Abstracts

Rationale: While quality of life (QOL) has been accepted as a primary outcome variable in pediatric epilepsy, there remains limited information about how different treatments affect or enhance QOL (Choi, et al., 2008). Zupanc, et al. (2010) recently published a comprehensive study on QOL outcomes from epilepsy surgery (N = 52); however, their study was limited by the lack of presurgical QOL information for comparison. Therefore, they were unable to comment on changes since the surgery and were limited to describing post-surgical QOL. The present investigation was designed to examine actual changes in QOL in children who undergo epilepsy surgery by comparing parent ratings of QOL before surgery and after surgery. Methods: Twenty eight children who underwent epilepsy surgery at St. Louis Children's Hospital between 2006 and 2009 were selected for this investigation because of the availability of both pre- and post-surgical neuropsychological data. The study was approved by the institutional review board, and the data were compiled through archival investigation. Pre- and post-surgical QOL data consisted of parent ratings on the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire (Sabaz et al, 2003). Cognitive changes following surgery were considered by comparing scores on the Wechsler Abbreviated Scale of Intelligence. Pre- and post-surgical changes were analyzed with paired t-tests or Wilcoxon's signed rank test. Results: The mean age of the sample at the time of surgery was 12.7 years (SD=2.6), and they were Caucasian and mostly male (54%). Mean post-surgical follow-up time was one year. While the children in the sample demonstrated stable full scale intelligence following surgery (p=0.74), parent reports on the QOLCE revealed significant improvements in Total QOL (p=0.002), as measured by calculating a mean of the subscale scores. When asked more subjectively, parents confirmed significant improvements in QOL (p=0.01), and they rated their children as having significant improvements in general health (p<0.0001). On individual subscales, parents rated significant improvements in most aspects of QOL, including behavior (p=0.004), physical activities (p=0.01), and social activities (p=0.004). However, changes in QOL related to cognition (p=0.06) and general well-being (p=0.11) were below statistical significance. Conclusions: These results reveal evidence of significant improvements in the QOL of children following epilepsy surgery. This improvement is apparent despite the fact that the children, as a whole, displayed no changes in intellectual functioning and limited improvements in cognitive functions related to QOL (e.g., making decisions). Nevertheless, improvements in QOL are evident in most other areas, including behavioral, physical, and social functioning. Interestingly, QOL related to well-being, which assesses emotional functioning and self-esteem, did not change significantly after surgery. This may indicate an important clinical feature of this population that may need to be monitored by caregivers, even in the presence of stable to improved functioning in other areas.