Quality of Life and Epilepsy Surgery

Abstract

EpilepsiaVolume 44, Issue s6 p. 61-61 Free Access Quality of Life and Epilepsy Surgery First published: 18 August 2003 https://doi.org/10.1046/j.1528-1157.44.s6.25.xCitations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat An important implicit aim of the surgical treatment of epilepsy has always been to improve the individual's well-being. Outcome measures, however, until recently have been focused mainly on seizure relief. It is clearly important that evaluation of surgical outcome should include an assessment of the effects of seizure relief or reduced seizure frequency on the individual's psychosocial functioning and well-being, often termed health-related quality of life (HRQOL). PSYCHOSOCIAL FUNCTIONING AND QOL Before the advent of the concept of QOL, postoperative improvement in psychosocial functioning was shown to be associated with freedom from, or substantial reduction in, seizures as well as with the preoperative level of functioning. However, positive changes were seen predominantly in those who already had a relatively high level of psychosocial function preoperatively (1–4). Furthermore, most studies have found that employment rates change only to a limited degree although relief from seizures may lead to improved vocational functioning (1,3–7). In two recent series, however, employment rates increased significantly among patients who became seizure free (8,9). Higher QOL scores have been reported following surgery for epilepsy in people who have achieved total seizure relief than in those who continue to have auras (10,11). In addition, people in whom seizure frequency has been substantially reduced have higher QOL scores than those who still have frequent seizures (9,11). However, even though complete seizure relief is a desired outcome of epilepsy surgery, it is not always achieved. In some people, the aim of surgery is to reduce the severity or frequency of disabling seizures, and for these people, the present measurement of QOL may not be appropriate (12). RECOMMENDATIONS The future use and development of existing epilepsy-specific QOL measures must take account of the wide range of surgical procedures performed in patients with varying disabilities. Individual rehabilitation plans should be based on realistic expectations of the possibilities and limitations of epilepsy surgery, with emphasis on the importance of initiating rehabilitation planning and counselling preoperatively (6). REFERENCES 1 Taylor DC, Falconer MA. Clinical, socioeconomic and psychological changes after temporal lobectomy for epilepsy. Br J Psychol 1968; 114: 1247– 61. 2 Rausch R, Crandall PH. Psychological status related to surgical control of temporal lobe seizure. Epilepsia 1982; 23: 191– 202. 3 Dodrill CB, Batzel LW, Fraser R. Psychosocial changes after surgery for epilepsy. In: HO Lüders, ed. Epilepsy surgery. New York: Raven Press, 1991: 661– 7. 4 Vickrey BG, Hays RD, Hermann BP, et al. Outcomes with respect to quality of life. In: Engel J Jr, ed. Surgical treatment of the epilepsies. New York: Raven Press, 1993:623–35. 5 Guldvog B, Löyning Y, Hauglie-Hanssen E, et al. Surgical versus medical treatment for epilepsy, II: outcome related to social areas. Epilepsia 1991; 32: 477– 86. 6 Fraser RT, Gumnit RJ, Thorbecke R, et al. Psychosocial rehabilitation: a pre- and postoperative perspective. In: J Engel, ed. Surgical treatment of the epilepsies. New York: Raven Press, 1993: 669– 77. 7 Lendt M, Helmstaedter C, Elger CE. Pre- and postoperative socioeconomic development of 151 patients with focal epilepsies. Epilepsia 1997; 38: 1330– 7. 8 Sperling MR, O'Connor MJ, Saykin AJ, et al. Temporal lobectomy for refractory epilepsy. JAMA 1996; 276: 470– 5. 9 Kellett MW, Smith DF, Baker GA, et al. Quality of life after epilepsy surgery. J Neurol Neurosurg Psychiatry 1997; 63: 52– 8. 10 Vickrey BG, Hays RD, Graber J, et al. A health-related quality of life instrument for patients evaluated for epilepsy surgery. Med Care 1992; 30: 299– 319. 11 Malmgren K, Sullivan M, Ekstedt G, et al. Health related quality of life after epilepsy surgery: a Swedish multicentre study. Epilepsia 1997; 38: 830– 8. 12 Taylor DC. New measures of outcome needed for the surgical treatment of epilepsy. Epilepsia 1997; 38: 625– 30. Citing Literature Volume44, Issues6September 2003Pages 61-61 ReferencesRelatedInformation