Abstracts

Rationale: Epilepsy surgery is an established treatment for patients with intractable epilepsy that has shown to improve seizure control and theorized to improve psycho-social factors. Previous studies have shown improved quality of life (QoL) in both adults and children who have undergone epilepsy surgery. However, there are limited studies evaluating the effects of epilepsy surgery in regards to specific psycho-social factors. This study aimed to evaluate 5 year outcome of temporal lobectomies on QoL, symptoms of depression and anxiety, as well as social factors such as education, employment, driving and extracurricular activities in adolescents. Methods: The NIH-sponsored Multicenter Study of Epilepsy Surgery Database was reviewed for adolescent patients who underwent temporal lobectomy and had 5 year follow-up. Clinical information regarding duration of epilepsy, current and prior AED use, seizure type and frequency, and surgical outcome at 5 years was obtained. Other factors evaluated were QoL, Beck Indices of depression and anxiety (BDI and BAI), cognitive outcome, as well as social factors like education, employment, driving and extracurricular activities (divided into the following subgroups: group, leisure, and physical activity). All statistical analyses were done using Fischer's exact test. Results: A total of 23 patients were identified with ages ranging from 14-18 years (median 17), with duration of epilepsy ranging from 0-18 years (median 11). 19 patients (82.6%) were seizure free at 5 years, 2 having had an isolated seizure recurrence at 3 and 36 months, respectively. Majority of patients had seizures consisting of complex partial seizures (CPS) and generalized tonic clonic seizures (GTCs) with mean frequency of CPS at 12.4/month and mean frequency of GTCs at 1x/3months. There was a significant improvement in the overall QoL score (p < 0.05), but no significant improvement was seen in BDI or BAI scores for all patients. In regards to social factors, there was little to no change seen in employment, education and participation in any subgroup of activities. For education, 63% of patients (12/19) and 57% of seizure-free patients (9/16) who did not previously complete high school prior to surgery, did not go on to graduate high school or college within the 5 years post-surgery. Minimal gains in the number of hours worked was seen with only 18% of patients (4/22) increasing their hours. Only 6 patients were employed for any period of time prior to surgery. The most significant change was seen in driving, with 84% of seizure-free patients (16/19) obtaining a driver's license. Conclusions: Our study, like others, found significant improvement in the QoL post-surgery. Although a majority of seizure-free patients obtained a driver's license, other social factors such as employment, activity and education were not significantly changed in either the seizure-free or non-seizure free groups. These results may be useful to counsel patients and their parents who are considering epilepsy surgery regarding life during the post-operative period. We hypothesize that earlier intervention, with services in life/job skills, may lead to better long term psycho-social outcomes. Funding: FACES - Finding a Cure for Epilepsy and Seizures