Quality of Life After Epilepsy Surgery in Children: A Systematic Review and Meta-Analysis

Maragkos, Georgios A; Geropoulos, Georgios; Kechagias, Konstantinos S.; Ziogas, Ioannis A.; Mylonas, Konstantinos S.

doi:10.1093/neuros/nyy471

Cited by 39 publications

(41 citation statements)

References 42 publications

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“…Although not the primary focus of this research, we found that seizure freedom was associated with improved HRQOL, thus corroborating the previous meta-analysis on HRQOL. 8 Importantly, we also found that treatment was not independently associated with improved HRQOL. Seizure freedom, rather than type of treatment, was associated with better HRQOL.…”

Section: Discussionmentioning

confidence: 60%

“…The Generalized Anxiety Disorder seven-item scale (GAD-7) 15 measured caregiver anxiety. The GAD-7 assesses symptoms and severity of anxiety as per the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, 16 with cutoff scores for mild (5)(6)(7)(8)(9), moderate (10)(11)(12)(13)(14), and severe (≥15) symptoms. 15 The GAD-7 has demonstrated good to excellent internal consistency and convergent validity.…”

Section: Methodsmentioning

confidence: 99%

“…18 The QIDS-SR 16 assesses symptoms and severity of major depressive disorder from the DSM criteria. 16 Scores range from 0 to 27, with cutoff scores for mild (6)(7)(8)(9)(10), moderate (11)(12)(13)(14)(15), severe (16)(17)(18)(19)(20), and very severe (≥21) depression. 18,19 The QIDS-SR 16 has adequate to good internal consistency, discriminant, and convergent validity.…”

Section: Methodsmentioning

confidence: 99%

“…6 Moreover, in children with drug-resistant epilepsy (DRE) who have poorly controlled seizures, 7 epilepsy surgery shown to improve HRQOL over the first 12-24 months following surgery. 8 However, not all children who achieve seizure freedom following epilepsy surgery experience improvement in HRQOL, indicating that other risk factors may account for poor outcomes in these children.…”

Section: Introductionmentioning

confidence: 99%

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Family resources moderate the relationship between seizure control and health‐related quality of life in children with drug‐resistant epilepsy

2020

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Objective: Pediatric drug-resistant epilepsy (DRE) is associated with poor health-related quality of life (HRQOL). Achieving seizure control, however, does not improve HRQOL in all children. This study sought to evaluate whether (1) baseline caregiver and family factors are associated with child HRQOL at 1-year follow-up over and above epilepsy characteristics, treatment, and seizure outcome; and (2) baseline family factors moderate the association between seizure outcome and child HRQOL at 1-year follow-up. Methods: This multicenter longitudinal cohort study recruited 152 children with DRE who were being evaluated for surgical candidacy. Child HRQOL was rated by caregivers using the Quality of Life in Childhood Epilepsy Questionnaire at baseline and 1-year follow-up. Additional data collected at baseline included child epilepsy characteristics, caregiver demographics, caregiver mood, and family environment. Results: Seizure freedom was achieved in 68% and 28% of patients 1 year after surgery and medical treatment, respectively. Caregiver and family factors were not associated with higher child HRQOL at follow-up after accounting for epilepsy characteristics, treatment, seizure outcome, and baseline child HRQOL, F 11, 131 = 1.34,

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Section: Discussionmentioning

confidence: 60%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Family resources moderate the relationship between seizure control and health‐related quality of life in children with drug‐resistant epilepsy

2020

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“…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 12,32,33 but also with presence of depression and anxiety symptoms. 34 AEDs were not associated with changes in psychopathology.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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Objective The objective was to systematically review studies that have focused on behavioral and emotional functioning before (baseline) and after (follow‐up) pediatric epilepsy surgery. Methods The systematic review was carried out according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines. PubMed and EMBASE were searched from inception. Findings are described with respect to (1) changes in behavior and emotions between baseline and follow‐up, (2) factors associated with changes in behavior and emotions, and (3) impact of study quality on findings. Results Fifteen studies met inclusion criteria. The majority of studies employed parent report screening checklists. In these studies, scores were reported to have significantly improved at follow‐up on at least one domain in seven studies and not to have changed significantly in two studies. In no studies was a deterioration in behavior noted. In studies that used Diagnostic and Statistical Manual of Mental Disorders (DSM) clinical diagnoses, no significant change was noted in the numbers of children diagnosed at baseline and at follow‐up. In total, 21 children lost diagnoses, whereas 16 children developed new diagnoses. A better seizure outcome was associated with improvements in behavioral‐emotional functioning at follow‐up in three of the four studies where it was considered. In terms of study quality, none of the studies was rated as strong (ie, had no weak ratings on a quality assessment tool). Significance There is some evidence of improvement in emotional and behavioral functioning after epilepsy surgery. However, this is confined to scores on parent‐reported screening measures of emotional and behavioral symptoms and not clinical diagnoses. Future research should focus on including responses from multiple respondents (child, parent, teacher) when using screening instruments, but also diagnostic interviews. There is a need for long‐term follow‐up (beyond 2 years) with sufficiently large sample sizes including data from nonsurgery controls to understand factors associated with changes in functioning postsurgery.

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Trajectory of Health-Related Quality of Life After Pediatric Epilepsy Surgery

et al. 2023

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ImportanceHealth-related quality of life (HRQOL) is regarded as a key outcome for evaluating treatment efficacy. However, it is uncertain how HRQOL evolves after epilepsy surgery compared with medical therapy, such as whether it continues to improve over time, improves and then remains stable, or deteriorates after a period of time.ObjectiveTo assess trajectory of HRQOL over 2 years in children with drug-resistant epilepsy (DRE) treated with surgery compared with medical therapy.Design, Setting, and ParticipantsProspective cohort study assessing HRQOL longitudinally over 2 years. Participants were children recruited from 8 epilepsy centers in Canada from 2014 to 2019 with suspected DRE aged 4 to 18 years who were evaluated for surgery. Data were analyzed from May 2014 to December 2021.ExposuresEpilepsy surgery or medical therapy.Main Outcomes and MeasuresHRQOL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55. HRQOL and seizure frequency were assessed at baseline, 6-month, 1-year, and 2-year follow-ups. Clinical, parent, and family characteristics were assessed at baseline. A linear mixed model was used to evaluate HRQOL over time, adjusting for baseline clinical, parent, and family characteristics.ResultsThere were 111 surgical and 154 medical patients (mean [SD] age at baseline was 11.0 [4.1] years; 118 [45%] were female). At baseline, HRQOL was similar among surgical and medical patients. HRQOL of surgical patients was 3.0 (95% CI, −0.7 to 6.8) points higher at 6-month, 4.9 (95% CI, 0.7 to 9.1) points higher at 1-year, and 5.1 (95% CI, 0.7 to 9.5) points higher at 2-year follow-ups compared with medical patients. Surgical patients experienced greater improvements in social functioning relative to medical patients, but not for cognitive, emotional, and physical functioning. At 2-year follow-up, 72% of surgical patients were seizure-free, compared with 33% of medical patients. Seizure-free patients reported higher HRQOL than those who were not.Conclusions and RelevanceThis study provided evidence on the association between epilepsy surgery and children’s HRQOL, with improvement in HRQOL occurring within the first year and remaining stable 2 years after surgery. By demonstrating that surgery improved seizure freedom and HRQOL, which has downstream effects such as better educational attainment, reduced health care resource utilization, and health care cost, these findings suggest that the high costs of surgery are justified, and that improved access to epilepsy surgery is necessary.

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Quality of Life After Epilepsy Surgery in Children: A Systematic Review and Meta-Analysis

Cited by 39 publications

References 42 publications

Family resources moderate the relationship between seizure control and health‐related quality of life in children with drug‐resistant epilepsy

Family resources moderate the relationship between seizure control and health‐related quality of life in children with drug‐resistant epilepsy

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

Trajectory of Health-Related Quality of Life After Pediatric Epilepsy Surgery

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