Predictors of long‐term quality of life after pediatric epilepsy surgery

Abstract

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.

Seizure freedom improves health‐related quality of life after epilepsy surgery in children

“…The proportion of seizure‐free outcome amongst the surgical and pharmacological groups in our study was within the range reported in observational studies . We have included children with a variety of pathologies and different types of seizures (temporal vs extra‐temporal), which reflects the ‘real‐world’ phenomenon of pediatric epilepsy surgery that is often characterized by heterogeneous underlying etiology and seizure location.…”

“…Second, we did not consider other factors such as patient mood, caregiver factors, and family function that could potentially influence HRQoL after surgery. Patient mood, including depression and anxiety, was previously shown to be an important predictor of HRQoL after surgery . Family variables such as fewer family resources, caregiver mood, and caregiver unemployment were shown to be associated with diminished HRQoL in children with DRE .…”

Do behavior and emotions improve after pediatric epilepsy surgery? A systematic review

“…A good seizure outcome appears to be associated with better behavioral outcome on parent‐reported measures, but this was considered in only four studies. Long‐term health‐related quality of life in children who have undergone epilepsy surgery has been shown to be associated with seizure freedom but also with presence of depression and anxiety symptoms . AEDs were not associated with changes in psychopathology.…”

Development of intelligence 4 to 11 years after paediatric epilepsy surgery

“…The data were collected as part of a larger study examining multiple long‐term outcomes following epilepsy surgery in childhood, including quality of life (Puka & Smith, ) and emotional functioning (Tavares, Puka & Smith, ). The study was approved by the Research Ethics Board of the Hospital for Sick Children, and informed consent/assent was obtained from the patients and/or their parents.…”