Abstracts

Rationale: Quality of life (QOL) after epilepsy surgery has been studied extensively but few systematic reviews are available on this topic. This review summarizes QOL outcomes and predictors of QOL after epilepsy surgery. Methods: A literature search was conducted as part of a larger project on the development of an appropriateness and necessity rating tool to identify patients with potentially resectable focal epilepsy. This search, using PubMed, EmBase and the Cochrane database, yielded 5061 articles related to epilepsy surgery. 763 of those met the following inclusion criteria: temporal & extratemporal partial epilepsy, focal resections (not including hypopthalamic hamartoma, subpial transaction, hemispherectomies, callosotomies and palliative procedure), English articles, n ≥ 20, and all ages except neonates. Of the 60 articles related to QOL, 27 articles were selected for final review based on additional inclusion criteria: used a general or specific QOL instrument and reported pre and post surgical data with numerical QOL results and with post-surgical follow up of ≥ 1 year. Results: The majority of controlled studies (10/13) demonstrated that post-surgical epilepsy patients had better QOL outcomes than non-surgical controls except when compared to “ineligible for surgery” controls, perhaps demonstrating an adaptation to life without the prospect of surgery. Normalization of QOL was seen in adults but not in children when comparing post-surgical QOL results with matched healthy controls in 2 studies. All 14 non-controlled studies demonstrated improvements in post-surgical QOL. Post-surgical seizure frequency was the strongest predictor of QOL, predicting 27% of the variance in QOL in one study. Notably, complete seizure freedom does not seem to be necessary for improvement in QOL. Post-surgical QOL improvements were seen between 3 months and 2 years in seizure free patients with most improvements reported at 2 years post surgery. Continued seizures, memory decline and psychiatric problems post-surgery predicted worsening of QOL outcomes whereas AED changes and baseline QOL scores are inconsistent predictors of post-surgical QOL. Conclusions: This systematic review demonstrates that epilepsy surgery patients show improvements in QOL post surgery, particularly when compared to epilepsy control patients either being medically treated or awaiting surgery. Future research is required to further elucidate the threshold of reduced seizure frequency required to improve QOL post-surgery. Additional research is also required to explore other predictors of post-surgery QOL outcomes.