Abstracts

Rationale: Seizure freedom without deficits is the prime goal for epilepsy surgery. However, patients with medically refractory epilepsy commonly suffer from a number of non-seizure co-morbidities like psychiatric, cognitive and sleep disturbances as well as various social problems, and resultant stigma. While recent studies on epilepsy surgery outcomes do mention about associated quality of life (QOL) and neuropsychological outcomes, results of comprehensive assessment of various common non-seizure outcomes of patients undergoing epilepsy surgery, have not been reported. The objective of this study was to evaluate the role of various non-seizure parameters in post-epilepsy-surgery QOL.Methods: Consecutive consenting adult patients operated for epilepsy surgery at least a year prior to initiation of this study, were included. Seizure outcomes were noted and classified as seizure free (group 1) and non-seizure-free (group 2). Quality of life (QOL) was assessed using the QOLIE-31 instrument and the overall score was calculated as per the manual and was converted to obtain a T score. Patients with scores less than 40th percentile (46 points) were categorized as having poor QOL. The non-seizure parameters assessed were cognition (language, memory and executive function) with tests based on our previous publications; psychiatric disturbances using Hamilton rating scales for depression and anxiety and noting if psychosis symptoms were reported or not; social improvement (in education, employment and marital prospects or harmony), presence or not of stigma; and sleep disturbances (sleeping too short or too long, excessive daytime sleepiness, non-refreshing sleep, sleep disordered breathing or restless legs syndrome). Simple categorization into good and poor outcome sub-groups on each item was carried out by dichotomization of scores on each.Results: Thirty-seven patients (16 F) with mean age 0f 23.5+5.6 years were evaluated; 26 were seizure free (group 1). In this group, a significantly higher number of patients with poor memory scores, those with no social improvement (34 v/s 0% each) and those with anxiety (34 v/s 12%), depression (78 v/s 47%), formed the sub-group with poor QOL compared to that with good QOL scores. In group 2, all patients had poor QOL scores and 91% patients had impaired language and executive functions each, 82% were stigmatized and 64% were depressed. Sleep disturbances were observed in 29-45% among the different sub-groups, but were equally prevalent among patients in both groups.Conclusions: Non-seizure factors, mainly impaired memory, psychiatric disturbances and lack of social improvement may be prevalent among patients with poorer QOL among post-epilepsy-surgery seizure free patients. A comprehensive evaluation for each of these should be uniform practice for identifying targets for post epilepsy surgery intervention to improve QOL.