Abstracts

Rationale: To evaluate long-term QOL in a homogenous group of patients with TLE due to mesial temporal sclerosis (MTS) and the impact of ATL on psychosocial function. Methods: Eligible patients were those with diagnosis of refractory TLE due to MTS from the Epilepsy Center surgery series at Hospital S o Paulo, Universidade Federal de S o Paulo, S o Paulo, Brazil. Ninety-one patients submitted to ATL were followed for a mean period of four years (range 2 to 6). All subjects were evaluated before and year-to-year after surgery. The pre-surgical evaluation comprised a semi-structured interview in order to obtain clinical and demographic characteristics, the QOL Brazilian validated Epilepsy Surgery Inventory (ESI-55) (Alonso et al., 2006), and the Global Assessment of Functioning Scale (GAF). Engel s classification was used for seizure outcome. Results: At six months after surgery 47/91 (51.6%) patients were Engel IA, 27/91 (29.7%) Engel IB, and 17/91 (18.7%) remained with seizures; at one year 42/90 (46.7%) were Engel IA, 33/90 (36.7%), IB and 15/90 (16.6%) had seizures; at two years 44/91(48.4%) were Engel IA, 28/91 (30.8%) were Engel IB, and 19/91 (20.9%) continued with seizures; at five years 18/39 (46.2%) were Engel IA, 10/39 (25.6%) IB, and 11/39 (28.2%) still had seizures. The side of resection was not associated with QOL perception. In general, there was a significant improvement (p<0.05) in QOL after surgery measured by most of ESI-55 sub-scales. A high correlation between GAF scores and ESI-55 domains was observed. As GAF points were increasing, QOL scores also increased. At six months assessment, analysis of the subgroup of seizure-free patients showed better QOL (p<0.05) compared with the other groups (auras and those who continue having seizures), except for Social Function (p=0.133) and Emotional Well-being (p=0.080) domains. After the first year, all ESI-55 scores were better in the seizure-free group (p<0.05), indicating a significant increasing in QOL compared with those patients Engel IB and others. The comparison between the seizure-free group and patients with auras showed that seizure-free patients had better QOL (p<0.05) than those who remained with auras in a short-time (first three years of follow-up), while at the four and five year evaluation, QOL was similar in both groups. Conclusions: Our results support the long-term positive effects of ATL to improve QOL and psychosocial functioning.