Abstracts

Rationale: Surgery is an established treatment for pharmacoresistant temporal lobe epilepsy (TLE), but limited data are available from prospective controlled studies regarding predictors of health outcomes and quality of life. Methods: We prospectively enrolled adult patients with TLE who completed a standardized evaluation for epilepsy surgery prior to review in surgical conference. Criteria included: 1) age greater than 17 years; 2) at least one partial seizure per month; 3) two or more antiepileptic drugs (AEDs); 4) normal MRI or MRI evidence of only mesial temporal sclerosis; 5) interictal and initial ictal EEG abnormalities limited to the temporal regions; 6) cognitive abilities allowing accurate completion of study instruments. All subjects signed an IRB-approved informed consent document. Demographic and clinical epilepsy data collected at baseline, as well as reliable and valid instruments that included the Adverse Event Profile (AEP), the Profile Of Mood States (POMS), and Quality Of Life In Epilepsy (QOLIE)-98. This comprehensive assessment was repeated every 6 months. Statistical analysis included univariate and multivariate analyses as appropriate. Results: 73 subjects received anterior/mesial temporal resection, and 32 did not undergo surgery. Comparison of each variable between groups at each assessment is presented in the table. There was no difference between groups in baseline total seizure frequency, age at enrollment, gender, driving status, full-time employment, AEP, POMS Depression Subscale, and QOLIE-89 scores. Duration of epilepsy (p=0.03), age at seizure onset (p=0.03) and number of AEDs (p=0.03) were significantly different between groups. At 12 months, proportion of subjects who were seizure-free, employed, driving and change in AEP and QOLIE-89 scores were significantly different between the two groups. In the multivariate linear regression model, significant predictors of change in quality of life in the entire cohort were change in AEP (β = 0.43; p < 0.001), change in POMS Depression Subscale (β = 0.23; p = 0.01), off-AEDs (β = 0.22; p = 0.01) and seizure freedom (β = 0.21; p = 0.03). Conclusions: Although cessation of seizures is the sine qua non of epilepsy surgery outcome, reduction of adverse AED effects, improvement of symptoms of depression, and achievement of medication-free status independently predict significant improvement in health-related quality of life.