Randomized Controlled Trial of Temporal Lobe Epilepsy Surgery: Quality of Life Analyses.
Abstract number :
H.02
Submission category :
Year :
2001
Submission ID :
2014
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
S. Wiebe, MD, MSc, Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada; S. Matijevic, Epilepsy, LHSC, London, ON, Canada; M. Eliasziw, PhD, Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada; W.
RATIONALE: Epilepsy surgery has not been assessed in randomized controlled trials (RCT). We report quality of life (QOL)outcomes in the first RCT of surgical versus medical therapy of temporal lobe epilepsy. Also, we present a novel QOL analysis based on the proportion of patients whose QOL reliably improved, as well as the proportion in whom it worsened and that in whom it did not change. Finally we compare these outcomes in surgically and medically treated patients.
METHODS: In a parallel-group, randomized controlled trial, patients with temporal lobe epilepsy were assigned to surgery (n=40) or to optimum medical therapy (n=40). Blinded epileptologists adjudicated eligibility, best medical therapy and seizure outcomes. We compared seizure freedom and frequency in both groups. QOL was assessed with the QOLIE-89, QOLIE-31, HUI-III and Liverpool Impact of Epilepsy and Drug Toxicity scales. Using previously established indexes (thresholds) of reliable change for each QOL scale, we compared the proportion of patients whose QOL improved, did not change, or worsened after surgical or medical therapy. Analysis was by intent to treat.
RESULTS: 58% and 8% of surgical and medical patients, respectively, achieved freedom of seizures with impaired awareness (p[lt]0.001). In all QOL scales except impact of epilepsy, more surgical (36-51%) than medical (7-18%) patients achieved reliable improvement (all statistically significant), and fewer surgical (44-50%) than medical (75-80%) patients remained unchanged (all statistically significant). By contrast, about the same proportion of surgical (5-15%) and medical (7-17%) patients worsened in all QOL scales except in impact of epilepsy.
CONCLUSIONS: This randomized controlled trial demonstrates the superiority of surgical therapy and the relative futility of prolonged medical therapy in temporal lobe epilepsy. This encompasses not only the ability to render patients seizure free, but also to achieve significant quality of life improvement and to prevent deterioration. Similar proportions of patients became seizure free and achieved reliable quality of life improvement after surgical therapy.
Support: Physicians[ssquote] Services Incorporated Foundation Grant 96-04