Artikel
Changes in health-related quality of life (HRQOL) after epilepsy surgery – analysis of preoperative, 1 year and 5 years postoperative result
Lebensqualität nach chirurgischer Behandlung therapierefraktärer Epilepsie – Analyse von präoperativen, 1 Jahr und 5 Jahren postoperativen Daten
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Autoren
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Daniel Delev
- Klinik für Neurochirurgie, RWTH Universität, Aachen, Deutschland; Medizinische Fakultät, Universität Bonn, Bonn, Deutschland
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Alexander Grote
- Klinik für Neurochirurgie, Evangelisches Krankenhaus Bethel, Bielefeld, Deutschland
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Max Rayermann
- Medizinische Fakultät, Universität Bonn, Bonn, Deutschland
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Hans Clusmann
- Klinik für Neurochirurgie, RWTH Universität, Aachen, Aachen, Deutschland; Medizinische Fakultät, Universität Bonn, Bonn, Deutschland
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Marec von Lehe
- Klinik für Neurochirurgie, Medizinische Hochschule Brandenburg, Neuruppin, Deutschland; Medizinische Fakultät, Universität Bonn, Bonn, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Resective surgery for drug-resistant temporal lobe epilepsy (TLE) is safe and effective treatment option. Although seizure freedom represents the main goal of the surgery, postoperative health-related quality of life (HRQOL) has developed to an important endpoint for assessing subjective outcomes and effects of the intervention.
Methods: A total of 84 patients with TLE answered a standardized questionnaire before undergoing surgery. After 1 year the same questionnaire was answered by 82 patients and after 5 years by 65 patients, who were included in the study. The questionnaire addressed the present self-assessed quality of life (given as percentage of the maximum achievable value) in four subdomains (physical function, cognitive function, mood, social interaction). Additionally, patients were asked to rate the postoperative changes compared to the presurgical status as better (+1), equal (0), or worse (-1).
Results: Complete preoperative, 1-year and 5-years postoperative HRQOL data were available in 65 patients. A total of 43 patients (66%) were completely seizure free (ILAE 1) after a mean follow up of 78 months. Mean absolute scores of overall HRQOL and of the three following domains improved significant 1-year postoperatively (p<0.01): overall HRQOL (from 69% to 75%), physical function (from 77% to 86%), cognitive function (from 63% to 69%) and mood (form 71% to 75%). The 5-years postoperative evaluation revealed further improvement of the overall HRQOL and all four domains, showing highest scores in the physical function (89%) and mood (81%). The self-assessed postoperative changes 1-year after surgery (trend-values) showed positive values in all domains. Of note, the 5-years evaluation showed continuous improvement of all trend-values except for the physical function. Subgroup analysis revealed complete seizure freedom (ILAE 1) as the strongest predictor for HRQOL improvement in both absolute scores and trend-value scores. Patients, who failed to become seizure-free showed improvements only in physical function and even revealed deterioration in the cognitive function domain.
Conclusion: HRQOL after surgical treatment of drug-resistant TLE improves in time. In particularly, the physical function domain and mood showed the highest positive development. However, HRQOL improvements were predominantly observed in seizure-free patients, while patients with on-going epilepsy revealed similar pre- and postoperative HRQOL scores.
