Abstracts

RATIONALE: Previous studies (e.g., McLachlan et al., 1997) have reported good seizure control and quality of life as long as two years following temporal lobectomy. No prospective outcome data have been reported on longer-term outcomes. It is important to evaluate whether improvements in seizure frequency and quality of life, seen at two years, are maintained several years later. Hence, the present study is a prospective 8.5-year follow-up of a cohort (N = 39) treated for epilepsy by medical or surgical (temporal lobectomy) management. It is unique for its length of follow-up, and for measurement of both seizure frequency and quality of life (QOL). The non-operated control group afforded a comparison of outcomes for the two groups.
METHODS: Two groups - Surgery (n=30) and Medical Management (n=9)- were followed consecutively for 8.5 years. Dependent measures were obtained prior to surgery (baseline), 2 years later, and again at 8.5 years. Patients were at least 18 yr. old when entering the study. Medical management control patients had inpatient evaluation as surgical candidates, but for various reasons (e.g., discovering a non-resectable focus, or generalized epilepsy) did not undergo surgery. Measures included seizure frequency and QOL (QOLIE-89).
RESULTS: At the 8.5 year follow-up, 73% of operated patients were seizure-free, compared to 22% of medically-managed patients (p[lt].001). Greater than 90% seizure improvement was seen in a further 10% of operated patients and in 33% of medical patients. Less than 90% seizure improvement was obtained in 17% of operated and 44% of non-operated patients. Relative to pre-operative baseline, operated patients showed improvement in 12 of 14 QOLIE-89 domains (p[lt].05), including Overall Quality of Life. These improvements in QOL appeared chiefly in seizure-free patients. In contrast, surgical patients who were Not-seizure-free showed improvement in only 2 of 14 QOLIE-90 domains. Finally, anti-epileptic drug (AED) use was evaluated at 8.5 years. Among operated patients, 30% were taking no AEDs, 23% were on 1 AED, and 47% were taking more than 1 AED. All medically treated patients were taking at least 1 AED.
CONCLUSIONS: This study is unique for its length of follow-up, its prospective design, and measurement of both seizure outcome and QOL. Temporal lobectomy appears superior to medical management for very long-term seizure reduction (with 73% of patients remaining seizure-free more than 8 years after surgery), as well as for sustained improvement in quality of life. Improved quality of life seen among surgical patients at 2 years was maintained at 8.5 years.