Abstracts

Rationale: Epilepsy is a condition with a profound impact on quality of life (QOL), with often severe levels of impairment across physical, cognitive, emotional, and social domains.  Seizure freedom is the single most important factor in determining QOL in people with epilepsy (PWE), as prior studies show PWE who were seizure free had a QOL comparable to the general population, whereas the presence of any seizures led to impaired QOL at a level comparable to other diseases.  Evaluation for epilepsy surgery is therefore essential for potentially improving QOL, most dramatically through achieving seizure freedom.  When seizure freedom cannot be achieved, other factors, particularly depression and adverse medication effects, can have a larger impact than seizure frequency, and so comprehensive assessments of QOL are needed.  Focal cortical dysplasia presents a spectrum of malformations of cortical development, which are often part of a widespread neurodevelopmental disease process, associated with cognitive and mood impairments, as well as being a frequent cause of medically refractory epilepsy.  There is a paucity of research on the results of epilepsy surgery in this specific population.  This study is designed to assess epilepsy and psychosocial outcomes, and to evaluate factors associated with positive outcomes. Methods: Medical records of PWE who underwent epilepsy surgery at Yale New Haven Hospital between 1986 and 2017 were reviewed to obtain clinical data on the following variables: age of epilepsy onset, duration of epilepsy prior to surgery, short- and long-term postsurgical outcomes defined by ILAE Classification, and pre- and postoperative trends of antiepileptic drug use. Data were collected at 1, 2, 3, 4, 5, and 10 years postoperatively and at the most recent available follow-up.  Subjects were contacted and completed an online survey designed to comprehensively assess characteristics of their current seizures and their QOL, with subsections of the survey including the QOLIE-31, BDI, and BAI. Results: Initial results include seizure outcome on 45 subjects and psychosocial outcomes on 11 of those 45.  After 1 year, 74% of patients were seizure-free or experiencing only non-disabling auras (ILAE 1, 1a, 2). This rate dropped to 62% after two years, then stabilized (for up to 28 years postoperatively). At latest follow-up, 89% of patients saw at least a 50% improvement in seizure frequency.  In addition, overall QOL, including emotional well-being, energy and social functioning domains was excellent after surgery with QOLIE-31 scores similar to those reported for other epilepsy surgery populations. Conclusions: Early results indicate that our population of patients with cortical dysplasia had similar outcomes to other epilepsy surgery populations, with significant rates of seizure freedom being associated with improved QOL and employment.  As we collect more data, we hope to be able to assess the impact of dysplasia subtype and predictors of better psychosocial outcomes. Funding: None