Epilepsy Surgery for Pathologically Proven Hippocampal Sclerosis Provides Long‐term Seizure Control and Improved Quality of Life

Epilepsy surgery as a treatment option is usually reserved for medically intractable epilepsy, when anticonvulsant medication has failed to achieve adequate seizure control and the seizure frequency impairs quality of life. Intraoperative brain mapping is often requested by the surgeon and necessitates special planning by the anesthesiologist to provide the best possible operating conditions. Awake craniotomy with the “asleep-awake-asleep” pattern can be considered as a technique in such procedures but requires cautious management for achieving maximum patient satisfaction. Certain patients are not appropriate candidates for craniotomy in the awake state, but general anesthesia can still be considered with specific considerations.

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LONG-TERM SEIZURES AND QUALITY OF LIFE AFTER EPILEPSY SURGERY COMPARED WITH MATCHED CONTROLS

Neurosurgery ◽

10.1227/01.neu.0000315999.58022.1c ◽

2008 ◽

Vol 62 (2) ◽

pp. 326-335 ◽

Cited By ~ 22

Author(s):

Knut Stavem ◽

Helge Bjørnæs ◽

Iver A. Langmoen

Keyword(s):

Quality Of Life ◽

Epilepsy Surgery ◽

Intractable Epilepsy ◽

Two Dimensions ◽

Three Dimensions ◽

Seizure Type ◽

Seizure Outcome

Abstract OBJECTIVE We compared long-term seizure outcome and health-related quality of life (HRQoL) of patients who underwent epilepsy surgery and matched medically treated nonsurgical controls with intractable epilepsy. METHODS Medically treated controls were identified for patients operated on for epilepsy between January 1, 1949 and December 31, 1992. We used a matched cohort design, matching for age, sex, and seizure type. The analysis was based on 70 complete matching pairs. HRQoL was assessed with the Quality of Life in Epilepsy Inventory 89 questionnaire an average of 15 years after surgery. RESULTS Among surgery patients, 48% were seizure-free during the previous year compared with 19% of the controls (P = 0.0004). Fewer surgery patients used antiepileptic drugs (70%) than controls (93%). The odds of being seizure-free were higher for surgery patients in total and in subgroups divided according to length of follow-up. The mean HRQoL for surgery patients was higher in five of the 17 Quality of Life in Epilepsy Inventory 89 dimensions and worse in none. Among patients with more than 7 years of follow-up, HRQoL was better in three dimensions and worse in none. Among patients with 7 years of follow-up or less, HRQoL was better in two dimensions and worse in the language dimension of the Quality of Life in Epilepsy Inventory 89. CONCLUSION After an average of more than 15 years of follow-up, epilepsy surgery patients had fewer seizures, used less antiepileptic medication, and had better HRQoL in several dimensions of the Quality of Life in Epilepsy Inventory 89 instrument than matched medically treated controls with refractory epilepsy, although possibly at a slight disadvantage in the language dimension among those with 7 years of follow-up or less.

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Mood, anxiety, and incomplete seizure control affect quality of life after epilepsy surgery

Neurology ◽

10.1212/wnl.0000000000000183 ◽

2014 ◽

Vol 82 (10) ◽

pp. 887-894 ◽

Cited By ~ 49

Author(s):

H. Hamid ◽

K. Blackmon ◽

X. Cong ◽

J. Dziura ◽

L. Y. Atlas ◽

...

Keyword(s):

Quality Of Life ◽

Epilepsy Surgery ◽

Seizure Control

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Impact of epilepsy surgery on seizure control and quality of life: A 26-year follow-up study

Epilepsia ◽

10.1111/j.1528-1167.2011.03398.x ◽

2012 ◽

Vol 53 (4) ◽

pp. 712-720 ◽

Cited By ~ 50

Author(s):

Hussan S. Mohammed ◽

Christian B. Kaufman ◽

David D. Limbrick ◽

Karen Steger-May ◽

Robert L. Grubb ◽

...

Keyword(s):

Quality Of Life ◽

Epilepsy Surgery ◽

Seizure Control ◽

Follow Up Study

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Epilepsy Surgery Outcomes: Quality of Life and Seizure Control

Pediatric Neurology ◽

10.1016/j.pediatrneurol.2009.07.018 ◽

2010 ◽

Vol 42 (1) ◽

pp. 12-20 ◽

Cited By ~ 48

Author(s):

Mary L. Zupanc ◽

Elliane J. dos Santos Rubio ◽

Rhonda R. Werner ◽

Michael J. Schwabe ◽

Wade M. Mueller ◽

...

Keyword(s):

Quality Of Life ◽

Epilepsy Surgery ◽

Seizure Control ◽

Surgery Outcomes

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Employment and quality of life in mesial temporal lobe epilepsy with hippocampal sclerosis: is there a change after surgical treatment?

Journal of Epilepsy and Clinical Neurophysiology ◽

10.1590/s1676-26492009000200008 ◽

2009 ◽

Vol 15 (2) ◽

pp. 89-93 ◽

Cited By ~ 4

Author(s):

Neide Barreira Alonso ◽

Auro Mauro Azevedo ◽

Ricardo Silva Centeno ◽

Laura M. F. Ferreira Guilhoto ◽

Luis Otávio Sales Ferreira Caboclo ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Epilepsy Surgery ◽

Hippocampal Sclerosis ◽

Mesial Temporal Lobe Epilepsy ◽

Before And After ◽

Mesial Temporal Lobe

PURPOSE: The aim of this study was to evaluate in patients with mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS): (1) employment patterns before and three years after epilepsy surgery and their impact in Quality of Life (QOL); (2) demographic and clinical variables associated with employment. METHODS: Data from 58 patients with diagnosis of refractory MTLE with HS who had corticoamygdalo-hippocampectomy were analyzed. The subjects answered to Brazilian validated version of the Epilepsy Surgery Inventory (ESI-55) before, and three years after surgery. In a semi-structured interview, sociodemographic and clinical characteristics were obtained. Changes in employment after surgery were classified in one of the three categories: (i) improvement status: those who were unemployed, no-formal employed, students, housewives and subjects who have never worked to employed category; (ii) unchanged status: no change in occupation; this category included subjects who were employed before and after the surgery, housewives, students, and the group who remained unemployed, receiving ill-health benefits or retired after the surgical treatment; and (iii) worsened status: loss of employment. RESULTS: Employment status did not show any significant change after surgery: in 51(87.9%) it remained unchanged, in six (10.3%) it improved, and one patient (1.7%), who was employed before the surgery, retired after that. In a subgroup of 22 patients employed after surgery, ten (45.5%) were seizure-free, seven (31.8%) had only rare auras, and five (22.7%) had seizures. In the group of improvement, 12 patients (70.5%) had no-formal employment and five (29.5%) had a formal job before surgery. After three years, 14 (63.6%) of 22 subjects were formally employed. Our data suggested that the employability was strongly correlated (p<0.05) with a positive perception of health-related quality of life measured by ESI-55, before and after surgical evaluation. CONCLUSION: Our study demonstrated in a homogeneous group of MTLE with HS, a modest, but positive relationship between surgical outcome and work gain, and that QOL had strong correlation with the fact of being employed.

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