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Quality of life after surgery for intractable partial epilepsy in children: a cohort study with controls
Mohamad A Mikati1, Nour Ataya, Jessica Ferzli
1Department of Pediatrics and Adolescent Medicine, Adult and Pediatric Epilepsy Program, American University of Beirut Medical Center, Beirut, Lebanon. mohamad.mikati@duke.edu
Insights
Pediatric epilepsy surgery improves quality of life (QOL) compared to non-surgical treatment. Seizure freedom after surgery can lead to normalized QOL in children with intractable partial epilepsy.
Area of Science:
- Pediatric Neurology
- Epileptology
- Quality of Life Research
Background:
- Intractable partial epilepsy in children significantly impacts quality of life (QOL).
- Long-term outcomes of epilepsy surgery on QOL in pediatric populations require further investigation.
Purpose of the Study:
- To assess if quality of life (QOL) normalizes in children long-term after undergoing surgery for partial epilepsy.
- To compare QOL outcomes between children who had epilepsy surgery, those with intractable epilepsy without surgery, and healthy controls.
Main Methods:
- A cohort study involving 19 children (ages 2-14) who underwent focal resections for intractable partial seizures.
- Matched controls included 19 non-surgery pediatric epilepsy patients and 19 healthy children.
- Quality of Life in Childhood Epilepsy Questionnaire (QOLCE) was used to assess QOL.
Main Results:
- Epilepsy surgery patients showed significantly better seizure control (Engel class-I) compared to non-surgery patients.
- Surgery patients reported QOL similar to healthy controls in social, emotional, cognitive, and behavioral domains, but lower in physical and health domains.
- Seizure-free children post-surgery demonstrated QOL comparable to healthy subjects across all domains.
Conclusions:
- Epilepsy surgery for pediatric partial seizures offers improved QOL compared to intractable epilepsy without surgery.
- Achieving seizure freedom through surgery holds the potential for normalizing QOL in children.
- Further research should explore factors influencing physical and health domains of QOL post-surgery.
Purpose:
Investigate if quality of life (QOL) normalizes on long-term follow-up after surgery for partial epilepsy in children.
Methods:
This is a cohort study with controls in which a consecutive cohort of nineteen 2-14-year-old children who underwent focal resections for intractable partial seizures between 1996 and 2006, were matched with 19 non-surgery intractable partial epilepsy patients, and with 19 healthy subjects. The two epilepsy groups were matched for age, sex, socio-economic status (SES), cognitive level, seizure type, and seizure frequency. The healthy group was matched with the two epilepsy groups for age, sex, SES, and cognitive level. QOL was assessed using the QOLCE (Quality of Life in Childhood Epilepsy Questionnaire).
Results:
In the surgery group (follow-up 3.84+/-2.26 years), 78.9% had Engel class-I versus 21.1% in non-surgery (p=0.01) (follow-up 3.44+/-2.95 years). Surgery patients were similar to healthy subjects in the social, emotional, cognitive, behavioral, and overall QOL (p>0.05) but had lower scores in the total QOL, physical, and health domains (p<0.05). Surgery patients scored better than non-surgery in the behavioral domain and the HASES (Hague Side Effects Scale) score (p<0.05). Non-surgery patients scored worse than healthy in total QOL, physical, behavioral, health, and overall QOL (p<0.05). IQ, HASS (Hague Seizure Severity Scale), and HASES scores were positively associated with total QOL score (p<0.05). Subgroup analysis on seizure-free surgery patients showed that they did not differ from healthy subjects in any of QOL domains (p>0.05, power>0.8).
Conclusion:
Our data indicate that epilepsy surgery for partial seizures in children is associated with better QOL as compared to children with intractable epilepsy who are not operated on, and suggest that in those who achieve seizure freedom normal QOL may at least potentially be possible.
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