Cognitive decline and quality of life after resective epilepsy surgery

Janecek, Julie K.; Brett, Benjamin L.; Pillay, Sara B.; Murphy, Heather M.; Binder, Jeffrey R.; Swanson, Sara J.

doi:10.1016/j.yebeh.2022.109005

Cited by 2 publications

(2 citation statements)

References 71 publications

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“…Seizure-freedom is associated with higher QoL, although there is no significant difference in seizure-free patients compared to those with a low seizure frequency (up to one seizure every six months). The likely causes of poorer QoL related to a higher seizure frequency are restrictions in everyday life, like driving a car [ 40 ], seizure-related injuries[ 8 ], and the fear of new seizures [ 41 ], highlighting the need for the adequate use of ASMs or epilepsy surgery, as QoL has been reported to improve following epilepsy surgery [ 42 ]. The effect of seizure frequency on QoL could also be explained by the possibility of reducing ASM numbers and doses to decrease the severity and number of side effects.…”

Section: Discussionmentioning

confidence: 99%

Determinants of quality of life in adults with epilepsy: a multicenter, cross-sectional study from Germany

Siebenbrodt

Willems

Podewils

et al. 2023

Neurol. Res. Pract.

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Background Assessment of quality of life (QoL) has become an important indicator for chronic neurological diseases. While these conditions often limit personal independence and autonomy, they are also associated with treatment-related problems and reduced life expectancy. Epilepsy has a tremendous impact on the QoL of patients and their families, which is often underestimated by practitioners. The aim of this work was to identify relevant factors affecting QoL in adults with epilepsy. Methods This cross-sectional, multicenter study was conducted at four specialized epilepsy centers in Germany. Patients diagnosed with epilepsy completed a standardized questionnaire focusing on QoL and aspects of healthcare in epilepsy. Univariate regression analyses and pairwise comparisons were performed to identify variables of decreased QoL represented by the overall Quality of Life in Epilepsy Inventory (QOLIE-31) score. The variables were then considered in a multivariate regression analysis after multicollinearity analysis. Results Complete datasets for the QOLIE-31 were available for 476 patients (279 [58.6%] female, 197 [41.4%] male, mean age 40.3 years [range 18–83 years]). Multivariate regression analysis revealed significant associations between low QoL and a high score on the Liverpool Adverse Events Profile (LAEP; beta=-0.28, p < 0.001), Hospital Anxiety and Depression Scale – depression subscale (HADS-D; beta=-0.27, p < 0.001), Neurological Disorders Depression Inventory in Epilepsy (NDDI-E; beta=-0.19, p < 0.001), revised Epilepsy Stigma Scale (beta=-0.09, p = 0.027), or Seizure Worry Scale (beta=-0.18, p < 0.001) and high seizure frequency (beta = 0.14, p < 0.001). Conclusion Epilepsy patients had reduced QoL, with a variety of associated factors. In addition to disease severity, as measured by seizure frequency, the patient’s tolerability of anti-seizure medications and the presence of depression, stigma, and worry about new seizures were strongly associated with poor QoL. Diagnosed comorbid depression was underrepresented in the cohort; therefore, therapeutic decisions should always consider individual psychobehavioral and disease-specific aspects. Signs of drug-related adverse events, depression, fear, or stigmatization should be actively sought to ensure that patients receive personalized and optimized treatment. Trial Registration German Clinical Trials Register (DRKS00022024; Universal Trial Number: U1111-1252-5331).

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Section: Discussionmentioning

confidence: 99%

Determinants of quality of life in adults with epilepsy: a multicenter, cross-sectional study from Germany

Siebenbrodt

Willems

Podewils

et al. 2023

Neurol. Res. Pract.

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“…Across all three cohorts, patients underwent a battery of neuropsychological tests prior to their respective interventions and again typically 6 to 12 months after they completed their procedures [18]. All testing was administered using standardized procedures by a trained psychometrist and scored using Heaton norms that adjust for age and education.…”

Section: Study Variablesmentioning

confidence: 99%

A Comparison of Neuropsychological Outcomes following Responsive Neurostimulation and Anterior Temporal Lobectomy in Drug-Resistant Epilepsy

O’Donnell,

Anderson,

Oleksy

et al. 2023

Brain Sciences

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Neuropsychological outcomes following temporal lobe resection for drug-resistant epilepsy (DRE) are well established. For instance, left anterior temporal lobectomy (LATL) is associated with a greater risk for cognitive morbidity compared to right (RATL). However, the impact of neuromodulatory devices, specifically responsive neurostimulation (RNS), remains an area of active interest. There are currently no head-to-head comparisons of neuropsychological outcomes after surgical resection and neuromodulation. This study reports on a cohort of 21 DRE patients with the RNS System who received comprehensive pre- and post-implantation neuropsychological testing. We compared both cognitive and seizure outcomes in the RNS group to those of 307 DRE patients who underwent LATL (n = 138) or RATL (n = 169). RNS patients had higher seizure rates pre-intervention. While fewer in the RNS group achieved Class I Engel outcomes compared to the ATL cohorts, RNS patients also showed seizure frequency declines from pre- to post-intervention that were similar to those who underwent resective surgery. Moreover, the RNS and RATL groups were similar in their neuropsychological outcomes, showing no significant cognitive decline post-intervention. In contrast, the LATL group notably declined in object naming and verbal list learning. Direct comparisons like this study may be used to guide clinicians in shared decision making to tailor management plans for patients’ overall treatment goals.

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Cognitive decline and quality of life after resective epilepsy surgery

Cited by 2 publications

References 71 publications

Determinants of quality of life in adults with epilepsy: a multicenter, cross-sectional study from Germany

Determinants of quality of life in adults with epilepsy: a multicenter, cross-sectional study from Germany

A Comparison of Neuropsychological Outcomes following Responsive Neurostimulation and Anterior Temporal Lobectomy in Drug-Resistant Epilepsy

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