Artikel
Seizure-outcome classifications and postoperative quality of life assessment – tools to define overall success after epilepsy surgery?
Klassifikation von Anfallsoutcome und postoperative Lebensqualität – was ermöglicht die Abschätzung des Gesamterfolges nach Epilepsiechirurgie?
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Autoren
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M. von Lehe
- Klinik für Neurochirurgie, Universitätsklinikum Bonn
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M. Lutz
- Klinik für Epileptologie, Universitätsklinikum Bonn
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T. Kral
- Klinik für Neurochirurgie, Universitätsklinikum Bonn
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H. Clusmann
- Klinik für Neurochirurgie, Universitätsklinikum Bonn
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Results after Epilepsy surgery are mostly reported with respect to seizure control only. The impact of seizure relief on different aspects of daily performance and quality of life (QOL) is unclear. We investigate two different classifications of postoperative seizure control (Engel and ILAE) and their correlation with different aspects of quality of life, in order to provide a comprehensive estimation of success or failure after surgery.
Methods: To correlate self-assessed QOL and seizure control, data from 128 of 140 consecutive patients (91.4%) operated for mesial temporal lobe epilepsy were analysed. The individual changes of different domains of QOL were assessed with a questionnaire (similar and adjusted to the ESI-55), seizure outcome was classified with the Engel scale (4 categories) and the ILAE-scale (6 categories) at a minimum of 18 months after surgery.
Results: High or stable QOL values were found in most patients with seizure control as classified in Engel I and II (109 patients, 85,2%) or classified in ILAE-1-3 (110 patients, 85,9%). A significant QOL cut-off was found between Engel Classes II and III, whereas ILAE class 4 represents a turning point between better and worse QOL findings. This dependency showed differences with respect to specific QOL-domains and seizure classification: Cognitive functioning correlated strongly with seizure control (p<0.001). Mood was significantly better with seizure relief (p<0.001). Physical capabilities and social situation were only somewhat less dependent on seizure relief (p=0.03 and p=0.04, respectively). Self-assessed intra-individual changes in cognitive functioning correlated with seizure control (p=0.01) and so did changes in physical capabilities and mood (p=0,006 and p<0.001, respectively), correlation was less tight for the social situation (p=0.06).
Conclusions: Correlation of QOL and seizure control suggested a comprehension of ILAE classes 1-3 and Engel Classes I-II for overall satisfactory outcomes. QOL data can be an important adjunct in the assessment of presumed overall success after epilepsy surgery.
