Abstracts

Rationale: The dynamic correlation between epilepsy, psychiatric illness, and quality of life are well established. Limited data exist, however, on the longitudinal and comprehensive interactions among these health determinants in surgical epilepsy patients. This study investigates depressive and anxiety symptoms, and quality of life measures after temporal lobe epilepsy (TLE) surgery analyzing characteristics of psychosocial well-being beyond the initial post-operative 6 months in the context of epilepsy etiology. Methods: This retrospective study included 263 adults who underwent resective TLE surgery in our center from 2008 to 2013, and completed baseline pre-surgery and post-operative questionnaires of health status measures (PHQ-9 for depression, GAD-7 anxiety, QOLIE-10 quality of life, driving status). Clinical, demographic, self-report questionnaires, imaging, and pathology were reviewed. Etiology of epilepsy was determined based on history, MRI, and pathology. A follow-up of at least 6 months was required. Pre and post-measures were compared using the Chi-square and t-tests as appropriate. Results: The mean age at time of surgery was 40 years (range 18 to 77) with 57% females. Most were white [88% (232 patients)], 7% (21) African American, and 4% (10) had other ethnicity. Forty-four percent (192) were married, 47% (204) single, 5% (22) divorced, and 3% had other social status. Fifty-two percent (137) of patients had left sided surgery. Pre-surgery characteristics of patients showed baseline Liverpool seizure severity mean score of 38, mostly normally distributed. Number of AEDs used prior to surgery ranged 1 to 5 with the largest group (46%) using two AEDs. Abnormal brain MRI was seen in 86% (226). Etiology of epilepsy was mesial temporal sclerosis (MTS) alone 32% (85), malformation of cortical development (MCD) alone 19% (49), MTS and MCD 14% (38), cavernous angioma 9% (23), other 4% (11), and cryptogenic 14% (37). PHQ-9 score pre-surgery mean was 7.8 (median 6), and post-surgery improved to mean 6.5 (median 4; p-value<0.05). GAD-7 pre-surgery score was mean 6 (median 4), and post-surgery improved to mean of 4 (median 3; p-value <0.05). QOLIE-10 pre-surgery mean and median was 27, and post mean was improved to 21 (median 19; p-value<0.0001). Reaching clinically meaningful improvement as defined by a 10% or larger reduction of baseline QOLIE-10 score in 65% of the patients. Comparisons are illustrated in figure 1. While 12% (32) were driving before surgery, 36% were driving at follow-up. Improvements in depression and anxiety after surgery correlated with clinically meaningful improvements in QOLIE-10 scores (p-value 0.0001 and 0.0002 respectively). When comparing the various etiologies for temporal lobe epilepsy there was no significant difference in mean change of PHQ-9, GAD-7, or QOLIE-10 between the groups. Conclusions: Overall, depressive symptoms, anxiety, and quality of life improve beyond 6 months post-operative following TLE surgery, independent of epilepsy etiology. Improvements in psychosocial outcomes are critical for an overall impact on quality of life.