The results show similar intellectual outcomes for surgical and non-surgical paediatric patients. Four to 11 years after paediatric epilepsy surgery, seizure freedom, whether attained through epilepsy surgery or other means, was found to be associated with intellectual improvements. Seizure status and baseline scores were the most consistent predictors.

SUMMARYObjective: This study examined the influence of seizures, antiepileptic drugs (AEDs), intelligence quotient (IQ), and symptoms of depression and anxiety on health-related quality of life (HRQOL) 4-11 years after pediatric epilepsy surgery. Methods: Participants were 109 patients with childhood-onset intractable epilepsy; 71 had undergone surgery on average 6.9 years before this study. Patients and their parents completed questionnaires assessing HRQOL and internalizing behavior, a measure of depression and anxiety symptoms. Results: Similar rates of recent seizure freedom were found for surgical and nonsurgical patients, although surgical patients had achieved seizure freedom sooner and with fewer AEDs. Few differences were found between surgical and nonsurgical patients. Differences emerged when comparing patients with continued seizures and those who had been seizure-free in the 12 months preceding the study. Almost all HRQOL ratings were enhanced in seizure-free patients. Internalizing behavior (anxiety/depression) mediated the relationship between seizure freedom and better HRQOL, where seizure freedom led to better ratings of anxiety/depression, which in turn led to better ratings of HRQOL. AED use was found to be associated with social functioning, medication effects, and seizure worry. IQ and duration of follow-up were not found to independently influence HRQOL. Significance: The findings highlight the integral role of depression and anxiety symptoms in determining HRQOL; seizure control seems to play a secondary role. This study expands this relationship to individuals who have a history of intractable childhood epilepsy. The findings highlight the importance of managing depression and anxiety in improving the HRQOL and reducing seizure burden on patients.

No abstract

No abstract

No abstract

to address the emerging public health emergency in persons who inject drugs in Middlesex-London, with further details on strategy and resources to come to the Board of Health in September. Key Points  Rates of HIV, Hepatitis C, Invasive Group A Streptococcal Disease, and infective endocarditis have all been increasing in persons who inject drugs in Middlesex-London.  Rates are being driven by several intersecting factors, including underlying mental health and addictions issues, and changes in prescription opioid drug practices.  Stakeholders will continue to be engaged at the local and provincial levels to ensure an integrated and coordinated response to this emerging public health issue.

Summary Objective To evaluate the social, educational, and vocational outcomes of young adults who underwent resective epilepsy surgery in childhood (4–11 years earlier), and in a comparison group of nonsurgical patients with intractable epilepsy. Methods Participants were 78 patients (mean age 22.37, standard deviation [SD] 2.47 years) with childhood onset intractable epilepsy, of whom 51 underwent surgery. At follow‐up, participants were at least 18 years of age. Patients' current education, employment, income, and various social factors, including living arrangements, relationship status, and involvement with friends and community organizations were recorded. In addition, parents of patients completed the Adult Behaviour Checklist (ABCL). Employment status, education, and income were compared with provincial census data. Results There was no statistically significant difference in the proportion of surgical and nonsurgical patients who were seizure‐free in the 12 months preceding the study: 53% and 33%, respectively (p = 0.10). Among all patients, 60% were enrolled in, or had completed, postsecondary education and 82% were employed or a student; similar to the general population. However, compared with population data, fewer patients with epilepsy (20%) had an annual income of $10,000 or greater (p < 0.001). Compared to normative data, a greater proportion of patients scored in the abnormal range in some ABCL scales (p < 0.028). Patients with IQs > 85 had significantly better educational, vocational, and psychosocial outcomes compared to patients with IQs ≤ 85. Surgical and nonsurgical patients did not differ on any outcome variable. Compared to patients with seizures, more seizure‐free patients were living independently (p = 0.03), and had a driver's licence (p < 0.001). Other outcomes were similar among patients with and without seizures. Significance Overall, patients with intractable epilepsy in childhood attained educational and vocational outcomes similar to that of the general population, but earned a significantly lower income. Seizure freedom, attained through surgery or medication management, was associated with better outcomes in limited psychosocial measures.

Although over 50 % of youth with intractable epilepsy present with behavioral problems, the long-term prognosis after resective epilepsy surgery in childhood is unclear. This study evaluated such outcomes in a cohort of surgical and nonsurgical patients. Participants were 108 patients (71 underwent surgery) with childhood-onset intractable epilepsy; their mean age at follow-up was 19.9 (standard deviation 4.3) years. The parent-rated Child or Adult Behavior Checklist (CBCL/ABCL) was used to document behavior prior to surgery and again 4-11 years later, and at comparable time points in the nonsurgical group. We focus primarily on externalizing and related symptomology in evaluating the CBCL/ABCL Externalizing Behavior summary scale and the Somatic Complaints, Thought Problems, Attention Problems, Aggressive Behavior, Intrusive, and Rule-breaking Behavior syndrome scales. Both groups improved in the Externalizing Behavior summary scale and in domains reflecting Somatic Complaints, Thought Problems, and Attention Problems from baseline to follow-up. Surgical and nonsurgical patients did not differ on any domain, whereas seizure-free patients had fewer symptoms in almost all behavioral domains, compared to patients with seizures. Regression analyses revealed that the most consistent predictor of improved behavior was greater behavior problems at baseline. Younger age at baseline was associated with improvements in Externalizing Behavior. The described long-term outcomes of behavior problems among patients with childhood-onset intractable epilepsy are encouraging, in that modest improvements were noted among all patient groups. Furthermore, seizure freedom, whether achieved through surgery or medication management, was associated with fewer behavioral problems in most domains.