Abstracts

Health-related quality of life (HRQOL) improves following resective surgery but most data are limited to short-term follow-up. We examined HRQOL and its relation to seizure outcome for up to five years after surgery. In a prospective, multicenter study, 396 patients underwent resective epilepsy surgery. They completed the QOLIE-89 before, and at 3 months, and yearly after surgery. Longitudinal regression methods were used for analysis. Overall QOLIE and its domains (epilepsy-targeted, cognitive distress, physical health, mental health) were studied. In the 304 participants with baseline QOLIE and over 2 years of follow-up, overall QOLIE and domain scores rose substantially by 3-months post surgery. Further increases were largely limited to the epilepsy-targeted domain. Patients who immediately entered remission and never relapsed (Best, N=112) achieved the greatest gains.The epilepsy-targeted domain continued to show small improvements over five years, from 45.3 presurgical to 55.2, 59.5, 61.1, 61.3, 61.7 and 62 at 3 months, 1, 2, 3, 4, and 5 years post-surgery (p[lt]0.0001 for trend). Participants who never became seizure-free (Worst, N=59) had a smaller increase in QOLIE scores at 3 months, and dropped to presurgical levels over time (presurgical score=42.8, and 50.2, 49.3, 48.5, 47.9, 49.3, 44.8 at 3 month, 1, 2, 3, 4, and 5 years post-surgery). Those who remitted after a few seizures were indistinguishable from the Best group. Those who remitted and later relapsed or took longer to remit had intermediate scores: when in remission, they were closer to the Best group, and scores dropped following relapse. HRQOL, particularly the epilepsy-targeted domain, is sensitive to seizure remission. Most of the change is apparent soon after attaining remission. Statistically significant improvement in the epilepsy-targeted domain continues to accrue with prolonged time seizure-free. Relapse after remission results in a drop in QOLIE scores. (Supported by NIH-NINDS NS32375)