Health‐related quality of life, mood, and patient satisfaction after epilepsy surgery in Sweden—A prospective controlled observational study

Abstract

ObjectiveTo evaluate health-related quality of life (HRQOL), mood, and patient satisfaction in epilepsy surgery candidates before and 2 years after epilepsy surgery or presurgical investigation.MethodsIn this prospective study of 141 patients, 96 underwent surgery and 45 did not. Questionnaires at baseline and at 2-year follow-up included the generic 36-item Short Form Health Survey (SF-36), the Hospital Anxiety and Depression scale (HAD), and operated patients answered patient satisfaction questions. SF-36 scores were compared with scores from a matched sample from the Swedish norm population. Numbers were calculated of patients achieving a minimum important change (MIC) in the SF-36 Physical Composite Summary (PCS) and Mental Composite Summary (MCS).ResultsAt baseline, patients had significantly lower values than the norm on all SF-36 domains. At follow-up, operated patients were divided into seizure-free (International League Against Epilepsy [ILAE] class 1 and 2, n = 53) or with continued seizures (n = 43). No differences in baseline HAD or SF-36 values were found between these groups. Seizure-free patients reached the same levels as the norm in all SF-36 domains except Social Function. Operated patients with continued seizures and nonoperated patients had unchanged scores. Fifty-one percent of seizure-free patients had an improvement reaching MIC for PCS and 45% for MCS. Corresponding results for patients with continued seizures were 28% in PCS and 28% in MCS, for nonoperated 33% in PCS and 29% in MCS. HAD anxiety scores improved significantly in only the seizure-free patients. Of all operated patients, 80% were satisfied with having had surgery and 86% considered that they had benefited, whereas 20% thought that surgery caused some harm.SignificanceIn patients who were seizure-free after epilepsy surgery HRQOL normalized and anxiety decreased. Operated patients overwhelmingly considered epilepsy surgery to be beneficial. Nonetheless, only about half of the seizure-free patients achieved important HRQOL improvements, suggesting that seizure freedom does not in and of itself guarantee improved patient well-being.

Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy

“…Notably, despite the relatively high overall complication rate, 91% of all operated patients were satisfied with having had epilepsy surgery and would undergo it again if necessary. This high satisfaction rate in our patients after epilepsy surgery is in agreement with other recent studies 30 . This finding reinforces the importance of surgical therapy in epilepsy -when well indicated.…”

Health‐related quality of life and emotional well‐being after epilepsy surgery: A prospective, controlled, long‐term follow‐up

“…Seizures are a major contributor to poor HRQOL in people with epilepsy . Seizure freedom or substantial seizure reduction has repeatedly been shown to be the most important determinant of HRQOL after epilepsy surgery . However, seizure outcome is not static; patterns of relapse and remission have been shown .…”

Identifying the trajectory of social milestones 15‐20 years after epilepsy surgery: Realistic timelines for postsurgical expectations

“…Driving was described as the first major milestone postsurgery. 34 In other words, a stable sense of HRQOL may be fostered by the mutual adjustment of expectations and perceptions of postsurgical experiences, such as the acceptance of social limitations described above. The timing of a return to driving is in part dictated by local medicolegal regulations; however, few patients delayed regaining their driver's license beyond 24 months.…”