Epilepsy Surgical Patients Report Subjective Improvement Regardless of Seizure Freedom Outcome One Year Post-op
Ella Kole1, Wajiha Yousuf2, Gabriela Bustamante2, Christina Boada2, Ramya Raghupathi2, Brian Emmert3
1Villanova University, 2Penn Neurology, Hospital of the University of Pennsylvania, 3Columbia University Irving Medical Center
Objective:
To investigate epilepsy surgical outcomes of Drug-Resistant Epilepsy (DRE) patients and their perceived quality of life (QoL).
Background:
The success of epilepsy surgery is classically measured by seizure freedom from disabling seizures. Not all patients who undergo surgery achieve this goal yet still may perceive benefit. To assess this gap, we evaluated whether QoL measures correlated with patient outcomes.
Design/Methods:
We completed a retrospective cohort analysis of all consecutive patients who underwent epilepsy surgery (laser ablation (LITT) and open resection) from 2022 to 2023. Surgical outcomes, post-operative Global Health Impression-Improvement Scale (GHIIS) score, and post-operative depression and anxiety scales were obtained by review of surgical conference, discharge, and one-year post-operative office visit notes. Chi-Square test of independence and Fisher’s exact test were performed.
Results:
55 patients underwent surgery, with 51% (n = 28) receiving LITT and 49% (n = 27) undergoing open resections. 71% (n = 39) were seizure free (Engel I) at one-year. 56% (n=31) reported stable memory and 61% (n=34) reported stable depression scores. 74% (n = 29) of Engel I, 75% (n =6) of Engel II, and 60% (n = 3) of Engel IV patients reported their QoL on the GHIIS was “improved” or “very much improved” one year post-operatively (p=0.75). 82% (n = 23) of the LITT ablative patients and 63% (n = 17) of the open resection patients reported improvement in QoL (p = 0.11).
Conclusions:
Patients demonstrate a noticeable perceived benefit in QoL after one year following resective and ablative epilepsy surgery despite not always achieving seizure freedom, even those with no worthwhile improvement (Engel IV) demonstrating improved QoL. The results underscore the importance of counseling patients on probability of seizure freedom and improvement in QoL. Future evaluation will assess the stability of this improvement, and develop combined seizure freedom and QoL predictive models for epilepsy surgical outcomes.
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