Quality of life before and after epilepsy surgery: Age is just a number

Punia, Vineet; Sheikh, Shehryar; Thompson, Nicolas R.; Bingaman, William; Jehi, Lara

doi:10.1016/j.yebeh.2020.107574

Cited by 7 publications

(12 citation statements)

References 11 publications

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“…One study found that extreme age (older than 97 years) at the time of surgery was cost-ineffective. 24 While older patients should not be excluded from surgery, 37 younger age at surgery and shorter epilepsy duration are correlated with better surgical outcomes, 38,39 and thus, timely surgery in younger age groups may be potentially more cost-effective.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Cost-Effectiveness Analysis for Surgical and Neurostimulation Treatments for Drug-Resistant Epilepsy in Adults

et al. 2023

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Background and Objectives:Surgical and neurostimulator treatments are effective for reducing seizure burden in selected individuals living with drug resistant epilepsy (DRE). We aimed to determine the presence and key model determinants for cost-effectiveness of these interventions, compared to medical management alone, to assist with decisions about resource allocation.Methods:A systematic literature search was conducted on June 1, 2022, using Medline, Embase, NHS Economic Evaluation Database, and the Cost-Effectiveness Analysis database. Included studies were economic evaluations in adult DRE cohorts; comparing surgical and neurostimulator treatments (vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS)) vs medical management alone; and reporting cost-benefit analysis, cost-utility, or cost-effectiveness. Exclusion criteria were studies with pediatric cohorts and those published in a language other than English. Three independent reviewers screened, extracted, and assessed data against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, and a fourth reviewer adjudicated discrepancies.Results:Ten studies met inclusion criteria. Seven studies evaluated epilepsy surgery, and three evaluated neurostimulation treatments. All relevant studies established that epilepsy surgery is a cost-effective intervention compared to medical management alone, with regards to quality adjusted life years (QALYs), and seizure freedom at 2- and 5 years. All relevant studies found neurostimulator treatments to be potentially cost-effective. The incremental cost-effectiveness ratio (ICER), with lower ICER indicating greater cost-effectiveness, was reported for nine studies, and varied between GBP £3,013 and US $61,333. Cost adaptation revealed ICERs from US $170 to US $121,726. Key model determinants included, but were not limited to, improved surgical outcomes and quality of life, reduced surgical and presurgical evaluation costs, higher rates of surgical eligibility after referral and evaluation, epilepsy subtype, less expensive neurostimulator devices with improved longevity, and cost analysis strategy used in the analysis.Discussion:There is consistent evidence that epilepsy surgery is a cost-effective treatment for eligible candidates with DRE. Limited evidence suggests that VNS, RNS, and DBS may be cost-effective therapies for DRE, although more health economic evaluations alongside prospective clinical trials are needed to validate these findings.

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Section: Discussionmentioning

confidence: 99%

Systematic Review of Cost-Effectiveness Analysis for Surgical and Neurostimulation Treatments for Drug-Resistant Epilepsy in Adults

et al. 2023

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“…These were published between 2009 and 2022. Nine studies were of prospective cohort design, [26][27][28][29][30][31][32][33][34] two studies were randomized control trials, 25,35 one was a prospective case-control study, 36 and four were retrospective cohort studies. [37][38][39][40] Two studies reported the same cohort at different follow-up time points (1 year vs. 7.8 years); only the most recently published study was included in the final systematic review and meta-analysis.…”

Section: Literature Search Findingsmentioning

confidence: 99%

“…Data were not reported consistently for other patient variables across studies. From the data that were available, mean age at time of study enrollment was 35.2 years, 26,28,29,30,31,33,35,36,38,39 mean age at epilepsy onset was 17.9 years, 25,27,29,31,32,33,38,39,40 mean preoperative seizure frequency was 7.5 seizures per month, 25,27,29,32,34,35,38,39 and mean age at epilepsy surgery was 37.1 years. 25,27,32,33,40…”

Section: Patient Characteristicsmentioning

confidence: 99%

Impact of epilepsy surgery on quality of life: Systematic review and meta‐analysis

et al. 2023

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Improved quality of life (QoL) is an important outcome goal following epilepsy surgery. This study aims to quantify change in QoL for adults with drug‐resistant epilepsy (DRE) who undergo epilepsy surgery, and to explore clinicodemographic factors associated with these changes. We conducted a systematic review and meta‐analysis using Medline, Embase, and Cochrane Central Register of Controlled Trials. All studies reporting pre‐ and post‐epilepsy surgery QoL scores in adults with DRE via validated instruments were included. Meta‐analysis assessed the postsurgery change in QoL. Meta‐regression assessed the effect of postoperative seizure outcomes on postoperative QoL as well as change in pre‐ and postoperative QoL scores. A total of 3774 titles and abstracts were reviewed, and ultimately 16 studies, comprising 1182 unique patients, were included. Quality of Life in Epilepsy Inventory–31 item (QOLIE‐31) meta‐analysis included six studies, and QOLIE‐89 meta‐analysis included four studies. Postoperative change in raw score was 20.5 for QOLIE‐31 (95% confidence interval [CI] = 10.9–30.1, I2 = 95.5) and 12.1 for QOLIE‐89 (95% CI = 8.0–16.1, I2 = 55.0%). This corresponds to clinically meaningful QOL improvements. Meta‐regression demonstrated a higher postoperative QOLIE‐31 score as well as change in pre‐ and postoperative QOLIE‐31 score among studies of cohorts with higher proportions of patients with favorable seizure outcomes. At an individual study level, preoperative absence of mood disorders, better preoperative cognition, fewer trials of antiseizure medications before surgery, high levels of conscientiousness and openness to experience at the baseline, engagement in paid employment before and after surgery, and not being on antidepressants following surgery were associated with improved postoperative QoL. This study demonstrates the potential for epilepsy surgery to provide clinically meaningful improvements in QoL, as well as identifies clinicodemographic factors associated with this outcome. Limitations include substantial heterogeneity between individual studies and high risk of bias.

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“…[6,7] However, postoperative antiepileptic drug treatment and rehabilitation of children with epilepsy is a long and arduous process, and the parents of the child is under great psychological pressure and prone to various psychological problems in this process, among which anxiety is the most common. [8,9] Importantly, the psychological problems of the family can directly affect the recovery of the child, so professional medical services are meaningful for these parents. [10,11] Continuity of care is designed through a series of actions to ensure that patients receive different levels of collaborative and continuous care in different health care settings (e.g., from hospital to home) and within the same health care setting (e.g., different departments of a hospital), usually referring to the continuation from hospital to home, including discharge planning developed by the hospital, referral, continuous follow-up and guidance after the patient return to the family or community.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

WeChat-based remote follow-up management reduces the burden of home care and anxiety on parents of children with refractory epilepsy: A randomized controlled study

et al. 2023

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Objective: The present research was designed to study the effect of WeChat-based remote follow-up management on the burden of home care and anxiety on parents of children with refractory epilepsy. Methods: 161 refractory epileptic children were included in this study. They were divided into control group and WeChat group according to their management protocols after discharge, namely, control group with traditional follow-up (n = 81) and WeChat group with remote follow-up based on WeChat (n = 81). We evaluated home care burden by family caregiver task Inventory (FCTI) scale and zarit burden interview (ZBI) scale, and evaluated negative emotion by self-rating anxiety Scale (SAS) scale and self-Rating depression scale (SDS) scale. Results: There was no significant difference in the demographic characteristics of epileptic children and their parents and the scores of FCTI, ZBI, SAS and SDS before treatment between the 2 groups (all P > .05), and the score of FCTI (20.86 ± 4.26), ZBI (39.63 ± 4.46), SAS (44.49 ± 4.15) and SDS (50.02 ± 4.13) in WeChat group were all significantly lower than the score of FCTI (25.25 ± 3.71), ZBI (45.47 ± 4.61), SAS (52.75 ± 4.93) and SDS (54.51 ± 6.59) in control group (all P < .05). Conclusion: WeChat-based remote follow-up management reduces the burden of home care and anxiety on parents of children with refractory epilepsy.

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Quality of life before and after epilepsy surgery: Age is just a number

Cited by 7 publications

References 11 publications

Systematic Review of Cost-Effectiveness Analysis for Surgical and Neurostimulation Treatments for Drug-Resistant Epilepsy in Adults

Systematic Review of Cost-Effectiveness Analysis for Surgical and Neurostimulation Treatments for Drug-Resistant Epilepsy in Adults

Impact of epilepsy surgery on quality of life: Systematic review and meta‐analysis

WeChat-based remote follow-up management reduces the burden of home care and anxiety on parents of children with refractory epilepsy: A randomized controlled study

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