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Updated: Apr 13, 2026
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Predictors of long-term quality of life after pediatric epilepsy surgery
Klajdi Puka1, Mary Lou Smith1,2,3
1Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Seizure freedom significantly improves health-related quality of life (HRQOL) in pediatric epilepsy patients. Managing anxiety and depression symptoms is key to enhancing HRQOL, even more than seizure control itself.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Quality of Life Research
Background:
- Pediatric epilepsy surgery aims to improve outcomes, but long-term effects on health-related quality of life (HRQOL) require further investigation.
- Understanding factors influencing HRQOL post-surgery, including seizure status, medication, and psychological symptoms, is crucial for comprehensive patient care.
Purpose of the Study:
- To investigate the long-term impact of seizures, antiepileptic drugs (AEDs), intelligence quotient (IQ), and depression/anxiety symptoms on HRQOL in pediatric epilepsy patients.
- To determine the relationship between seizure freedom and HRQOL, and the mediating role of psychological factors.
Main Methods:
- A cohort of 109 pediatric patients with intractable epilepsy was studied, with 71 having undergone surgery.
- HRQOL and internalizing behaviors (depression/anxiety symptoms) were assessed using questionnaires an average of 6.9 years post-surgery.
- Comparison between surgical and nonsurgical groups, and between seizure-free and ongoing seizure groups was performed.
Main Results:
- Seizure freedom was the primary determinant of enhanced HRQOL, surpassing the influence of surgical status.
- Symptoms of depression and anxiety significantly mediated the relationship between seizure freedom and improved HRQOL.
- Antiepileptic drug (AED) use was associated with social functioning, medication side effects, and seizure worry; IQ and follow-up duration did not independently affect HRQOL.
Conclusions:
- Managing depression and anxiety symptoms is paramount for improving HRQOL in pediatric epilepsy patients, playing a more significant role than seizure control alone.
- These findings emphasize the need for integrated psychological support in the long-term management of childhood-onset intractable epilepsy.
- Improving mental health outcomes can substantially reduce the overall burden of epilepsy on patients' quality of life.
Objective:
This study examined the influence of seizures, antiepileptic drugs (AEDs), intelligence quotient (IQ), and symptoms of depression and anxiety on health-related quality of life (HRQOL) 4-11 years after pediatric epilepsy surgery.
Methods:
Participants were 109 patients with childhood-onset intractable epilepsy; 71 had undergone surgery on average 6.9 years before this study. Patients and their parents completed questionnaires assessing HRQOL and internalizing behavior, a measure of depression and anxiety symptoms.
Results:
Similar rates of recent seizure freedom were found for surgical and nonsurgical patients, although surgical patients had achieved seizure freedom sooner and with fewer AEDs. Few differences were found between surgical and nonsurgical patients. Differences emerged when comparing patients with continued seizures and those who had been seizure-free in the 12 months preceding the study. Almost all HRQOL ratings were enhanced in seizure-free patients. Internalizing behavior (anxiety/depression) mediated the relationship between seizure freedom and better HRQOL, where seizure freedom led to better ratings of anxiety/depression, which in turn led to better ratings of HRQOL. AED use was found to be associated with social functioning, medication effects, and seizure worry. IQ and duration of follow-up were not found to independently influence HRQOL.
Significance:
The findings highlight the integral role of depression and anxiety symptoms in determining HRQOL; seizure control seems to play a secondary role. This study expands this relationship to individuals who have a history of intractable childhood epilepsy. The findings highlight the importance of managing depression and anxiety in improving the HRQOL and reducing seizure burden on patients.
