Abstracts

Rationale: Although available literature suggests that mood and quality of life improve after epilepsy surgery, little is known about the longterm evolution of postoperative benefits.  Furthermore, studies investigating whether lobe of surgery impacts psychosocial outcomes had inconsistent findings due to small sample sizes, particularly among extratemporal epilepsy surgery subgroups. In this project, we describe self-reported longitudinal depressive and anxiety symptoms, and quality of life measures in a large, well-characterized cohort of temporal, frontal, and parietal lobe epilepsy surgery patients to characterize the extent, sustainability, and longitudinal trajectory of psychosocial post-surgical outcomes. Methods: This retrospective study included 229 adults (140 temporal, 68 frontal, 21 parietal) who underwent resective epilepsy surgery in Cleveland Clinic Epilepsy Center from 2008 to 2013. Patients completed questionnaires Patient Health Questionnaire (PHQ-9) for depression, Generalized Anxiety Disorder (GAD-7), and the Quality of Life in Epilepsy (QOLIE-10).  Self-reported measures were collected before surgery, follow-up visit at least six months after surgery, and at most recent follow-up. Scores from pre-surgical and at most recent follow-up visit (mean 3.2 years) were analyzed using the linear mixed-effects models. Patient characteristics were included as covariates to examine subgroup differences. Results: Patients were 51.5% women, 50% single, 50.7% had left-sided surgery, and 85% had abnormal brain MRI (Table). Scores on QOLIE-10, PHQ-9 and GAD-7 decreased with time, reflecting an improvement in all measures. After adjusting for gender, age, marital status, and lobe of surgery using linear modeling, the mean PHQ-9 score decreased by 0.331 points/year, mean GAD-7 score by 0.299 points/year, and mean QOLIE-10 score by 1.157 points/year. Investigation of predictors of quality of life change showed that seizure freedom was a strong predictor (p=0.001), and depressive symptoms showed a trend (p=0.07).The non-linear exploratory analysis trajectories of QOLIE-10, PHQ-9, and GAD-7 (figure) show improvement in QOLIE-10 continued to be observed throughout the follow-up duration, whereas both depression and anxiety improved the most within the first postoperative year and then stabilized.Subgroup analysis found that frontal lobe surgery compared to temporal lobe was strongly correlated with greater improvements in QOLIE, PHQ, and GAD measures, which is illustrated in the trajectory curves. Conclusions: Encouraging and sustained improvements of quality of life, depression, and anxiety measures are observed following epilepsy surgery, particularly for frontal lobe surgery patients. The different trajectories and factors driving psychosocial outcomes in temporal versus extratemporal surgeries warrant further investigation into the mechanistic and therapeutic aspects of our approach to epilepsy psychosocial co-morbidities in the context of epilepsy surgery. Funding: na