutch Medical Research Involving Human Subjects Act and the Declaration of Helsinki. The results will be publicly disclosed and submitted for publication in international peer-reviewed scientific journals. There is no veto on publication by the involved parties. TRIAL REGISTRATION NL8278; Pre-results.
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Affiliation(s)
- Julia T F Kellenaers
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kim Rijkers
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Olaf E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Govert Hoogland
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jim Dings
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sander van Kuijk
- Clinical Epidemiology and Medical Technology Assessment, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | | | | | - Sander Idema
- Department of Neurosurgery, Amsterdam UMC VUMC Site, Amsterdam, The Netherlands
| | | | - Sandra M A van der Salm
- Department of Neurology, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands
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Shakhatreh L, Foster E, Siriratnam P, Neal A, Carney PW, Jackson GD, O'Brien TJ, Kwan P, Chen Z, Ademi Z. Impact of epilepsy surgery on quality of life: Systematic review and meta-analysis. Epilepsia 2023; 64:1709-1721. [PMID: 37157209 DOI: 10.1111/epi.17644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/05/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
Improved quality of life (QoL) is an important outcome goal following epilepsy surgery. This study aims to quantify change in QoL for adults with drug-resistant epilepsy (DRE) who undergo epilepsy surgery, and to explore clinicodemographic factors associated with these changes. We conducted a systematic review and meta-analysis using Medline, Embase, and Cochrane Central Register of Controlled Trials. All studies reporting pre- and post-epilepsy surgery QoL scores in adults with DRE via validated instruments were included. Meta-analysis assessed the postsurgery change in QoL. Meta-regression assessed the effect of postoperative seizure outcomes on postoperative QoL as well as change in pre- and postoperative QoL scores. A total of 3774 titles and abstracts were reviewed, and ultimately 16 studies, comprising 1182 unique patients, were included. Quality of Life in Epilepsy Inventory-31 item (QOLIE-31) meta-analysis included six studies, and QOLIE-89 meta-analysis included four studies. Postoperative change in raw score was 20.5 for QOLIE-31 (95% confidence interval [CI] = 10.9-30.1, I2 = 95.5) and 12.1 for QOLIE-89 (95% CI = 8.0-16.1, I2 = 55.0%). This corresponds to clinically meaningful QOL improvements. Meta-regression demonstrated a higher postoperative QOLIE-31 score as well as change in pre- and postoperative QOLIE-31 score among studies of cohorts with higher proportions of patients with favorable seizure outcomes. At an individual study level, preoperative absence of mood disorders, better preoperative cognition, fewer trials of antiseizure medications before surgery, high levels of conscientiousness and openness to experience at the baseline, engagement in paid employment before and after surgery, and not being on antidepressants following surgery were associated with improved postoperative QoL. This study demonstrates the potential for epilepsy surgery to provide clinically meaningful improvements in QoL, as well as identifies clinicodemographic factors associated with this outcome. Limitations include substantial heterogeneity between individual studies and high risk of bias.
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Affiliation(s)
- Lubna Shakhatreh
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Neurology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Emma Foster
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | | - Andrew Neal
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Neurology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Patrick W Carney
- Neurology Department, Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Graeme D Jackson
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Terence J O'Brien
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Neurology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Kwan
- Neurology Department, Alfred Health, Melbourne, Victoria, Australia
- Neurology Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Faculty of Pharmacy, Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
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Janecek JK, Brett BL, Pillay S, Murphy H, Binder JR, Swanson SJ. Cognitive decline and quality of life after resective epilepsy surgery. Epilepsy Behav 2023; 138:109005. [PMID: 36516616 DOI: 10.1016/j.yebeh.2022.109005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/04/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The objectives of this study were to examine the association between cognitive decline and quality of life (QoL) change in a large sample of individuals with drug-resistant epilepsy who underwent resective surgery and to examine whether the association between cognitive decline and QoL is differentially affected by seizure classification outcome (Engel Class 1 vs. 2-4) or side of surgery (left vs. right hemisphere). MATERIALS AND METHODS The sample comprised 224 adults (ages ≥ 18) with drug-resistant focal epilepsy treated with resective surgery who underwent comprehensive pre-operative and post-operative evaluations including neuropsychological testing and the Quality of Life in Epilepsy Inventory - 31 between 1991 and 2020. Linear mixed-effects models were fit to examine subject-specific trajectories and assess the effects of time (pre- to post-operative), cognitive decline (number of measures that meaningfully declined), and the interaction between time and cognitive decline on pre- to post-operative change in QoL. RESULTS Increases in QoL following resection were observed (B = -10.72 [SE = 1.22], p < .001; mean difference between time point 1 and time point 2 QoL rating = 8.11). There was also a main effect of cognitive decline on QoL (B = -.85 [SE = .27], p = .002). Follow-up analyses showed that the number of cognitive measures that declined was significantly associated with post-surgical QoL, (r = -.20 p = .003), but not pre-surgical QoL, (r = -.04 p = .594), and with pre-to post-surgery raw change in QoL score, (r = -.18 p = .009). A cognitive decline by time point interaction was observed, such that those who had greater cognitive decline had less improvement in overall QoL following resection (B = .72 [SE = .27], p = .009). Similar results were observed within the Engel Class 1 outcome subgroup. However, within the Engel Class 2-4 outcome subgroup, QoL improved following resection, but there was no main effect of cognitive decline or interaction between cognitive decline and time point on QoL change. There was no main effect of resection hemisphere on overall QoL, nor were there interactions with hemisphere by time, hemisphere by cognitive decline, or hemisphere by time by cognitive decline. CONCLUSIONS Quality of life improves following epilepsy surgery. Participants who had cognitive decline across a greater number of measures experienced less improvement in QoL post-operatively overall, but there was no clear pattern of domain-specific cognitive decline associated with change in QoL. Our results indicate that cognitive decline in a diffuse set of cognitive domains negatively influences post-operative QoL, particularly for those who experience good seizure outcomes (i.e., seizure freedom), regardless of the site or side of resection.
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Affiliation(s)
- Julie K Janecek
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Benjamin L Brett
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA; Department of Neurosurgery, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Sara Pillay
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Heather Murphy
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Sara J Swanson
- Department of Neurology, Medical College of Wisconsin, 8701 W. Watertown Plank Rd., Milwaukee, WI 53226, USA.
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9
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Shlobin NA, Wang A, Phillips HW, Yan H, Ibrahim GM, Elkaim LM, Wang S, Liu X, Cai L, Nguyen DK, Fallah A, Weil AG. Sensorimotor outcomes after resection for perirolandic drug-resistant epilepsy: a systematic review and individual patient data meta-analysis. J Neurosurg Pediatr 2022; 30:410-427. [PMID: 35932272 DOI: 10.3171/2022.6.peds22160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The prevalence of long-term postoperative sensorimotor deficits in children undergoing perirolandic resective epilepsy surgery is unclear. The risk of developing these deficits must be weighed against the potential reduction in seizure frequency after surgery. In this study, the authors investigated the prevalence of sensorimotor deficits after resective surgery at ≥ 1 year postoperatively. METHODS A systematic review and individual patient data meta-analysis was conducted using PubMed, Embase, and Scopus databases. Subgroups of patients were identified and categorized according to their outcomes as follows: group A patients were denoted as seizure free with no postoperative sensorimotor deficits; group B patients experienced seizure recurrence with no deficit; group C patients were seizure free with deficits; and group D patients were not seizure free and with deficits. Rates of sensory deficits were examined in patients undergoing postcentral gyrus resection, and rates of motor deficits were aggregated in patients undergoing precentral gyrus resection. RESULTS Of 797 articles resulting from the database searches, 6 articles including 164 pediatric patients at a mean age of 7.7 ± 5.2 years with resection for drug-resistant perirolandic epilepsy were included in the study. Seizure freedom was observed in 118 (72.9%) patients at a mean follow-up of 3.4 ± 1.8 years. In total, 109 (66.5%) patients did not develop sensorimotor deficits at last follow-up, while 55 (33.5%) had permanent deficits. Ten (14.3%) of 70 patients with postcentral gyrus resection had permanent sensory deficits. Of the postcentral gyrus resection patients, 41 (58.6%) patients were included in group A, 19 (27.1%) in group B, 7 (10.0%) in group C, and 3 (4.3%) in group D. Forty (37.7%) of 106 patients with precentral resections had permanent motor deficits. Of the precentral gyrus resection patients, 50 (47.2%) patients were in group A, 16 (15.1%) in group B, 24 (22.6%) in group C, and 16 (15.1%) in group D. Patients without focal cortical dysplasia were more likely to have permanent motor deficits relative to those with focal cortical dysplasia in the precentral surgery cohort (p = 0.02). CONCLUSIONS In total, 58.6% of patients were seizure free without deficit, 27.1% were not seizure free and without deficit, 10.0% were seizure free but with deficit, and 4.3% were not seizure free and with deficit. Future studies with functional and quality-of-life data, particularly for patients who experience seizure recurrence with no deficits (as in group B in the present study) and those who are seizure free with deficits (as in group C) after treatment, are necessary to guide surgical decision-making.
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Affiliation(s)
- Nathan A Shlobin
- 1Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Andrew Wang
- 2Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California
| | - H Westley Phillips
- 2Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Han Yan
- 3Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario
| | - George M Ibrahim
- 3Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario
| | - Lior M Elkaim
- 4Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Shuang Wang
- 5Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Xiaoyan Liu
- 5Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Lixin Cai
- 5Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Dang K Nguyen
- 6Division of Neurology, University of Montreal Hospital Centre (CHUM), Montreal
- 7CHUM Research Centre, Montreal
- 9Department of Neuroscience, University of Montreal; and
| | - Aria Fallah
- 2Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Alexander G Weil
- 8Division of Neurosurgery, Sainte-Justine University Hospital and University of Montreal Hospital Centre (CHUM), Montreal
- 9Department of Neuroscience, University of Montreal; and
- 10Sainte-Justine Research Centre, University of Montreal, Quebec, Canada
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10
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Cheung EYH, Lau CKY, Leung HHW, Fung ELW, Tang VYH, Cheung TCY, Kwong WKM, Zhu XL, Chan DYC, Chan DTM, Poon WS. Deep brain stimulation of the anterior nucleus of the thalamus for drug‐resistant epilepsy: Long‐term efficacy and outcomes from a prospective cohort. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eric Y. H. Cheung
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong, HKSAR Hong Kong Hong Kong
| | - Claire K. Y. Lau
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong, HKSAR Hong Kong Hong Kong
- Divsion of Neurology, Department of Medicine and Therapeutics Prince of Wales Hospital, HKSAR Hong Kong Hong Kong
| | - Howan H. W. Leung
- Divsion of Neurology, Department of Medicine and Therapeutics Prince of Wales Hospital, HKSAR Hong Kong Hong Kong
| | - Eva L. W. Fung
- Department of Paediatrics Prince of Wales Hospital, HKSAR Hong Kong Hong Kong
| | - Venus Y. H. Tang
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong, HKSAR Hong Kong Hong Kong
- Department of Clinical Psychology Prince of Wales Hospital, HKSAR Hong Kong Hong Kong
| | - Tom C. Y. Cheung
- Department of Organ Imaging and Diagnostic Radiology Prince of Wales Hospital, HKSAR Hong Kong Hong Kong
| | - William K. M. Kwong
- Department of Organ Imaging and Diagnostic Radiology Prince of Wales Hospital, HKSAR Hong Kong Hong Kong
| | - Xian Lun Zhu
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong, HKSAR Hong Kong Hong Kong
| | - David Y. C. Chan
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong, HKSAR Hong Kong Hong Kong
| | - Danny T. M. Chan
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong, HKSAR Hong Kong Hong Kong
| | - Wai Sang Poon
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital The Chinese University of Hong Kong, HKSAR Hong Kong Hong Kong
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11
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Associations between cognition and employment outcomes after epilepsy surgery. Epilepsy Behav 2022; 131:108709. [PMID: 35526464 DOI: 10.1016/j.yebeh.2022.108709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/31/2022] [Accepted: 04/15/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Previous studies have shown that younger age, higher education, and seizure freedom after epilepsy surgery are associated with employment. However, very few studies have investigated associations with cognition and employment status in epilepsy surgery patients. METHODS This retrospective study consists of 46 adult patients, who underwent resective epilepsy surgery in the Helsinki University Hospital between 2010 and 2018 and who had been assessed by a neuropsychologist prior to surgery and 6 months after surgery using a systematic test battery. In addition to neuropsychological evaluation, neurologists assessed the patients prior to surgery and followed up the patients up to 24 months after the surgery and evaluated work status of the patients. Logistic regression models were used to assess the effects of cognition on changes in employment status, while controlling for age and education. RESULTS Out of the 46 patients 38 (82.6%) were seizure free and 7 (15.2%) had their seizures reduced 2 years postsurgically. From prior to surgery to 2 years postsurgery, use of antiseizure medication was reduced in most of the patients, mean reduction of the dosage being 26.9%. Employment status improved in 10 (21.7%) patients, remained unchanged in 27 (58.7%) and worsened in 3 (6.5%). An additional 6 patients were already not working prior to surgery. Subsequent analyses are based on the subsample of 37 patients whose employment status improved or remained unchanged. Mistakes in executive function tasks (p = 0.048) and working memory performance (p = 0.020) differentiated between the group whose employment status remained similar and those who were able to improve their employment status. Epilepsy surgery outcome or changes in antiseizure medication (ASM) use were not associated with changes in employment status. CONCLUSIONS In the subsample of 37 patients, errors in executive function tasks and poorer working memory differentiated patients whose employment status did not change from those patients who could improve their employment status. Problems in executive function and working memory tasks might hinder performance in a complex work environment. When assessing the risks and opportunities in returning to work after surgery, difficulties in working memory and executive function performance should be taken into consideration as they may predispose the patient to challenges at work.
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12
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Cook C, Baxendale S. Preoperative predictors of postoperative satisfaction with surgery. Epilepsy Behav 2022; 129:108612. [PMID: 35203015 DOI: 10.1016/j.yebeh.2022.108612] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patient reported outcome measures (PROMs) are an important metric in the assessment of outcomes following elective treatments such as epilepsy surgery. The Epilepsy Surgery Satisfaction Questionnaire (ESSQ-19) is a new (2020), valid, and reliable measure of patient satisfaction that provides measures of satisfaction in multiple domains. This study examined preoperative psychiatric predictors of ESSQ-19 scores. METHODS All patients who underwent epilepsy surgery at our center in the decade between January 2010 and 2020 and who were at least one year out from surgery were invited to complete the ESSQ-19 (n = 284). RESULTS Responses were received from 29% of the sample. Non responders did not differ from responders in age, type of surgery, sex, or seizure outcome, but had a lower Verbal Comprehension Index score. Reported satisfaction rates were high in each ESSQ-19 domain (Seizure control, mean = 83.9; Psychosocial function, mean = 72.4; Surgical Complications, mean = 86.4; Recovery from surgery, mean = 77.4; Overall satisfaction, mean = 80.8) and broadly comparable to those reported in the original validation sample for the ESSQ-19. Preoperative levels of anxiety predicted postoperative satisfaction with recovery from surgery and psychosocial outcomes, with high levels of preoperative anxiety associated with higher levels of dissatisfaction in both sub domains. CONCLUSIONS Satisfaction with some aspects of postoperative outcome is not just dependent upon postoperative factors, but can be predicted from preoperative levels of anxiety. Clinicians offering preoperative counseling and preparation with respect to patients' expectations of surgical outcome should be cognizant of the possible impact of anxiety on postoperative satisfaction, particularly with respect to psychosocial function.
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Affiliation(s)
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, United Kingdom.
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13
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Lozano-García A, Hampel KG, Gutiérrez A, Villanueva V, Cano-López I, González-Bono E. Clinical utility of Epitrack for differentiating profiles and patterns of post-surgical change in memory and quality of life in patients with drug-resistant epilepsy. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-12. [PMID: 35148237 DOI: 10.1080/23279095.2022.2036990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To assess whether performance in attention and executive functions evaluated with the Epitrack screening tool before surgery can differentiate memory and quality of life (QOL) profiles, and detect different post-surgical change patterns in these variables in patients with epilepsy. METHODS This is a longitudinal study. Seventy-seven patients with drug-resistant epilepsy (mean age = 37.91) underwent a neuropsychological assessment before and one year after surgery. Epitrack, a screening tool that exclusively evaluates attention and executive functioning, was administered in the pre-surgical assessment, and verbal and visual memory and QOL were assessed before and after surgery. RESULTS Patients with impaired Epitrack performance had poorer verbal and visual memory than those with intact Epitrack performance, regardless of the time point (for all, p < 0.0001). They also showed a post-surgical decline in immediate verbal recall (p = 0.04) and discriminability (p = 0.001). Patients with intact Epitrack performance did not exhibit this decline. Epitrack total score significantly contributed to 13 and 11% of the variance of post-surgical changes in immediate verbal recall and discriminability, respectively. Epitrack groups did not differ in QOL profiles or changes, but post-surgical immediate verbal recall improvements were related to post-surgical QOL improvements. CONCLUSION Our findings underline the utility of Epitrack screening tool to detect different patterns of verbal and visual memory dysfunction, as well as to predict post-surgical verbal memory decline in patients with drug-resistant epilepsy. Patients with lower pre-surgical Epitrack scores appear to be at increased risk for post-surgical memory decline.
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Affiliation(s)
- Alejandro Lozano-García
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
| | - Kevin G Hampel
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Antonio Gutiérrez
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Esperanza González-Bono
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
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14
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Shlobin NA, Campbell JM, Rosenow JM, Rolston JD. Ethical considerations in the surgical and neuromodulatory treatment of epilepsy. Epilepsy Behav 2022; 127:108524. [PMID: 34998267 PMCID: PMC10184316 DOI: 10.1016/j.yebeh.2021.108524] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/19/2021] [Accepted: 12/19/2021] [Indexed: 02/08/2023]
Abstract
Surgical resection and neuromodulation are well-established treatments for those with medically refractory epilepsy. These treatments entail important ethical considerations beyond those which extend to the treatment of epilepsy generally. In this paper, the authors explore these unique considerations through a framework that relates foundational principles of bioethics to features of resective epilepsy surgery and neuromodulation. The authors conducted a literature review to identify ethical considerations for a variety of epilepsy surgery procedures and to examine how foundational principles in bioethics may inform treatment decisions. Healthcare providers should be cognizant of how an increased prevalence of somatic and psychiatric comorbidities, the dynamic nature of symptom burden over time, the individual and systemic barriers to treatment, and variable sociocultural contexts constitute important ethical considerations regarding the use of surgery or neuromodulation for the treatment of epilepsy. Moreover, careful attention should be paid to how resective epilepsy surgery and neuromodulation relate to notions of patient autonomy, safety and privacy, and the shared responsibility for device management and maintenance. A three-tiered approach-(1) gathering information and assessing the risks and benefits of different treatment options, (2) clear communication with patient or proxy with awareness of patient values and barriers to treatment, and (3) long-term decision maintenance through continued identification of gaps in understanding and provision of information-allows for optimal treatment of the individual person with epilepsy while minimizing disparities in epilepsy care.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Justin M Campbell
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA; Department of Neuroscience, University of Utah, Salt Lake City, UT, USA
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
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15
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Bjellvi J, Cross JH, Gogou M, Leclercq M, Rheims S, Ryvlin P, Sperling MR, Rydenhag B, Malmgren K. Classification of complications of epilepsy surgery and invasive diagnostic procedures: A proposed protocol and feasibility study. Epilepsia 2021; 62:2685-2696. [PMID: 34405890 DOI: 10.1111/epi.17040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/07/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In epilepsy surgery, which aims to treat seizures and thereby to improve the lives of persons with drug-resistant epilepsy, the chances of attaining seizure relief must be carefully weighed against the risks of complications and expected adverse events. The interpretation of data regarding complications of epilepsy surgery and invasive diagnostic procedures is hampered by a lack of uniform definitions and method of data collection. METHODS Based on a review of previous definitions and classifications of complications, we developed a proposal for a new classification. This proposal was then subject to revisions after expert opinion within E-pilepsy, an EU-funded European pilot network of reference centers in refractory epilepsy and epilepsy surgery, later incorporated into the ERN (European Reference Network) EpiCARE. This version was discussed with recognized experts, and a final protocol was agreed to after further revision. The final protocol was evaluated in practical use over 1 year in three of the participating centers. One hundred seventy-four consecutive procedures were included with 35 reported complications. RESULTS This report presents a multidimensional classification of complications in epilepsy surgery and invasive diagnostic procedures, where complications are characterized in terms of their immediate effects, resulting permanent symptoms, and consequences on activities of daily living. SIGNIFICANCE We propose that the protocol will be helpful in the work to promote safety in epilepsy surgery and for future studies designed to identify risk factors for complications. Further work is needed to address the reporting of outcomes as regards neuropsychological function, activities of daily living, and quality of life.
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Affiliation(s)
- Johan Bjellvi
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, Sweden
| | - J Helen Cross
- UCL-NIHR BRC Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children, Member of the ERN EpiCARE, London, UK.,Young Epilepsy, Lingfield, UK
| | - Maria Gogou
- Great Ormond Street Hospital for Children, Member of the ERN EpiCARE, London, UK
| | - Mathilde Leclercq
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and Lyon 1 University, Member of the ERN EpiCARE, Lyon, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and Lyon 1 University, Member of the ERN EpiCARE, Lyon, France
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
| | - Michael R Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bertil Rydenhag
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, Sweden
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Gothenburg, Sweden
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16
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Mandge V, Correa DJ, McGinley J, Boro A, Legatt AD, Haut SR. Factors associated with patients not proceeding with proposed resective epilepsy surgery. Seizure 2021; 91:402-408. [PMID: 34303161 DOI: 10.1016/j.seizure.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/15/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study evaluated the association between eligible patients not proceeding with resective epilepsy surgery and various demographic, disease-specific, and epilepsy-evaluation variables. METHODS This retrospective case-control study included patients identified as candidates for resective epilepsy surgery at the Montefiore Medical Center between January 1, 2009 and June 30, 2017. Chi-squared, two-tailed, independent sample t-test, Mann-Whitney U test and logistic regression were utilized to identify variables associated with patients not proceeding with surgery. RESULTS Among the 159 potential surgical candidates reviewed over the 8.5-year study period, only 53 ultimately proceeded with surgery (33%). Eighty-seven (55%) out of these 159 patients were identified as appropriate for resective epilepsy surgery during the study period. Thirty-four (39%) of these 87 patients did not proceed with surgery. Variables independently correlated (either positively or negatively) with the patient not proceeding with surgery were: being employed [Odds Ratio (OR) 4.2, 95% confidence interval (CI) 1.12-15.73], temporal lobe lesion on MRI (OR 0.35, 95% CI 0.14-0.84), temporal lobe EEG ictal onsets (OR 0.21, 95% CI 0.07-0.62), and temporal lobe epileptogenic zone (OR 0.19, 95% CI 0.07-0.55). CONCLUSION The novel finding in this study is the association between employment status and whether the patient had epilepsy surgery: employed patients were 4.2 times more likely to not proceed with surgery compared to unemployed patients. In addition, patients with a temporal lobe lesion on MRI, temporal lobe EEG ictal onsets, and/or a temporal epileptogenic zone were more likely to proceed with surgery. Future work will be needed to evaluate these findings prospectively, determine if they generalize to other patient populations, explore the decision whether or not to proceed with epilepsy surgery from a patient-centered perspective, and suggest strategies to reduce barriers to this underutilized treatment.
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Affiliation(s)
- Vishal Mandge
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, United States.
| | - Daniel José Correa
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - John McGinley
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - Alexis Boro
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - Alan D Legatt
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - Sheryl R Haut
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
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17
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Iwasaki M, Saito T, Tsubota A, Murata T, Fukuoka Y, Jin K. Budget Impact Analysis of Treatment Flow Optimization in Epilepsy Patients: Estimating Potential Impacts with Increased Referral Rate to Specialized Care. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2021; 8:80-87. [PMID: 34183974 PMCID: PMC8192732 DOI: 10.36469/jheor.2021.24061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/27/2021] [Indexed: 06/13/2023]
Abstract
Objectives: We developed a Markov model to simulate a treatment flow of epilepsy patients who refer to specialized care from non-specialized care, and to surgery from specialized care for estimation of patient distributions and expenditures caused by increasing the referral rate for specialized care. Methods: This budget impact analysis of treatment flow optimization in epilepsy patients was performed as a long-term simulation using the Markov model by comparing the current treatment flow and the optimized treatment flow. In the model, we simulated the prognosis of new onset 5-year-old epilepsy patients (assuming to represent epilepsy occurring between 0 and 10 years of age) treated over a lifetime period. Direct costs of pharmacotherapies, management fees and surgeries are included in the analysis to evaluate the annual budget impact in Japan. Results: In the current treatment flow, the number of refractory patients treated with four drugs by non-specialized care were estimated as 8766 and yielded JPY5.8 billion annually. However, in the optimized treatment flow, the number of patients treated with four drugs by non-specialized care significantly decreased and who continued the monotherapy increased. The costs for the four-drug therapy by non-specialized care were eliminated. Hence cost-saving of JPY9.5 billion (-5% of the current treatment flow) in total national expenditures would be expected. Conclusion: This study highlights that any policy decision-making for referral optimization to specialized care in appropriate epilepsy patients would be feasible with a cost-savings or very few budget impacts. However, important information in the decision-making such as transition probability to the next therapy or excuse for sensitive limitations is not available currently. Therefore, further research with reliable data such as big data analysis or a national survey with real-world treatment patterns is needed.
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Affiliation(s)
- Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry
| | - Takashi Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry
| | | | | | | | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine
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18
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Benevides ML, Costa Nunes J, Guarnieri R, Pauli C, Wolf P, Lunardi M, Kondageski C, Neves Linhares M, Lin K, Walz R. Quality of life long after temporal lobe epilepsy surgery. Acta Neurol Scand 2021; 143:629-636. [PMID: 33751549 DOI: 10.1111/ane.13406] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/29/2020] [Accepted: 01/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify variables independently associated with a meaningful improvement in QOL long after surgical treatment of drug-resistant MTLE-HS patients. MATERIAL & METHODS We prospectively evaluated 72 consecutive MTLE-HS surgically treated patients and analyzed pre and post-surgical variables independently associated with a meaningful improvement in QOL evaluated by the Quality of Life in Epilepsy-31 (QOLIE-31) overall score, and its domain scores determined at follow-up after 36 to 131 months (mean 93 months) after surgery. RESULTS The mean overall QOLIE-31 score and its subdomain scores improved significantly after surgery (p < 0.01), and 55 patients (76.4%) had a meaningful QOL improvement. Being seizure-free (Engel IA) after surgery showed a non-significant association (OR 2.63, CI 95% 0.53 to 13.05, p = 0.23) and lower depressive symptoms a significant association (OR 4.15, CI 95% 1.19 to 14.53, p = 0.03) with meaningful improvement of QOL. CONCLUSIONS Patients with MTLE-HS who underwent epilepsy surgery show a sustained, meaningful improvement in their QOL. Pre-surgical variables do not predict long-term QOL improvement after surgery. Lower levels of depressive symptoms at postoperative evaluation are associated with meaningful QOL improvement.
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Affiliation(s)
- Maria L. Benevides
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Graduate Program in Translational Neurosciences Federal University of Rio de Janeiro (UFRJ) Rio de Janeiro Brazil
| | - Jean Costa Nunes
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC) HU UFSC Florianópolis Brazil
- Division of Neuropathology UFSC Florianópolis Brazil
- Neurodiagnostic Brasil ‐ Diagnósticos em Neuropatologia Florianópolis Brazil
| | - Ricardo Guarnieri
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Psychiatry Division Internal Medicine Department HU UFSC Florianópolis Brazil
| | - Carla Pauli
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
| | - Peter Wolf
- Graduate Program in Medical Sciences HU UFSC Florianópolis Brazil
| | - Mariana Lunardi
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Graduate Program in Medical Sciences HU UFSC Florianópolis Brazil
| | - Charles Kondageski
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
| | - Marcelo Neves Linhares
- Department of Neurology Governador Celso Ramos Hospital Florianópolis Brazil
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Neurosurgery Division HU UFSC Florianópolis Brazil
| | - Katia Lin
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC) HU UFSC Florianópolis Brazil
- Graduate Program in Medical Sciences HU UFSC Florianópolis Brazil
- Neurology Division Internal Medicine Department HU UFSC Florianópolis Brazil
| | - Roger Walz
- Center for Applied Neurosciences University Hospital (HU) Federal University of Santa Catarina (UFSC) Florianópolis Brazil
- Graduate Program in Translational Neurosciences Federal University of Rio de Janeiro (UFRJ) Rio de Janeiro Brazil
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC) HU UFSC Florianópolis Brazil
- Neurology Division Internal Medicine Department HU UFSC Florianópolis Brazil
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19
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Wada test results contribute to the prediction of change in verbal learning and verbal memory function after temporal lobe epilepsy surgery. Sci Rep 2021; 11:10979. [PMID: 34040075 PMCID: PMC8154896 DOI: 10.1038/s41598-021-90376-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/07/2021] [Indexed: 02/04/2023] Open
Abstract
In recent years, the clinical usefulness of the Wada test (WT) has been debated among researchers in the field. Therefore, we aimed to assess its contribution to the prediction of change in verbal learning and verbal memory function after epilepsy surgery. Data from 56 patients with temporal lobe epilepsy who underwent WT and subsequent surgery were analyzed retrospectively. Additionally, a standard neuropsychological assessment evaluating attentional, learning and memory, visuospatial, language, and executive function was performed both before and 12 months after surgery. Hierarchical linear regression analyses were used to determine the incremental value of WT results over socio-demographic, clinical, and neuropsychological characteristics in predicting postsurgical change in patients' verbal learning and verbal memory function. The incorporation of WT results significantly improved the prediction models of postsurgical change in verbal learning (∆R2 = 0.233, p = .032) and verbal memory function (∆R2 = 0.386, p = .005). Presurgical performance and WT scores accounted for 41.8% of the variance in postsurgical change in verbal learning function, and 51.1% of the variance in postsurgical change in verbal memory function. Our findings confirm that WT results are of significant incremental value for the prediction of postsurgical change in verbal learning and verbal memory function. Thus, the WT contributes to determining the risks of epilepsy surgery and, therefore, remains an important part of the presurgical work-up of selected patients with clear clinical indications.
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20
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Benevides ML, Costa Nunes J, Guarnieri R, Melo H, Lunardi M, Neves Linhares M, Kupek E, Wolf P, Lin K, Walz R. Anxiety and depressive symptoms long after mesial temporal epilepsy surgery: A prospective study. Epilepsy Behav 2021; 118:107936. [PMID: 33839452 DOI: 10.1016/j.yebeh.2021.107936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anxiety and depressive symptoms are prevalent in patients with refractory mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) before and after anterior temporal lobectomy (ATL). AIMS (1) To follow the levels of anxiety and depressive symptoms long-term after ATL among patients with refractory MTLE-HS; (2) To identify pre- and postsurgical variables associated with the levels of anxiety and depressive symptoms after surgery. METHODS We compared the levels of anxiety and depressive symptoms determined by the Hospital Anxiety and Depression Scale (HADS) before and long after ATL (mean 104 months, range 70-130) in 41 consecutive patients refractory MTLE-HS. The last follow-up was between September 2018 and March 2020. We also determined pre- and postsurgical variables independently associated with the HADS scores after surgery. RESULTS The scores of HADS and its subdomains related to anxiety and depression decreased significantly (p < 0.01) after ATL. After multiple linear regressions, the HADS-Anxiety scores before surgery (B = 0.47, CI 95% 0.20 to 0.75, p = 0.001) and at follow-up after surgery (B = 0.07, CI 0.00 to 0.14, p = 0.05) remain independently and positively associated with HADS-Anxiety scores after surgery. The HADS-Depression scores after surgery were independently positively associated with HADS-Depression scores before surgery (B = 0.39, CI 95% 0.10 to 0.76, p = 0.01) and worse seizure control after surgery (B = 1.55, CI 95% 0.23 to 2.87, p = 0.02). CONCLUSION Anxiety and depressive symptoms in patients with MTLE-HS significantly improved after ATL. Presurgical levels of anxiety and depressive symptoms, respectively, were positively associated with the postsurgical levels of those symptoms. Length of follow-up is associated with anxiety, and worse seizure control is associated with depressive symptoms after ATL. The results have implications for the surgical management of MTLE-HS patients.
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Affiliation(s)
- Maria Luiza Benevides
- Department of Neurology, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina (SC), Brazil; Graduate Program in Translational Neuroscience, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil.
| | - Jean Costa Nunes
- Graduate Program in Translational Neuroscience, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Division of Neuropathology, HU, UFSC, Florianópolis, SC, Brazil; Neurodiagnostic Brasil - Diagnósticos em Neuropatologia, Florianópolis, SC, Brazil; Psychiatry Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil
| | - Ricardo Guarnieri
- Department of Neurology, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina (SC), Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Graduate Program in Neuroscience, UFSC, Florianópolis, Brazil
| | - Hiago Melo
- Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Graduate Program in Neuroscience, UFSC, Florianópolis, Brazil
| | - Mariana Lunardi
- Department of Neurology, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina (SC), Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Marcelo Neves Linhares
- Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Neurosurgery Division, Surgery Department, HU, UFSC, Florianópolis, Brazil; Neurosurgery Service, Governador Celso Ramos Hospital, Florianópolis, Brazil
| | - Emil Kupek
- Neurology Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil; Departament of Public Health, UFSC, Florianópolis, SC, Brazil
| | - Peter Wolf
- Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
| | - Kátia Lin
- Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Neurology Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil; Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
| | - Roger Walz
- Graduate Program in Translational Neuroscience, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Center for Applied Neuroscience, University Hospital (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Graduate Program in Neuroscience, UFSC, Florianópolis, Brazil; Neurology Division, Internal Medicine Department, HU, UFSC, Florianópolis, Brazil; Graduate Program in Medical Sciences, UFSC, Florianópolis, SC, Brazil
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21
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Mann C, Conradi N, Freiman TM, Spyrantis A, Konczalla J, Hattingen E, Wagner M, Harter PN, Mueller M, Leyer AC, Reif PS, Bauer S, Schubert-Bast S, Strzelczyk A, Rosenow F. Postoperative outcomes and surgical ratio at a newly established epilepsy center: The first 100 procedures. Epilepsy Behav 2021; 116:107715. [PMID: 33493802 DOI: 10.1016/j.yebeh.2020.107715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To describe the patients' characteristics, surgical ratio, and outcomes following epilepsy surgery at the newly established Epilepsy Center Frankfurt Rhine-Main. METHODS We retrospectively studied the first 100 consecutive patients, including adult (n = 77) and pediatric (n = 23) patients, with drug-resistant epilepsy who underwent resective or ablative surgical procedures at a single, newly established epilepsy center. Patient characteristics, seizure and neuropsychological outcomes, histopathology, complications, and surgical ratio were analyzed. RESULTS The mean patient age was 28.8 years (children 10.6 years, adults 34.2 years). The mean epilepsy duration was 11.9 years (children 3.9 years, adults 14.3 years), and the mean follow-up was 1.5 years. At the most recent visit, 64% of patients remained completely seizure free [Engel IA]. The rates of perioperative complications and unexpected new neurological deficits were 5%, each. The proportion of patients showing deficits in one or more cognitive domains increased six months after surgery and decreased to presurgical proportions after two years. Symptoms of depression were significantly decreased and quality of life was significantly increased after surgery. The surgical ratio was 25.3%. CONCLUSION Similar postsurgical outcomes were achieved at a newly established epilepsy center compared with long-standing epilepsy centers. The lower time to surgery may reflect a general decrease in time to surgery over the last decade or the improved accessibility of a new epilepsy center in a previously underserved area. The surgical ratio was not lower than reported for established centers.
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Affiliation(s)
- Catrin Mann
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
| | - Nadine Conradi
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Thomas M Freiman
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany; Department of Neurosurgery, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Andrea Spyrantis
- Department of Neurosurgery, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Juergen Konczalla
- Department of Neurosurgery, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Elke Hattingen
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt am Main, Germany; Institute for Neuroradiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Marlies Wagner
- Institute for Neuroradiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Patrick N Harter
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany; Neurological Institute (Edinger Institute), University Hospital Frankfurt, Germany; University Cancer Center (UCT), University Hospital Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Frankfurt, Germany; German Cancer Consortium (DKTK) partner site Frankfurt/Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Mueller
- Department of Ophthalmology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Anne-Christine Leyer
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Philipp S Reif
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
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22
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Punia V, Sheikh SR, Thompson NR, Bingaman W, Jehi L. Quality of life before and after epilepsy surgery: Age is just a number. Epilepsy Behav 2020; 113:107574. [PMID: 33232893 DOI: 10.1016/j.yebeh.2020.107574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND In a rapidly aging population, it is critical to analyze if the quality of life (QOL) in patients with drug-resistant epilepsy (DRE) and the change in it after epilepsy surgery is dependent on the age at operation. METHODS A prospective registry-based retrospective cohort study including adults with a completed pre- and post-surgery Quality of Life in Epilepsy 10 (QOLIE-10) survey. Multivariable linear regression models analyzed the baseline, postoperative, or change in QOLIE-10 score. RESULTS We analyzed 416 patients (51% females) with the mean age of 39.6 (SD = 12.6) years at the time of surgery, including 100 (24%) individuals 50 years or older. The younger and older adults (dichotomized as <50 vs. ≥50 and <60 vs. ≥60) had comparable pre- and post-surgery QOLIE 10 total scores. The change in total and individual QOLIE-10 items score were comparable between the groups as well. Within group improvements in total QOLIE-10 score post-surgery was in younger as well as older groups. The linear regression models showed that age, regardless of parameterization (linear or dichotomized), was not related to pre-surgery, post-surgery, and change in QOLIE-10 score, both before and after adjustment for covariates. The change in QOLIE-10 score did not show correlation with age, whether seizure freedom or relative seizure reduction was used in the model. CONCLUSION With QOL, before or after surgery, being independent of a patient's age, our findings suggest that well-selected older adults and the elderly should be offered epilepsy surgery without concern for an inferior improvement in QOL compared to their younger counterparts.
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Affiliation(s)
- Vineet Punia
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, United States.
| | - Shehryar R Sheikh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Nicolas R Thompson
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - William Bingaman
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, United States; Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, United States
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23
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Cramer SW, McGovern RA, Wang SG, Chen CC, Park MC. Resective epilepsy surgery: assessment of randomized controlled trials. Neurosurg Rev 2020; 44:2059-2067. [PMID: 33169227 DOI: 10.1007/s10143-020-01432-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022]
Abstract
Epilepsy is the most common form of chronic neurologic disease. Here, we review the available randomized controlled trials (RCTs) that examined the efficacy of resective epilepsy surgery in select patients suffering from medically intractable epilepsy (defined as persistent epilepsy despite two or more antiepileptic drugs [AEDs]). Three RCTs (two adult RCTs and one pediatric RCT) consistently supported the efficacy of resective surgery as treatment for epilepsy with semiology localized to the mesial temporal lobe. In these studies, 58-100% of the patients who underwent resective surgery achieved seizure freedom, in comparison to 0-13% of medically treated patients. In another RCT, the likelihood of seizure freedom after resective surgery was independent of the surgical approach (transSylvian [64%] versus subtemporal [62%]). Two other RCTs demonstrated that hippocampal resection is essential to optimize seizure control. But, no significant gain in seizure control was achieved beyond removing 2.5 cm of the hippocampus. Across RCTs, minor complications (deficit lasting < 3 months) and major complications (deficit > 3 months) ranged 2-5% and 5-11% respectively. However, nonincapacitating superior subquadrantic visual-field defects (not typically considered a minor or major complication) were noted in up to 55% of the surgical cohort. The available RCTs provide compelling support for resective surgery as a treatment for mesial temporal lobe epilepsy and offer insights toward optimal surgical strategy.
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Affiliation(s)
- Samuel W Cramer
- Department of Neurosurgery, University of Minnesota, 420 Delaware St SE, MMC 96, D-429 Mayo Memorial Building, Minneapolis, MN, 55455, USA.
| | - Robert A McGovern
- Department of Neurosurgery, University of Minnesota, 420 Delaware St SE, MMC 96, D-429 Mayo Memorial Building, Minneapolis, MN, 55455, USA.,Department of Neurology, University of Minnesota, 516 Delaware St SE, 12-100 Phillips Wangensteen Building, Minneapolis, MN, 55455, USA
| | - Sonya G Wang
- Department of Neurology, University of Minnesota, 516 Delaware St SE, 12-100 Phillips Wangensteen Building, Minneapolis, MN, 55455, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, 420 Delaware St SE, MMC 96, D-429 Mayo Memorial Building, Minneapolis, MN, 55455, USA
| | - Michael C Park
- Department of Neurosurgery, University of Minnesota, 420 Delaware St SE, MMC 96, D-429 Mayo Memorial Building, Minneapolis, MN, 55455, USA.,Department of Neurology, University of Minnesota, 516 Delaware St SE, 12-100 Phillips Wangensteen Building, Minneapolis, MN, 55455, USA
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24
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Quality of life in elderly patients after surgery for drug-resistant epilepsy - The impact of seizure outcome, neurological deficits and anxiety. Epilepsy Behav 2020; 112:107410. [PMID: 32956942 DOI: 10.1016/j.yebeh.2020.107410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Health related quality of life (HRQoL) has become a pivotal outcome parameter after surgery for drug-resistant epilepsy. The aim of the study was to investigate HRQoL and its relationship to seizure outcome, neurological deficits and anxiety after epilepsy surgery in a specific subpopulation of elderly patients. METHODS A total of 85 elderly patients (older than 50 years) answered a standardized HRQoL questionnaire one year after epilepsy surgery. The questionnaire addressed the present self-assessed HRQoL in four subdomains (physical function, cognitive function, mood, social interaction). The questionnaire was based on the "Epilepsy Surgery Inventory-55", adapted for use in German speaking patients and validated by the QOLIE -10 and Beck Depression Inventory. RESULTS A total of 51 patients (60%) were completely seizure free (ILAE1) at last available outcome (LAO). Permanent neurological deficits were observed in 8 patients (7%). Correlation analysis confirmed significant association between seizure outcome and overall HRQoL (r = -0.368, p < .001). New permanent neurological deficits showed impact on both HRQoL and the "cognitive function" subdomain. Anxiety and subjective assessment of postoperative status were strongly correlated with overall HRQoL (r = 0.692, p < .001 and r = 0.591, p < .001 respectively) and remained as independent prognostic factors in a multivariate regression analysis. CONCLUSION Surgery for drug-resistant epilepsy in elderly improves patients' HRQoL. Both seizure freedom and new neurological deficits influence overall HRQoL. Interestingly, anxiety and patients' subjective assessment of postoperative status showed the highest impact on HRQoL in this subpopulation of epilepsy patients.
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25
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Conradi N, Behrens M, Hermsen AM, Kannemann T, Merkel N, Schuster A, Freiman TM, Strzelczyk A, Rosenow F. Assessing Cognitive Change and Quality of Life 12 Months After Epilepsy Surgery-Development and Application of Reliable Change Indices and Standardized Regression-Based Change Norms for a Neuropsychological Test Battery in the German Language. Front Psychol 2020; 11:582836. [PMID: 33178083 PMCID: PMC7593256 DOI: 10.3389/fpsyg.2020.582836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022] Open
Abstract
Objective The establishment of patient-centered measures capable of empirically determining meaningful cognitive change after surgery can significantly improve the medical care of epilepsy patients. Thus, this study aimed to develop reliable change indices (RCIs) and standardized regression-based (SRB) change norms for a comprehensive neuropsychological test battery in the German language. Methods Forty-seven consecutive patients with temporal lobe epilepsy underwent neuropsychological assessments, both before and 12 months after surgery. Practice-effect-adjusted RCIs and SRB change norms for each test score were computed. To assess their usefulness, the presented methods were applied to a clinical sample, and binary logistic regression analyses were conducted to model the odds of achieving improvement in quality of life (QOL) after surgery. Results The determined RCIs at 90% confidence intervals and the SRB equations for each test score included in the test battery are provided. Cohen’s kappa analyses revealed a moderate mean agreement between the two measures, varying from slight to almost perfect agreement across test scores. Using these measures, a negative association between improvement in QOL and decline in verbal memory functions after surgery was detected (adjusted odds ratio = 0.09, p = 0.006). Significance To the best of our knowledge, this study is the first to develop RCIs and SRB change norms necessary for the objective determination of neuropsychological change in a comprehensive test battery in the German language, facilitating the individual monitoring of improvement and decline in each patients’ cognitive functioning and psychosocial situations after epilepsy surgery. The application of the described measures revealed a strong negative association between improvement in QOL and decline in verbal memory functions after surgery.
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Affiliation(s)
- Nadine Conradi
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt and Goethe University, Frankfurt, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe University, Frankfurt, Germany
| | - Marion Behrens
- Department of Neurology, University Hospital Frankfurt and Goethe University, Frankfurt, Germany
| | - Anke M Hermsen
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt and Goethe University, Frankfurt, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe University, Frankfurt, Germany
| | - Tabitha Kannemann
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt and Goethe University, Frankfurt, Germany
| | - Nina Merkel
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt and Goethe University, Frankfurt, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe University, Frankfurt, Germany
| | - Annika Schuster
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt and Goethe University, Frankfurt, Germany
| | - Thomas M Freiman
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt and Goethe University, Frankfurt, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe University, Frankfurt, Germany.,Department of Neurosurgery, University Hospital Frankfurt and Goethe University, Frankfurt, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt and Goethe University, Frankfurt, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe University, Frankfurt, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt and Goethe University, Frankfurt, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe University, Frankfurt, Germany
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26
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Winslow J, Hu B, Tesar G, Jehi L. Longitudinal trajectory of quality of life and psychological outcomes following epilepsy surgery. Epilepsy Behav 2020; 111:107283. [PMID: 32759066 PMCID: PMC8892470 DOI: 10.1016/j.yebeh.2020.107283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study investigated self-reported longitudinal quality of life (QOL) and symptoms of depression and anxiety in patients who had resective surgery. The study characterized the extent, sustainability, and longitudinal trajectory of psychosocial postsurgical outcomes. METHODS This retrospective study included adults who underwent resective epilepsy surgery in Cleveland Clinic Epilepsy Center between 2008 and 2013. Clinic visits were between October 2007 and December 2014. Data studied were from visits prior to surgery, early postsurgery follow-up (mean: 0.9 years; range: 0.5 to 3.4), and most recent follow-up (mean: 3.2 years; range: 0.8 to 6.9). Patient demographics, clinical features, and surgical factors were collected. Analysis focused on self-reported quality of life (QOLIE-10), depression (PHQ-9), and anxiety (GAD-7). RESULTS The study included 229 adults, of whom 178 had complete follow-up with data from all three time points. Following surgery, scores on Quality of life in epilepsy inventory (QOLIE-10), Patient health questionnaire (PHQ-9), and General anxiety disorder (GAD-7) improved significantly with time. After adjusting for gender, age, marital status, and type of surgery using linear modeling, the mean QOLIE-10 score decreased by 1.157 points/year, mean PHQ-9 score by 0.331 points/year, and mean GAD-7 score by 0.299 points/year. Improvement in QOL continued to be observed throughout the follow-up duration, whereas both depression and anxiety improved the most within the first postoperative year and then stabilized. Seizure freedom was strongly correlated with improved QOL (p = 0.001), while depressive symptoms showed a nonstatistically significant correlation with worse QOL (p = 0.07). Patients who underwent frontal resection had significantly superior QOL and depression symptom improvement compared with temporal resections during full data analysis (QOLIE-10, p = 0.024; PHQ-9, p = 0.027), but only significant depression symptom improvement on secondary analysis of complete follow-up patients only (PHQ, p = 0.040; QOL, p = 0.104). SIGNIFICANCE This study provides a longitudinal perspective of QOL and psychological symptoms in patients with postresective epilepsy with a cohort with 38% extratemporal cases. Results illustrate positive trajectory of psychosocial outcomes postsurgery with early QOL and mood improvement, and years of further QOL gains. Frontal lobe surgery patients may have superior improvement in some psychosocial measures compared with temporal lobe surgery patients.
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Affiliation(s)
- Jessica Winslow
- Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Bo Hu
- Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - George Tesar
- Psychiatry and Psychology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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27
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Foit NA, Bernasconi A, Bernasconi N. Functional Networks in Epilepsy Presurgical Evaluation. Neurosurg Clin N Am 2020; 31:395-405. [PMID: 32475488 DOI: 10.1016/j.nec.2020.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Continuing advancements in neuroimaging methodology allow for increasingly detailed in vivo characterization of structural and functional brain networks, leading to the recognition of epilepsy as a disorder of large-scale networks. In surgical candidates, analysis of functional networks has proved invaluable for the identification of eloquent brain areas, such as hemispherical language dominance. More recently, connectome-based biomarkers have demonstrated potential to further inform clinical decision making in drug-refractory epilepsy. This article summarizes current evidence on epilepsy as a network disorder, emphasizing potential benefits of network analysis techniques for preoperative assessments and resection planning.
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Affiliation(s)
- Niels Alexander Foit
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 Rue Université, Montreal, Quebec H3A 2B4, Canada
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 Rue Université, Montreal, Quebec H3A 2B4, Canada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, 3801 Rue Université, Montreal, Quebec H3A 2B4, Canada.
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Joudi Mashhad M, Harati H, Parooie F, Salarzaei M. Epilepsy surgery for refractory seizures: a systematic review and meta-analysis in different complications. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00168-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nearly one-third of epilepsy patients are refractory/resistant to medical treatment. Developments made in surgical techniques have significantly increased the effectiveness and safety of these techniques, as such techniques have been demonstrated to improve seizure control/freedom outcomes.
Objectives
The aim of this systematic review and meta-analysis was to evaluate the complications of epilepsy surgery.
Patient and methods
The searches were conducted by three independent researchers to find the relevant studies published from January 1, 2009, until the end of January 6, 2019. For English published statistical studies, all studies conducted on epileptic patients who have undergone epilepsy surgery were included.
Statistical analysis
A meta-analysis was conducted in the STATA14 statistical software.
Results
A total of 6735 patients with epilepsy who had undergone the epilepsy surgery were studied. The overall prevalence of complications was 5%. The prevalence of major and minor complications was 5.4% and 3.2% respectively. The prevalence of complications related to the temporal epilepsy surgery and the extra-temporal epilepsy surgery based on 3 studies was 7.9% and 8.2 % respectively. The frequency of neurological and surgical complications after epilepsy surgery was 4.4% and 4.1% respectively.
Conclusion
The overall rate of complications caused by epilepsy surgery was reasonably low (5%), implying that epilepsy surgery especially temporal lobe resection can be safe preferably when performed by an experienced surgeon.
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Enhancing quality of life among epilepsy surgery patients: Interlinking multiple social and relational determinants. Epilepsy Behav 2020; 102:106721. [PMID: 31785483 DOI: 10.1016/j.yebeh.2019.106721] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Achieving seizure control through resective brain surgery is a major predictor of improved quality of life (QOL) among people with refractory (drug-resistant) epilepsy. Nevertheless, QOL is a comprehensive and dynamic construct, consisting of broad dimensions such as physical health, psychosocial well-being, level of independence, social relationships, and beyond. This study highlights the interlinkage and complementarity of these diverse dimensions, and how in practice, patients, clinicians, and others in a social support system can actively promote QOL among surgery patients. METHOD Twenty-one qualitative in-depth interviews with patients with refractory epilepsy who are either undergoing presurgical assessment or postsurgery follow-up were conducted, to consider their perspective on QOL in relation to their experience of illness and surgical treatment. Data were thematically analyzed, resulting in three key thematic findings. RESULTS (1) A myriad of QOL dimensions are highly interrelated and interdependent with mutual 'spin-off' effects: Uncontrolled seizures impacted beyond physical and cognitive health, disrupting important social identities such as being successful parents, spouses, and career professionals. The desire for good clinical outcomes from surgery was justified against the need to mitigate these social and personal concerns. (2) In postsurgery care, there were complementary effects of clinical interventions and social factors on patients' QOL. Psychosocial well-being was supported by a combination of improved physical health, self-confidence, psychological interventions, and social support from employers and educators who were sensitive to patients' specialized needs. (3) Engaging in education, employment, and government services influenced not only socioeconomic well-being, but also a sense of social inclusion. Advocacy made on behalf of patients by clinicians and family members has helped to better manage patients' eligibility for social services provision. CONCLUSION Quality of life is achieved through a comprehensive and interactive social process, and not simply an outcome measure of clinical treatment. The responses and interactions of many others within the patients' life and treatment process, including family members, clinicians, and social service workers, can culminate to influence QOL, highlighting the importance of a relational and social determinants perspective in patient care.
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Jones FJS, Ezzeddine FL, Herman ST, Buchhalter J, Fureman B, Moura LMVR. A feasibility assessment of functioning and quality-of-life patient-reported outcome measures in adult epilepsy clinics: A systematic review. Epilepsy Behav 2020; 102:106704. [PMID: 31816482 DOI: 10.1016/j.yebeh.2019.106704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the study was to identify functioning and quality-of-life (QOL) patient-reported outcome measurements (PROMs) feasible for use in the waiting room of adult epilepsy clinics. MATERIAL AND METHODS We searched PubMed and Web of Science for articles on in English, Spanish, Portuguese, Italian, and French published by the end of February 15th, 2019. We screened retrieved titles and abstracts looking for publications that reported the use of PROMs to measure functioning and QOL in epilepsy. The authors, clinical experts, and patient advocates from the Epilepsy Foundation of America conceptualized a set of desirable feasibility attributes for PROMs implementation in the waiting room of adult epilepsy clinics. These attributes included brief time for completion (i.e., ≤3 min), free cost, coverage of four minimum QOL domains and respective facets, and good evidence of psychometric properties. We defined QOL domains according to the World Health Organization's classification and created psychometric appraisal criteria based on the Food and Drug Administration's (FDA) Guidance. RESULTS Eighteen candidate instruments were identified and compared with respect to desirable attributes for use in adult epilepsy clinics. We found that the Quality-of-life in epilepsy (QOLIE)-10 and Patient-Reported Outcome Measurement Information System-10 (PROMIS-10) were the most feasible PROMs for implementation in adult epilepsy clinics based on our criteria. The QOLIE-10 and PROMIS-10 still lack ideal evidence of responsiveness in people with epilepsy. CONCLUSION This is the first systematic review that aimed to assess feasibility properties of available functioning and QOL PROMs. The QOLIE-10 and PROMIS-10 are potentially feasible instruments for implementation in the waiting room of adult epilepsy clinics. Further studies assessing the responsiveness of these PROMs are needed and will contribute to the selection of the most appropriate instrument for longitudinal use in adult epilepsy clinical practice.
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Affiliation(s)
- Felipe J S Jones
- Department of Neurology, Massachusetts General Hospital, Wang Ambulatory Care Center, 720, 55 Fruit Street, Boston, MA 02114, United States of America.
| | - Farrah L Ezzeddine
- Department of Epidemiology, Harvard T.H Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States of America.
| | - Susan T Herman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, United States of America.
| | - Jeffrey Buchhalter
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada
| | - Brandy Fureman
- Research and New Therapies, Epilepsy Foundation, 8301 Professional Pl #200, Landover, MD 20785, United States of America.
| | - Lidia M V R Moura
- Department of Neurology, Massachusetts General Hospital, Wang Ambulatory Care Center, 720, 55 Fruit Street, Boston, MA 02114, United States of America.
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Ham AS, Nirola DK, Ayub N, Tshering L, Dem U, Jette N, Dorji C, Mateen FJ. Missed opportunities for epilepsy surgery referrals in Bhutan: A cohort study. Epilepsy Res 2019; 159:106252. [PMID: 31838172 DOI: 10.1016/j.eplepsyres.2019.106252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/07/2019] [Accepted: 12/06/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To quantify the missed opportunities for epilepsy surgery referral and operationalize the Canadian Appropriateness of Epilepsy Surgery (CASES) tool for use in a lower income country without neurologists. METHODS People with epilepsy were recruited from the Jigme Dorji Wangchuck National Referral Hospital from 2014-2016. Each participant was clinically evaluated, underwent at least one standard EEG, and was invited to undergo a free 1.5 T brain MRI. Clinical variables required for CASES were operationalized for use in lower-income populations and entered into the free, anonymous website tool. FINDINGS There were 209 eligible participants (mean age 28.4 years, 56 % female, 179 with brain MRI data). Of the 179 participants with brain MRI, 43 (24.0 %) were appropriate for an epilepsy surgery referral, 21 (11.7 %) were uncertain, and 115 (64.3 %) were inappropriate for referral. Among the 43 appropriate referral cases, 36 (83.7 %) were "very high" and 7 (16.3 %) were "high" priorities for referral. For every unit increase in surgical appropriateness, quality of life (QoL) dropped by 2.3 points (p-value <0.001). Among the 68 patients who took >1 antiepileptic drug prior to enrollment, 42 (61.8 %) were appropriate referrals, 14 (20.6 %) were uncertain, and 12 (17.6 %) were inappropriate. CONCLUSION Approximately a quarter of Bhutanese epilepsy patients who completed evaluation in this national referral-based hospital should have been evaluated for epilepsy surgery, sometimes urgently. Surgical services for epilepsy are an emerging priority for improving global epilepsy care and should be scaled up through international partnerships and clinician support algorithms like CASES to avoid missed opportunities.
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Affiliation(s)
| | - Damber K Nirola
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | | - Lhab Tshering
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Ugyen Dem
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Nathalie Jette
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chencho Dorji
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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Milovanović JR, Janković SM, Milovanović D, Ružić Zečević D, Folić M, Kostić M, Ranković G, Stefanović S. Contemporary surgical management of drug-resistant focal epilepsy. Expert Rev Neurother 2019; 20:23-40. [DOI: 10.1080/14737175.2020.1676733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Dragan Milovanović
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | | | - Marko Folić
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marina Kostić
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Goran Ranković
- Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Srđan Stefanović
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Predictors of meaningful improvement in quality of life after selective amygdalohippocampectomy in Chinese patients with refractory temporal lobe epilepsy: A prospective study. Epilepsy Behav 2019; 97:1-7. [PMID: 31181423 DOI: 10.1016/j.yebeh.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/26/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Our aim was to determine the independent predictors of minimum clinically important difference (MCID) in quality of life (QOL) after selective amygdalohippocampectomy (SAH) among Chinese patients with refractory mesial temporal lobe epilepsy (MTLE). METHODS We conducted a prospective study and enrolled 50 consecutive patients with refractory MTLE who underwent SAH after their presurgical evaluations. The variables independently associated with MCID in the Quality of Life in Epilepsy Inventory-31 (QOLIE-31) overall score 1 year after SAH were analyzed by multiple binary logistic regression analysis. RESULTS Significant improvements in the QOLIE-31 overall score and all subscale scores were observed after SAH (p < 0.001). Among 50 patients with refractory MTLE, 78% reached the criteria for MCID of QOL overall score after SAH. In the multiple binary logistic regression model, the presurgical independent predictors of significant improvement by MCID in QOL were absence of depression diagnosis (adjusted odds ratio [OR] = 8.391, 95% confidence interval [CI] = 1.240-56.776, p = 0.029) and good cognitive function (adjusted OR = 8.427, 95% CI = 1.115-63.670, p = 0.039); the postoperative independent predictor was seizure freedom (adjusted OR = 8.477, 95% CI = 1.195-60.122, p = 0.032). The sensitivity and specificity for significant improvement in the QOL were 97.4% and 45.5% respectively, with an overall model accuracy of 86.0%. CONCLUSIONS Presurgical depression, cognitive function, and postsurgical seizure freedom are independent predictors for meaningful improvement in QOL after SAH among the Chinese patients with refractory MTLE. Preoperative evaluation of patients with refractory MTLE should consider the cognitive dysfunction and psychological disorders.
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Lee AT, Burke JF, Chunduru P, Molinaro AM, Knowlton R, Chang EF. A historical cohort of temporal lobe surgery for medically refractory epilepsy: a systematic review and meta-analysis to guide future nonrandomized controlled trial studies. J Neurosurg 2019; 133:71-78. [PMID: 31252393 DOI: 10.3171/2019.4.jns183235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recent trials for temporal lobe epilepsy (TLE) highlight the challenges of investigating surgical outcomes using randomized controlled trials (RCTs). Although several reviews have examined seizure-freedom outcomes from existing data, there is a need for an overall seizure-freedom rate estimated from level I data as investigators consider other methods besides RCTs to study outcomes related to new surgical interventions. METHODS The authors performed a systematic review and meta-analysis of the 3 RCTs of TLE in adults and report an overall surgical seizure-freedom rate (Engel class I) composed of level I data. An overall seizure-freedom rate was also collected from level II data (prospective cohort studies) for validation. Eligible studies were identified by filtering a published Cochrane meta-analysis of epilepsy surgery for RCTs and prospective studies, and supplemented by searching indexed terms in MEDLINE (January 1, 2012-April 1, 2018). Retrospective studies were excluded to minimize heterogeneity in patient selection and reporting bias. Data extraction was independently reverified and pooled using a fixed-effects model. The primary outcome was overall seizure freedom following surgery. The historical benchmark was applied in a noninferiority study design to compare its power to a single-study cohort. RESULTS The overall rate of seizure freedom from level I data was 72.4% (55/76 patients, 3 RCTs), which was nearly identical to the overall seizure-freedom rate of 71.7% (1325/1849 patients, 18 studies) from prospective cohorts (z = 0.134, p = 0.89; z-test). Seizure-freedom rates from level I and II studies were consistent over the years of publication (R2 < 0.01, p = 0.73). Surgery resulted in markedly improved seizure-free outcomes compared to medical management (RR 10.82, 95% CI 3.93-29.84, p < 0.01; 2 RCTs). Noninferiority study designs in which the historical benchmark was used had significantly higher power at all difference margins compared to using a single cohort alone (p < 0.001, Bonferroni's multiple comparison test). CONCLUSIONS The overall rate of seizure freedom for temporal lobe surgery is approximately 70% for medically refractory epilepsy. The small sample size of the RCT cohort underscores the need to move beyond standard RCTs for epilepsy surgery. This historical seizure-freedom rate may serve as a useful benchmark to guide future study designs for new surgical treatments for refractory TLE.
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Affiliation(s)
| | | | | | | | - Robert Knowlton
- 2Department of Neurology, University of California, San Francisco, San Francisco, California
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Zingano BDL, Guarnieri R, Diaz AP, Schwarzbold ML, Wolf P, Lin K, Walz R. Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) and The State-Trait Anxiety Inventory (STAI) accuracy for anxiety disorders detection in drug-resistant mesial temporal lobe epilepsy patients. J Affect Disord 2019; 246:452-457. [PMID: 30599368 DOI: 10.1016/j.jad.2018.12.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/18/2018] [Accepted: 12/23/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is the most prevalent type of surgically remediable epilepsy and highly associated with psychiatric comorbidities. This study aimed to evaluate Hospital anxiety and depression scale-anxiety subscale (HADS-A) and The State-Trait Anxiety Inventory - Trait subscale (STAI-T) accuracy for detection of anxiety disorders in patients with drug-resistant MTLE-HS. METHODS One hundred three consecutive patients with drug-resistant MTLE-HS were enrolled. Diagnosis was based on the anamnesis, neurological examination, video-electroencephalogram (VEEG) analyses, and magnetic resonance imaging (MRI). Psychiatric interviews were based on DSM-IV-TR criteria and ILAE Commission of Psychobiology classification as a gold standard; HADS-A and STAI-T were used as psychometric diagnostic tests, and receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores. RESULTS The areas under the curve (AUCs) were higher than 0.7 (0.6-0.8) for both scales. The STAI-T cutoff point of ˃53 and the HADS-A cutoff point of ˃7 showed both around of 80% (44.4-97.7) sensitivity and 80% (66.9-86.9) and 60% (46.5-68.6) of specificity, respectively. In this sample the prevalence of anxiety disorders was 11.7% and both scales showed a high negative predictive value such as 96% (87.1-99.0) but low positive predictive value such as 30% (22.1-45.2) and 20% (15.0-27.2) respectively. LIMITATIONS The small number of cases in the diagnostic population; the results are only applied to drug resistant MTLE-HS; the psychiatric diagnosis were not based on a structured psychiatric interview; possible observer bias in 7 illiterate patients; the antidepressant treatment was not controlled. CONCLUSIONS In MTLE-HS, STAI-T and HADS-A had a similar and low positive predictive value and high negative predictive value. The implications for the HADS-A and STAI-T usefulness for anxiety disorders screening in patients with other epilepsies types deserve further investigations. If replicated in other populations, these findings may have important relevance for the presurgical screening of anxiety disorders in MTLE-HS patients who are candidates to epilepsy surgery.
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Affiliation(s)
- Bianca de Lemos Zingano
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Psiquiatria, Hospital Governador Celso Ramos (HGCR), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil.
| | - Ricardo Guarnieri
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Psiquiatria, HU-UFSC, Florianópolis, SC, Brazil
| | - Alexandre Paim Diaz
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Psiquiatria, HU-UFSC, Florianópolis, SC, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina (UNISUL), Palhoça, SC, Brazil
| | - Marcelo Libório Schwarzbold
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Psiquiatria, HU-UFSC, Florianópolis, SC, Brazil
| | - Peter Wolf
- Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil; Danish Epilepsy Center, Dianalund, Denmark
| | - Katia Lin
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil
| | - Roger Walz
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil
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Neuroradiological findings in patients with “non-lesional” focal epilepsy revealed by research protocol. Clin Radiol 2019; 74:78.e1-78.e11. [DOI: 10.1016/j.crad.2018.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/26/2018] [Indexed: 11/21/2022]
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Ehrlich T, Reyes A, Paul BM, Uttarwar V, Hartman S, Mathur K, Chang YHA, Hegde M, Shih JJ, McDonald CR. Beyond depression: The impact of executive functioning on quality of life in patients with temporal lobe epilepsy. Epilepsy Res 2019; 149:30-36. [PMID: 30468945 PMCID: PMC6326842 DOI: 10.1016/j.eplepsyres.2018.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/14/2018] [Accepted: 11/12/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Individuals with temporal lobe epilepsy (TLE) often experience diminished quality of life (QoL). Although comorbid depression is one of the most recognized predictors of poor QoL in TLE, impairments in verbal memory (VM) and executive functioning (EF), have also been identified as risk factors, independent of other biological and psychosocial factors. In this study, we examine the contribution of depression, VM, and EF to QoL in 52 well-characterized medically-refractory TLE patients. METHODS Quality of life was assessed with the Quality of Life in Epilepsy (QOLIE-31) questionnaire and depression symptomatology was evaluated with the Beck Depression Inventory-II (BDI-II). Tests of VM included the California Verbal Learning Test-Second Edition and the Wechsler Memory Scale-Third Edition, Logical Memory and Verbal Paired Associates subtests. Tests of EF included the D-KEFS Category Switching and Color Word Interference Tests, and the Trail Making Test. Using these measures, a principal component (PC) was derived for VM and for EF. Hierarchical multiple linear regression analysis was used to evaluate the unique contributions of BDI-II Score, VM PC, and EF PC to the QOLIE-31 Total Score, while controlling for important clinical and demographic variables. Post-hoc analyses were also performed to examine the contribution of each variable to specific QOLIE subscales. RESULTS Of the clinical variables, only number of antiepileptic drugs contributed to QOLIE scores. As expected, severity of depressive symptoms was the most significant predictor of QOLIE Total Score, explaining 43.4% of the variance in total QoL. The VM PC did not contribute to the QOLIE Total Score. Rather, our EF PC emerged as an important predictor of QoL, explaining an additional 5% of the variance, after controlling for clinical variables, depression severity, and VM performance. SIGNIFICANCE These findings suggest that a combination of clinical, affective, and cognitive factors influence QoL in patients with TLE. Designing interventions with careful attention to depression and EF may be needed to optimize QoL in patients with refractory TLE and potentially other epilepsy syndromes.
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Affiliation(s)
- Tobin Ehrlich
- Palo Alto University, 1971 Arastradero Drive, Palo Alto, CA 94304, USA
| | - Anny Reyes
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Brianna M Paul
- UCSF Comprehensive Epilepsy Center, San Francisco, CA, USA; Department of Neurology, University of California - San Francisco, San Francisco, CA, USA
| | - Vedang Uttarwar
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Stephen Hartman
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Kushagra Mathur
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA
| | - Yu-Hsuan A Chang
- Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Manu Hegde
- UCSF Comprehensive Epilepsy Center, San Francisco, CA, USA
| | - Jerry J Shih
- UCSD Comphrensive Epilepsy Center, San Diego, CA, USA
| | - Carrie R McDonald
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA; UCSD Comphrensive Epilepsy Center, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA.
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Smith JAD, Armacost M, Ensign E, Shaw S, Jimenez N, Millett D, Liu C, Heck CN. Epilepsy surgery in the underserved Hispanic population improves depression, anxiety, and quality of life. Epilepsy Behav 2018; 83:1-6. [PMID: 29631155 DOI: 10.1016/j.yebeh.2018.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/06/2018] [Accepted: 03/08/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the effect of epilepsy surgery on depression, anxiety, and quality of life (QOL) in a Hispanic, primarily immigrant, Spanish-speaking population with intractable epilepsy (IE). METHODS Patients with IE from a comprehensive epilepsy treatment center in an urban, public healthcare setting who underwent resective brain surgery between 2008 and 2014 (N=47) and completed presurgical and postsurgical neuropsychological evaluation were retrospectively identified. Presurgical and 1-year postsurgical Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and QOLIE-31 ratings were analyzed as postsurgical outcome measures. One-tailed paired sample t-tests were used to evaluate whether scores improved postoperatively. Established severity level classifications of depression and anxiety (i.e., minimal, mild, moderate, or severe) were used to analyze changes in occurrence of depression and anxiety. RESULTS Medium to large improvements on the BDI-II and most QOLIE-31 subscales, with a smaller effect on the BAI and remaining QOLIE-31 subscales, were noted 1-year postsurgery. Levels of depression and anxiety were significantly reduced 1-year postsurgery. Depression, anxiety, and QOL improvements were robust and unaffected by gender, levels of education, or hemisphere of surgery. CONCLUSIONS This study supports the positive benefits of epilepsy surgery on depression, anxiety, and QOL in Hispanic, primarily undocumented immigrant, Spanish-speaking people with epilepsy (PWE) in the US. These results are useful for educating this particular population about the possible benefits of surgery for IE and can enhance presurgical counseling.
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Affiliation(s)
- Jason A D Smith
- Rancho Los Amigos National Rehabilitation Center, 7601 Imperial Hwy, Downey, CA 90242, USA; University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., CS6.104, Dallas, TX 75390-9055, USA.
| | - Michelle Armacost
- Rancho Los Amigos National Rehabilitation Center, 7601 Imperial Hwy, Downey, CA 90242, USA; Los Angeles County - University of California Medical Center, 2051 Marengo Street, Los Angeles, CA 90033, USA; University of Southern California, Department of Neurology, 1540 Alcazar Street, Suite 215, Los Angeles, CA 90033, USA.
| | - Emily Ensign
- Rancho Los Amigos National Rehabilitation Center, 7601 Imperial Hwy, Downey, CA 90242, USA.
| | - Susan Shaw
- Rancho Los Amigos National Rehabilitation Center, 7601 Imperial Hwy, Downey, CA 90242, USA; Los Angeles County - University of California Medical Center, 2051 Marengo Street, Los Angeles, CA 90033, USA; University of Southern California, Department of Neurology, 1540 Alcazar Street, Suite 215, Los Angeles, CA 90033, USA.
| | - Nora Jimenez
- Los Angeles County - University of California Medical Center, 2051 Marengo Street, Los Angeles, CA 90033, USA.
| | - David Millett
- Rancho Los Amigos National Rehabilitation Center, 7601 Imperial Hwy, Downey, CA 90242, USA; Los Angeles County - University of California Medical Center, 2051 Marengo Street, Los Angeles, CA 90033, USA; University of Southern California, Department of Neurology, 1540 Alcazar Street, Suite 215, Los Angeles, CA 90033, USA.
| | - Charles Liu
- Rancho Los Amigos National Rehabilitation Center, 7601 Imperial Hwy, Downey, CA 90242, USA; Los Angeles County - University of California Medical Center, 2051 Marengo Street, Los Angeles, CA 90033, USA; University of Southern California, Department of Neurosurgery, 1200 North State Street, Suite 3300, Los Angeles, CA 90033, USA.
| | - Christianne N Heck
- Los Angeles County - University of California Medical Center, 2051 Marengo Street, Los Angeles, CA 90033, USA; University of Southern California, Department of Neurology, 1540 Alcazar Street, Suite 215, Los Angeles, CA 90033, USA.
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Walther K, Dogan Onugoren M, Buchfelder M, Gollwitzer S, Graf W, Kasper BS, Kriwy P, Kurzbuch K, Lang J, Rössler K, Schwab S, Schwarz M, Stefan H, Hamer HM. Psychosocial outcome in epilepsy after extratemporal surgery. Epilepsy Behav 2018; 81:94-100. [PMID: 29454606 DOI: 10.1016/j.yebeh.2018.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/29/2018] [Accepted: 01/29/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Only limited data exist on psychosocial long-term outcome after epilepsy surgery in patients with extratemporal epilepsy. The aim of this study was to investigate psychosocial outcome after extratemporal epilepsy surgery and to assess factors predicting favorable outcome. METHOD Sixty-five out of 104 eligible patients who had undergone extratemporal epilepsy surgery at our epilepsy center between 1990 and 2015 (mean age: 42.2. years; 75% of the resections in the frontal lobe) completed a questionnaire asking about seizure status, employment status, marital and living situation, driving status, depressive symptoms, and quality of life (QOL). Follow-up was on average 9.2years after surgery (range: 1-26years). RESULTS Thirty-eight (58%) patients were free of disabling seizures (Engel class I), and 28 (43%) have not experienced any seizures after surgery (Engel class IA). Employment rate in the primary labor market remained at 45%, but more patients lost employment (14%) than gained employment (8%). Postoperative employment was predicted by preoperative employment (p=.007), seizure freedom (p=.025), older age at seizure onset (p=.018), younger age at follow-up (p=.035), and female gender (p=.048). Seizure-free patients were more likely to be driving; have a partner, particularly in males; and have lower depressive scores. Quality of life at follow-up was best predicted by employment (p=.012), partnership (p=.025), and seizure freedom (p=.025). In contrast, recurrence of seizures and early seizure onset were associated with poor psychosocial outcome, particularly in men. CONCLUSION The study provides support that extratemporal surgery can lead to improved QOL and favorable psychosocial outcome. Seizure freedom is important but not the only determinant of good psychosocial outcome.
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Affiliation(s)
- Katrin Walther
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Müjgan Dogan Onugoren
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Stephanie Gollwitzer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Wolfgang Graf
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Burkhard S Kasper
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Peter Kriwy
- Institute of Sociology, Chemnitz University of Technology, Thüringer Weg 9, 09126 Chemnitz, Germany
| | - Katrin Kurzbuch
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Johannes Lang
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Michael Schwarz
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hermann Stefan
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany
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Does early postoperative drug regimen impact seizure control in patients undergoing temporal lobe resections? J Neurol 2018; 265:500-509. [PMID: 29307009 DOI: 10.1007/s00415-017-8700-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/30/2017] [Accepted: 12/02/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the impact of postoperative antiepileptic drug (AED) load on seizure control in patients who underwent surgical treatment for pharmacoresistant mesiotemporal lobe epilepsy during the first two postoperative years. PATIENTS AND METHODS 532 consecutive patients (48.7% males and 51.7% females) who underwent surgical treatment for mesiotemporal lobe epilepsy were retrospectively evaluated regarding effects of AED load on seizures control during the first 2 years following epilepsy surgery. We analyzed whether postoperative increases in postoperative AED load are associated with better seizure control in patients initially not seizure free, and if postoperative decreases in postoperative AED load would increase the risk for seizure persistence or recurrence. For statistical analyses, Fisher's exact and Wilcoxon test were applied. RESULTS 68.9, 64.0 and 59.1% of patients were completely seizure free (Engel Ia) at 3, 12 and 24 months after surgery, respectively. Patients in whom daily drug doses were increased did not have a higher rate of seizure freedom at any of the three follow-up periods. Of 16 patients achieving secondary seizure control at 12 months after surgery, only one did so with an increase in drug load in contrast to 15 patients who experienced a running down of seizures independent of drug load increases. Decreases in drug load did not significantly increase the risk for seizure recurrence. Of postoperatively seizure free patients at 3 months after surgery in whom AED were consequently reduced, 85% remained completely seizure free at 1 year and 76% at 1 year after surgery, respectively, as opposed to 86% each when AED was not reduced (differences n.s.). Mean daily drug load was significantly lower in seizure free patients at 12 and 24 months compared to patients with ongoing seizures. CONCLUSION In this large patient cohort stratified to the epilepsy syndrome neither did a postoperative reduction in drug load significantly increase the risk for seizure relapse nor did increases in drug dosages lead to improved seizure control. Mean drug load was on average lower in seizure free- than non-seizure free patients at 12 and 24 months of follow-up. Secondary seizure control after initial postoperative seizures in > 90% of cases occurred as a running down, independent of an AED increase. Thus, the effect of the surgical intervention rather than the postoperative drug regimen was the key determinant for seizure control. This finding supports a curative role of temporal lobe surgery rather than an effect rendering the majority of patients' pharmacoresponsive with a critical role of the antiepileptic drug regime for seizure control.
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Mehmood S, Dale C, Parry M, Snead C, Valiante TA. Predictive coding: A contemporary view on the burden of normality and forced normalization in individuals undergoing epilepsy surgery. Epilepsy Behav 2017; 75:110-113. [PMID: 28843211 DOI: 10.1016/j.yebeh.2017.06.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/22/2017] [Accepted: 06/11/2017] [Indexed: 12/21/2022]
Abstract
Following epilepsy surgery, a good psychosocial outcome is not necessarily contingent on a good seizure outcome. Increasingly, it is believed that "successful" surgery is a combination of both an acceptable and expected seizure status as well as the individual's perception of improvements in quality of life (QOL). The factors that create this optimal outcome remain an ongoing area of research in the epilepsy community. That being said, there have been some major breakthroughs in observing and understanding poor outcomes seen in a subset of postoperative patients with epilepsy. Characteristics of burden of normality and forced normalization are two phenomena that have been evident in cases of poor postoperative outcomes. In this review, we provide a summary of research and concepts used to explain these poor QOL outcomes for a seemingly successful surgery and suggest a contemporary view in understanding the mechanism of forced normalization through understanding the brain as a predictive organ. Using such a predictive coding model together with recommendations of other studies, we suggest the crucial need for a preoperative intervention addressing patient predictions and expectations to optimize on the benefits achievable through epilepsy surgery.
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Affiliation(s)
- Sumayya Mehmood
- Krembil Research Institute, Toronto Western Hospital (TWH), Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Carter Snead
- Division of Neurology, Departments of Medicine, Paediatrics and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Taufik A Valiante
- Krembil Research Institute, Toronto Western Hospital (TWH), Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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Edelvik A, Taft C, Ekstedt G, Malmgren K. Health-related quality of life and emotional well-being after epilepsy surgery: A prospective, controlled, long-term follow-up. Epilepsia 2017; 58:1706-1715. [PMID: 28836662 DOI: 10.1111/epi.13874] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate health-related quality of life (HRQOL) and emotional well-being in resective epilepsy surgery and nonoperated patients at long-term follow-up. METHODS This is a prospective cohort study where patients undergoing presurgical work-up during 1995-1998 completed the Short-Form Health Survey (SF-36) and the Hospital Anxiety and Depression scale (HAD) at baseline, and 2 and 14 years after resective surgery or presurgical evaluation (nonoperated patients). SF-36 scores were compared to a normative population. Proportions of patients reaching HRQOL changes of minimum clinically important difference (MCID) were calculated. RESULTS At 14-year follow-up, operated patients scored equal to or better than the normative sample on all SF-36 domains except Social Functioning and Mental Health. Physical component summary (PCS) was better and mental component summary (MCS) was worse than for the normative sample. Nonoperated patients scored worse than the normative sample on five of eight domains, and on PCS and MCS. Change in seizure status from 2 to 14 years did not affect PCS or MCS means. Improvement reaching MCID from baseline to long-term was seen in 50% (PCS) and 47% (MCS) of operated and in 33% (PCS) and 38% (MCS) of nonoperated patients. Worsening was seen in 18% (PCS) and 22% (MCS) of operated and in 38% (PCS) and 38% (MCS) of nonoperated patients. Differences between groups were nonsignificant. HAD scores did not differ between groups, and the numbers of possible or probable cases were low. Patient satisfaction with surgery was higher in operated seizure-free patients. Only 5% of all operated patients considered surgery not to be overall beneficial. SIGNIFICANCE At the group level, HRQOL was stable 14 years after surgery compared to after 2 years. Social Functioning and Mental Health were still below, but other domains were similar to the normative sample. Individual patterns did not follow seizure outcome changes, indicating that multiple factors are important for long-term HRQOL.
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Affiliation(s)
- Anna Edelvik
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Charles Taft
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Center for Person-Centered Care, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Gerd Ekstedt
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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Pauli C, Schwarzbold ML, Diaz AP, de Oliveira Thais MER, Kondageski C, Linhares MN, Guarnieri R, de Lemos Zingano B, Ben J, Nunes JC, Markowitsch HJ, Wolf P, Wiebe S, Lin K, Walz R. Predictors of meaningful improvement in quality of life after temporal lobe epilepsy surgery: A prospective study. Epilepsia 2017; 58:755-763. [PMID: 28332703 DOI: 10.1111/epi.13721] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate prospectively the independent predictors of a minimum clinically important change (MCIC) in quality of life (QOL) after anterior temporal lobectomy (ATL) for drug-resistant mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) in Brazilian patients. METHODS Multiple binary logistic regression analysis was performed to identify the clinical, demographic, radiologic, and electrophysiologic variables independently associated with MCIC in the Quality of Life in Epilepsy-31 Inventory (QOLIE-31) overall score 1 year after ATL in 77 consecutive patients with unilateral MTLE-HS. RESULTS The overall QOLIE-31 score and all its subscale scores increased significantly (p < 0.0001) 1 year after ATL. In the final logistic regression model, absence of presurgical diagnosis of depression (adjusted odds ratio [OR] 4.4, 95% confidence interval [CI] 1.1-16.1, p = 0.02) and a complete postoperative seizure control (adjusted OR 4.1, 95% CI 1.2-14.5, p = 0.03) were independently associated with improvement equal to or greater than the MCIC in QOL after ATL. The overall model accuracy for MCIC improvement in the QOL was 85.6%, with a 95.2% of sensitivity and 46.7% of specificity. SIGNIFICANCE These results in Brazilian patients reinforce the external validation of previous findings in Canadian patients showing that presurgical depression and complete seizure control after surgery are independent predictors for meaningful improvement in QOL after ATL, and have implications for the surgical management of MTLE patients.
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Affiliation(s)
- Carla Pauli
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.,Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Marcelo Liborio Schwarzbold
- Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Psychiatric Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil
| | - Alexandre Paim Diaz
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.,Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Psychiatric Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil
| | | | - Charles Kondageski
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.,Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Department of Surgery, HU, UFSC, Florianópolis, Santa Catarina, Brazil
| | - Marcelo Neves Linhares
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.,Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Department of Surgery, HU, UFSC, Florianópolis, Santa Catarina, Brazil
| | - Ricardo Guarnieri
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.,Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Psychiatric Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil
| | - Bianca de Lemos Zingano
- Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.,Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Juliana Ben
- Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Jean Costa Nunes
- Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Laboratory of Neuropathology, Pathology Division, HU, UFSC, Florianópolis, Santa Catarina, Brazil
| | | | - Peter Wolf
- Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Neurology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil.,Danish Epilepsy Centre, Dianalund, Denmark
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Katia Lin
- Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Neurology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil
| | - Roger Walz
- Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.,Neurology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil
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Moura LMVR, Eskandar EN, Hassan M, Salinas J, Cole AJ, Hoch DB, Cash SS, Hsu J. Anterior temporal lobectomy for older adults with mesial temporal sclerosis. Epilepsy Res 2016; 127:358-365. [PMID: 27760412 DOI: 10.1016/j.eplepsyres.2016.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 09/07/2016] [Accepted: 09/29/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare postoperative seizure-free survival between older and younger adults. METHODS A retrospective cohort of 107 temporal lobe epilepsy patients with a diagnosis of mesial temporal sclerosis (MTS) received anterior temporal lobectomy (ATL) between 1993 and 2014. We divided the lower three quartiles (younger) and top quartile (older, all 47+ years) of patients, then reviewed patient registry and electronic medical records to determine time to first self-reported seizure after ATL, the primary outcome (mean=3.5years of follow-up, SD=3.6). We also assessed Engel classifications, intraoperative and postoperative treatment complications, and social disability. We used Cox proportional hazard models to assess the association between individual traits and time of seizure recurrence. RESULTS During follow-up, 35/107 (32.7%) patients had post-operative seizure(s). After adjustment for potential confounders there were no significant differences in the probability of post-operative seizures between the older and younger groups, though we had limited precision (hazard ratio of 0.67 [0.28-1.59]), (p=0.36). There were more treatment complications and disability in older patients (18% vs. 1.3% for any complications, 84.62% vs. 58.23% for driving disability, and 84.6% vs. 60.7% for work disability, p<0.05). CONCLUSION Older patients appear to have more complications after ATL, compared with younger patients. Age, however, does not appear to have a large independent association with seizure recurrence.
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Affiliation(s)
- Lidia M V R Moura
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States.
| | - Emad N Eskandar
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Mursal Hassan
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Joel Salinas
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Andrew J Cole
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Daniel B Hoch
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - John Hsu
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA 02114, United States; Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, United States
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Kemp S, Garlovsky J, Reynders H, Caswell H, Baker G, Shah E. Predicting the psychosocial outcome of epilepsy surgery: A longitudinal perspective on the 'burden of normality'. Epilepsy Behav 2016; 60:149-152. [PMID: 27206234 DOI: 10.1016/j.yebeh.2016.04.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 04/11/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
Good seizure outcomes and good psychosocial outcomes following epilepsy surgery do not necessarily follow one from the other. This study explored the relationship between several presurgical psychosocial characteristics and postsurgical quality-of-life outcomes. The study aimed to develop the concept of 'the burden of normality' and identify risk factors for a poor psychosocial outcome that could be targeted with ameliorative presurgery cognitive behavioral techniques. Data were collected from 77 epilepsy surgery patients from three UK epilepsy centers and presurgery and postsurgery follow-up data were obtained from 30-34 patients, depending on the measure. Measures were self-report. Postsurgery intervals were determined by the epilepsy surgery care pathway at individual centers. Presurgery poor levels of mental health, poor social functioning, increased belief in illness chronicity, and associating epilepsy with social role limitations were all associated with poor postsurgical quality of life. Adopting an accepting coping strategy presurgery was associated with good postoperative quality of life. Regression analysis showed that a good postsurgical quality of life was positively predicted by a presurgical coping style of being able to make the best of a situation and see challenges in a positive light (i.e., positive reinterpretation and growth from the COPE scale) and negatively predicted by presurgical levels of anxiety. These data are presented as an important step in identifying psychological red flags for an adverse psychosocial outcome to epilepsy surgery, as exemplified by the concept of the 'burden of normality' and specifying targets for preoperative ameliorative psychological advice.
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Affiliation(s)
- Steven Kemp
- Department of Clinical and Health Psychology, St James' Hospital, Leeds, United Kingdom.
| | - Jack Garlovsky
- Sheffield Children's Hospital, Sheffield, United Kingdom
| | | | | | - Gus Baker
- The Walton Centre, Liverpool, United Kingdom
| | - Emily Shah
- Department of Clinical and Health Psychology, St James' Hospital, Leeds, United Kingdom
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Fabris RR, Cascino TG, Mandrekar J, Marsh WR, Meyer FB, Cascino GD. Drug-resistant focal epilepsy in women of childbearing age: Reproduction and the effect of epilepsy surgery. Epilepsy Behav 2016; 60:17-20. [PMID: 27176879 DOI: 10.1016/j.yebeh.2016.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/22/2016] [Accepted: 04/02/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Women with epilepsy (WWE) have lower birth rates than expected. The reasons for this are multifactorial and involve a complex interaction between reproductive endocrine and psychosocial factors. The effect of epilepsy surgery on reproduction in women with drug-resistant focal epilepsy has not previously been studied. METHODS Adult women of childbearing age (18-45years old) with drug-resistant focal epilepsy who had undergone a focal cortical resection between 1997 and 2008 at the Mayo Clinic in Rochester, MN were included in the study. Patients who had a history of hysterectomy or tubal ligation or who were menopausal at the time of surgery were excluded. Data on prior pregnancies and births, epilepsy history, surgical treatment, hormonal dysfunction, and socioeconomic status were obtained using a retrospective chart review. Associations between various clinical and demographic variables with changes in pregnancies and births from pre- to postsurgery were assessed using Chi-square or Fisher's exact test for categorical variables and Wilcoxon rank sum test for continuous variables. All tests were 2-sided, and p-values less than 0.05 were considered statistically significant. All analyses were performed using SAS software version 9.2 (SAS INC, Cary NC). RESULTS One hundred and thirteen women (average age: 30.5years) were included in the study. Average length of follow-up was 5.7years (SD-3.90). Sixty-four patients (57.5%) were nulliparous at the time of surgery. Sixty-one patients (54%) had never been married. Average number of pregnancies per patient prior to surgery was 0.93, and average number of births prior to surgery was 0.73. After surgery, a total of 17 women had a total of 35 pregnancies and 25 births. The average number of pregnancies and births after surgery was 1.27 and 0.96, respectively. Infertility was reported in one patient postoperatively. Patients who were younger at the time of surgery experienced a greater change in the number of pregnancies and births after surgery (p=0.0036 and 0.0060, respectively). Patients who received fewer antiepileptic drug medication trials by the time of surgery also had a greater change in the number of births after surgery (p=0.0362). Seizure onset localization and lateralization, presurgical seizure frequency, age at seizure onset, duration of epilepsy, and postoperative seizure outcome were not statistically significant factors. CONCLUSION The present retrospective observational study provides additional evidence for the importance of early surgical treatment in women with drug-resistant focal epilepsy. Patients who had received fewer medications prior to surgery were more likely to experience an increase in births following surgery. The significance of these findings requires further investigation but may support a role for earlier surgical intervention in the management of drug-resistant focal epilepsy.
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Affiliation(s)
- Rachel R Fabris
- Mayo Clinic, Division of Epilepsy, Department of Neurology, Rochester, MN, United States
| | | | - Jay Mandrekar
- Mayo Clinic, Department of Health Sciences Research, Rochester, MN, United States
| | - W Richard Marsh
- Mayo Clinic, Department of Neurosurgery, Rochester, MN, United States
| | - Frederic B Meyer
- Mayo Clinic, Department of Neurosurgery, Rochester, MN, United States
| | - Gregory D Cascino
- Mayo Clinic, Division of Epilepsy, Department of Neurology, Rochester, MN, United States
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Alonso NB, Mazetto L, de Araújo Filho GM, Vidal-Dourado M, Yacubian EMT, Centeno RS. Psychosocial factors associated with in postsurgical prognosis of temporal lobe epilepsy related to hippocampal sclerosis. Epilepsy Behav 2015; 53:66-72. [PMID: 26520878 DOI: 10.1016/j.yebeh.2015.09.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 11/28/2022]
Abstract
We examined the long-term psychosocial trajectory in a consecutive and homogeneous series of 120 patients followed up for five years after corticoamygdalohippocampectomy (CAH). Evaluation of psychosocial variables at baseline and at five-year follow-up were compared. After five years of CAH, a significant improvement in educational level (p=0.004) and employment status (p<0.001) was observed, although retirement (p<0.001) and divorce (p=0.021) rates increased. In a long-term follow-up, a tendency to have similar QOL profile was observed between Engel classes IA and IB (p>0.05). A more favorable surgical outcome (Engel IA) was related to better psychiatric status (p=0.012). Poor psychosocial adjustment before surgery was the most important predictor of QOL outcome (p<0.05). Patients' trajectory after surgical treatment showed positive effects mainly in those with better seizure outcome. Our results emphasized the influence regarding baseline psychosocial functioning on postoperative psychosocial adjustment. Furthermore, many psychosocial gains and difficulties after surgery may be similar in developing and developed countries.
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Affiliation(s)
| | - Lenon Mazetto
- Department of Neurology, Escola Paulista de Medicina/UNIFESP, São Paulo, Brazil
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Abstract
Epilepsy affects 65 million people worldwide and entails a major burden in seizure-related disability, mortality, comorbidities, stigma, and costs. In the past decade, important advances have been made in the understanding of the pathophysiological mechanisms of the disease and factors affecting its prognosis. These advances have translated into new conceptual and operational definitions of epilepsy in addition to revised criteria and terminology for its diagnosis and classification. Although the number of available antiepileptic drugs has increased substantially during the past 20 years, about a third of patients remain resistant to medical treatment. Despite improved effectiveness of surgical procedures, with more than half of operated patients achieving long-term freedom from seizures, epilepsy surgery is still done in a small subset of drug-resistant patients. The lives of most people with epilepsy continue to be adversely affected by gaps in knowledge, diagnosis, treatment, advocacy, education, legislation, and research. Concerted actions to address these challenges are urgently needed.
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Affiliation(s)
- Solomon L Moshé
- Saul R Korey Department of Neurology, Dominick P Purpura Department of Neuroscience and Department of Pediatrics, Laboratory of Developmental Epilepsy, Montefiore/Einstein Epilepsy Management Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, NY, USA
| | - Emilio Perucca
- Department of Internal Medicine and Therapeutics, University of Pavia, and C Mondino National Neurological Institute, Pavia, Italy.
| | - Philippe Ryvlin
- Department of Functional Neurology and Epileptology and IDEE, Hospices Civils de Lyon, Lyon's Neuroscience Research Center, INSERM U1028, CNRS 5292, Lyon, France; Department of Clinical Neurosciences, Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Jobst BC. Beyond pills, machines and surgery: rehabilitation after epilepsy surgery. Epilepsy Curr 2015; 15:28-9. [PMID: 25678884 PMCID: PMC4320954 DOI: 10.5698/1535-7597-15.1.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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