Abstracts

Rationale: Surgery can provide an effective way to decrease or eliminate seizures in patients whose epilepsy is unresponsive to antiepileptic drugs. When compared to the continued use of AEDs, surgery offers the best option for a positive outcome in the long term. Health-related quality of life is an important measure of positive outcome after epilepsy surgery in children. This study proposed to examine the results of a variety of surgical procedures in a prospective cohort of children as gauged by a variety of measures of quality of life. Methods: Quality of life data was prospectively collected pre- and post-operatively at the Alberta Children's Hospital for many of the children who underwent epilepsy surgery from January 2006 to present. Quality of life was assessed using the Impact of Childhood Illness (ICI) scale, the Hague Restrictions in Childhood Epilepsy Scale (HARCES), and two forms of the Impact of Childhood Neurologic Disability (ICND) scale: one specific for epilepsy and one for general quality of life. Individual changes were examined and compared to determine if the type of surgery impacted the quality of life outcome. A significant individual change was defined as a change of more than one standard deviation from the mean change observed. For all four scales, pre- and post-operative mean scores were compared using a Paired T-Test. An adjusted P-value of 0.0125 was considered significant. Results: 128 paediatric epilepsy surgeries were performed at the Alberta Children's Hospital during the specified time period. 70 of these patients underwent pre-operative quality of life assessments, 46 of whom were followed up with post-operative testing. These preliminary results are based on those 46 patients (average age of surgery was 10.56 years, male to female ratio was 1:1.3) while we work to collect data on the remainder. The surgeries performed on those 46 patients included anterior temporal lobectomy (n=13, 28%), cortical resection (n=13, 28%), lesionectomy (n=11, 24%), hemispherectomy (n=4, 9%), vagus nerve stimulator implantation (n=2, 4%), posterior quadrant disconnection (n=2, 4%), and corpus callosotomy (n=1, 2%). Pre-operative testing was performed an average of 6.2 (SD=6.8) months prior to surgery, while post-operative testing was performed an average of 15.0 (SD=5.3) months after surgery. Patients who underwent temporal lobectomies or lesionectomies exhibited a significant individual change across all four quality of life scales. The scores for ICI (t=2.7028, p=0.0105) and HARCES (t=3.4904, p=0.0013) were found to increase significantly when comparing post-operative to pre-operative scores. The differences in the pre- and post-operative scores for the two ICND tests, both epilepsy-specific (t=0.2350, p=0.8156) and just for quality of life (t=-1.7838, p=0.0831), were not found to be significant. Conclusions: The preliminary data suggests that surgery for intractable epilepsy significantly improves quality of life when measured using certain tests. In addition, significant individual changes in quality of life ratings from every measure are only seen following temporal lobectomies and lesionectomies.