Safety, efficacy, and life satisfaction following epilepsy surgery in patients aged 60 years and older

OBJECT Despite its potential to offer seizure freedom, resective epilepsy surgery (RES) is seldom performed in patients 60 years of age or older. Demonstrating successful outcomes including an improved quality of life may raise awareness about the advantages of referring this underrepresented population for specialized evaluation. Accordingly, the authors investigated outcomes and life fulfillment in patients with an age ≥ 60 years who had undergone RES. METHODS All patients who, at the age of 60 years or older, had undergone RES for medically refractory focal onset seizures at the authors’ center were evaluated. A modified Liverpool Life Fulfillment (LLF) tool was administered postoperatively (maximum score 32). Seizure outcomes were classified according to the Engel classification system. RESULTS Twelve patients underwent RES. The majority of patients (9 [75%] of 12) had at least 1 medical comorbidity in addition to seizures. The mean follow-up was 3.1 ± 2.1 years. At the time of the final follow-up, 11 (91.7%) of 12 patients were documented as having a good postsurgical outcome (Engel Class I-II). Half (6 of 12 patients) were completely seizure free (Engel Class IA). Liverpool Life Fulfillment (LLF) data were available for 11 patients. Following surgery, the mean LLF score was 26.7 ± 6. Eight patients (72.7%) noted excellent satisfaction with their RES, with 5 (45.5%) noting postoperative improvements in overall health. CONCLUSIONS Resective epilepsy surgery is safe and effective in patients with an age ≥ 60 years. Over 90% had a good surgical outcome, with 50% becoming completely seizure free despite 1 or more medical comorbidities in the majority. The study data indicated that an advancing age should not negatively influence consideration for RES.

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Epilepsziasebészeti beavatkozások eredményei a Pécsi Epilepszia Centrumban 2005 és 2016 között

Orvosi Hetilap ◽

10.1556/650.2019.31321 ◽

2019 ◽

Vol 160 (7) ◽

pp. 270-278 ◽

Cited By ~ 1

Author(s):

Katalin Nóra Lőrincz ◽

Beáta Bóné ◽

Márton Tóth ◽

Réka Horváth ◽

Norbert Kovács ◽

...

Keyword(s):

Quality Of Life ◽

Epilepsy Surgery ◽

Employment Status ◽

Postoperative Outcome ◽

Seizure Freedom ◽

Neurologic Disease ◽

Exact Test ◽

Epileptic Patients

Abstract: Introduction: Epilepsy as a chronic, severe neurologic disease significantly influences the quality of life of the epileptic patients. In candidates well selected for surgery, the seizure freedom is realistically achievable, and the quality of life can be further improved with complex individual rehabilitation. Aim: We aimed to evaluate the postoperative outcome of patients who underwent epilepsy surgery between 2005 and 2016 at the Epilepsy Center at Pécs. Method: We evaluated seizure status at regular follow-up visits after surgery and the quality of life using questionnaires focusing on employment and social status. Results: 76% of the 72 patients who underwent surgical resection for epilepsy were free from disabling seizures , and 10% had rare disabling seizures (almost seizure-free), 7% experienced worthwhile improvement and 7% had no worthwhile improvement. Comparing the employment status of patients free from disabling seizures to patients not free from disabling seizures, we found that the employment status is significantly influenced by seizure freedom (p<0.01, Fisher’s exact test). While 67% of seizure-free patients were employed, only 19% of patients not free from disabling seizures were hired. Conclusion: Our results resemble the international tendencies and success rate, proving epilepsy surgery as an available, valid and effective treatment in well selected patients. Orv Hetil. 2019; 160(7): 270–278.

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Resective epilepsy surgery in tuberous sclerosis complex: a nationwide multicentre retrospective study from China

Brain ◽

10.1093/brain/awz411 ◽

2020 ◽

Vol 143 (2) ◽

pp. 570-581 ◽

Cited By ~ 5

Author(s):

Shiyong Liu ◽

Tao Yu ◽

Yuguang Guan ◽

Kai Zhang ◽

Ping Ding ◽

...

Keyword(s):

Quality Of Life ◽

Tuberous Sclerosis ◽

Epilepsy Surgery ◽

Tuberous Sclerosis Complex ◽

Intelligence Quotient ◽

Influence Factors ◽

Seizure Freedom ◽

Postoperative Seizure

Abstract At least 50% of patients with tuberous sclerosis complex present with intractable epilepsy; for these patients, resective surgery is a treatment option. Here, we report a nationwide multicentre retrospective study and analyse the long-term seizure and neuropsychological outcomes of epilepsy surgery in patients with tuberous sclerosis complex. There were 364 patients who underwent epilepsy surgery in the study. Patients’ clinical data, postoperative seizure outcomes at 1-, 4-, and 10-year follow-ups, preoperative and postoperative intelligence quotients, and quality of life at 1-year follow-up were collected. The patients’ ages at surgery were 10.35 ± 7.70 years (range: 0.5–47). The percentage of postoperative seizure freedom was 71% (258/364) at 1-year, 60% (118/196) at 4-year, and 51% (36/71) at 10-year follow-up. Influence factors of postoperative seizure freedom were the total removal of epileptogenic tubers and the presence of outstanding tuber on MRI at 1- and 4-year follow-ups. Furthermore, monthly seizure (versus daily seizure) was also a positive influence factor for postoperative seizure freedom at 1-year follow-up. The presence of an outstanding tuber on MRI was the only factor influencing seizure freedom at 10-year follow-up. Postoperative quality of life and intelligence quotient improvements were found in 43% (112/262) and 28% (67/242) of patients, respectively. Influence factors of postoperative quality of life and intelligence quotient improvement were postoperative seizure freedom and preoperative low intelligence quotient. The percentage of seizure freedom in the tuberectomy group was significantly lower compared to the tuberectomy plus and lobectomy groups at 1- and 4-year follow-ups. In conclusion, this study, the largest nationwide multi-centre study on resective epilepsy surgery, resulted in improved seizure outcomes and quality of life and intelligence quotient improvements in patients with tuberous sclerosis complex. Seizure freedom was often achieved in patients with an outstanding tuber on MRI, total removal of epileptogenic tubers, and tuberectomy plus. Quality of life and intelligence quotient improvements were frequently observed in patients with postoperative seizure freedom and preoperative low intelligence quotient.

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Psychiatric and psychosocial morbidity 1 year after epilepsy surgery

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2020.114 ◽

2020 ◽

pp. 1-8

Author(s):

S. Patel ◽

M. Clancy ◽

H. Barry ◽

N. Quigley ◽

M. Clarke ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Epilepsy Surgery ◽

Refractory Epilepsy ◽

Post Surgery ◽

Axis I ◽

Patients With Epilepsy ◽

The Impact

Abstract Objectives: There is a high rate of psychiatric comorbidity in patients with epilepsy. However, the impact of surgical treatment of refractory epilepsy on psychopathology remains under investigation. We aimed to examine the impact of epilepsy surgery on psychopathology and quality of life at 1-year post-surgery in a population of patients with epilepsy refractory to medication. Methods: This study initially assessed 48 patients with refractory epilepsy using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life in Epilepsy Inventory 89 (QOLIE-89) on admission to an Epilepsy Monitoring Unit (EMU) as part of their pre-surgical assessment. These patients were again assessed using the SCID-I, QOLIE-89 and HADS at 1-year follow-up post-surgery. Results: There was a significant reduction in psychopathology, particularly psychosis, following surgery at 1-year follow-up (p < 0.021). There were no new cases of de novo psychosis and surgery was also associated with a significant improvement in the quality of life scores (p < 0.001). Conclusions: This study demonstrates the impact of epilepsy surgery on psychopathology and quality of life in a patient population with refractory surgery. The presence of a psychiatric illness should not be a barrier to access surgical treatment.

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Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis

Journal of Neurosurgery Spine ◽

10.3171/2015.2.spine141185 ◽

2015 ◽

Vol 23 (4) ◽

pp. 400-411 ◽

Cited By ~ 48

Author(s):

Claudio E. Tatsui ◽

R. Jason Stafford ◽

Jing Li ◽

Jonathan N. Sellin ◽

Behrang Amini ◽

...

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Real Time ◽

Spinal Cord Compression ◽

Spinal Metastasis ◽

Cord Compression ◽

The Mean ◽

Interstitial Thermotherapy

OBJECT High-grade malignant spinal cord compression is commonly managed with a combination of surgery aimed at removing the epidural tumor, followed by spinal stereotactic radiosurgery (SSRS) aimed at local tumor control. The authors here introduce the use of spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery prior to SSRS. METHODS Patients with a high degree of epidural malignant compression due to radioresistant tumors were selected for study. Visual analog scale (VAS) scores for pain and quality of life were obtained before and within 30 and 60 days after treatment. A laser probe was percutaneously placed in the epidural space. Real-time thermal MRI was used to monitor tissue damage in the region of interest. All patients received postoperative SSRS. The maximum thickness of the epidural tumor was measured, and the degree of epidural spinal cord compression (ESCC) was scored in pre- and postprocedure MRI. RESULTS In the 11 patients eligible for study, the mean VAS score for pain decreased from 6.18 in the preoperative period to 4.27 within 30 days and 2.8 within 60 days after the procedure. A similar VAS interrogating the percentage of quality of life demonstrated improvement from 60% preoperatively to 70% within both 30 and 60 days after treatment. Imaging follow-up 2 months after the procedure demonstrated a significant reduction in the mean thickness of the epidural tumor from 8.82 mm (95% CI 7.38–10.25) before treatment to 6.36 mm (95% CI 4.65–8.07) after SLITT and SSRS (p = 0.0001). The median preoperative ESCC Grade 2 was scored as 4, which was significantly higher than the score of 2 for Grade 1b (p = 0.04) on imaging follow-up 2 months after the procedure. CONCLUTIONS The authors present the first report on an innovative minimally invasive alternative to surgery in the management of spinal metastasis. In their early experience, SLITT has provided local control with low morbidity and improvement in both pain and the quality of life of patients.

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TOLTERODINE IMPROVES QUALITY OF LIFE IN PATIENTS WITH AN OVERACTIVE BLADDER, WITH OR WITHOUT URINARY INCONTINENCE: A PROSPECTIVE MULTICENTER STUDY

Urogynaecologia ◽

10.4081/uij.2008.1.5 ◽

2010 ◽

Vol 22 (1) ◽

pp. 5

Author(s):

F. Mantovani ◽

G. Bozzini ◽

P. Acquati ◽

S.S. Di Pierro ◽

M.G. Spinelli ◽

...

Keyword(s):

Quality Of Life ◽

Overactive Bladder ◽

Clinical Effects ◽

Health Questionnaire ◽

Prospective Multicenter Study ◽

Study Materials ◽

Trial Entry ◽

The Mean

AIMS: In order to analyse the effect of tolterodine on the Quality of life (QoL) of patients with overactive bladder (OB) we conducted a prospective multicentre clinical study. MATERIALS AND METHODS: Subjects were questioned at entry and 4, 12 and 24 weeks later about the number of micturitions and incontinent and urgency episodes/day, using a micturition diary. The mean volume voided per micturition and the number of pads used per day was also recorded. The QoL was measured using the Kings Health Questionnaire (KHQ) and the Incontinence Impact Questionnaire (IIQ). A total of 179 patients entered the study: 59 dropped out (4 due to lack of efficacy, 10 due to adverse events, 25 because of lack of interest in the study/other reason and 20 were lost at follow up), leaving 120 patients for analysis. One hundred and eight patients (90%) were female, their mean age was 56.5 years (SD 11.2); 87 had never received treatment for OB/UI (80.6%) and their mean weight was 70.0 Kg (SD 12.7). RESULTS: The mean number of micturitions/day was 9.3 at trial entry and it decreased to 6.8 by the end of the study. The corresponding values for the number of urge episodes, incontinence episodes and number of pads used per day were 3.5, 2.7 and 1.2 and 0.8, 0.9 and 0.4 respectively. The mean volume voided per micturition increased from 146 ml. to 178 ml. All the differences between trial entry and end of study values were statistically significant (p<0.05). Considering the results of the KHQ, the values of all the different areas/domini (?) decreased markedly and in a statistically significant way between the start of treatment and the end of study evaluations. Similar findings emerged when we considered values of the IIQ. The decrease was constant and marked during the first three months and remained constant thereafter. CONCLUSIONS: This study, conducted in a population of subjects with dry and wet OB, shows that tolterodine given for six months lowers the frequency of urgency episodes and incontinence episodes without troublesome adverse effects. These clinical effects are mirrored in the QoL, KHQ and IIQ questionnaire scores, which improved by about 50% over the same period.

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Responsiveness and minimally important difference of a generic quality of life measure for complementary health practices

Alternative Medicine Studies ◽

10.4081/ams.2012.e12 ◽

2012 ◽

Vol 2 (1) ◽

pp. 12 ◽

Cited By ~ 2

Author(s):

Tomoaki Kimura ◽

Kiyoshi Suzuki ◽

Seiya Uchida ◽

Hiroshi Katamura

Keyword(s):

Quality Of Life ◽

Minimally Important Difference ◽

Health Practices ◽

Life Questionnaire ◽

Age Group ◽

Japanese Adults ◽

The Mean ◽

Generic Quality

Shorter and easier methods of conducting community health surveys would be useful. We conducted a study to demonstrate the responsiveness of the 10-item Mokichi Okada Association quality of life questionnaire (MQL-10) in a follow-up survey and to determine the minimally important difference (MID) for this measure. In 2007, Japanese adults participated in a survey on health prac- tices. We analyzed the MQL-10 scores (n=6365) together with the following factors: gender, age group, disease, reason for participation, and complementary health practices, such as food and eating. The mean baseline MQL-10 score was 26.4±5.83 [standard deviation (SD)] and the mean follow-up score was 27.6±5.45 SD with a mean change of 1.20±4.41 SD. The effect size for change was 0.21 and the standardized response mean was 0.27. The MQL-10 scores in the baseline condition were associated with gender, age group, disease, reason for participation and complementary health practices. Furthermore, the changes in the MQL-10 during the 12 weeks of study were associated with age group, disease, reason for participa- tion and complementary health practices. The increase in frequency of health practices was significantly associated with improvements in the participants’ quality of life (QOL). These results suggest that the MQL-10 is use- ful for assessing the effects of complementary health practices on QOL. The estimate of 3 points for the range of this measure (0-40) was higher than half of the SD of scores; therefore, it was considered reasonable for the MID.

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Effectiveness of Cognitive-Behavioral Therapy (CBT) on Quality of Life (QOL) and Worry in Patients with Generalized Anxiety Disorder (GAD)

International Journal of Indian Psychology ◽

10.25215/0202.021 ◽

2015 ◽

Vol 2 (2) ◽

Author(s):

Sheida Jabalameli ◽

Hamid Taher Neshat Doost ◽

Mohammad Bagher Kajbaf ◽

Hossein Molavi

Keyword(s):

Quality Of Life ◽

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Behavioral Therapy ◽

Control Group ◽

Generalized Anxiety ◽

The Mean ◽

Experimental Group

Generalized Anxiety Disorder (GAD) is one of the most common anxiety disorders. It has been reported that psychological treatments like Cognitive-Behavioral Therapy (CBT) is effective for patients with GAD. The purpose of the present research was to investigate the effectiveness of CBT on Quality of Life (QOL) and worry in patients with GAD. A sample of 30 patients with GAD who had been referred to psychiatry offices in Isfahan, Iran were selected and assigned into an experimental group (n=15) and a control group (n=15) randomly. The experimental group received CBT in 8 weekly sessions. All participants completed the World Health Organization Quality Of Life-Brief (WHOQOL-BREF) questionnaire and the Penn State Worry Questionnaire (PSWQ) at pretest, posttest and follow up. The results of MANCOVA showed that the mean scores of QOL in the experimental group was significantly higher than the control group at the posttest and follow up (P<0.05) and the mean scores of worry in the experimental group was significantly lower than the control group at the posttest and follow up (P<0.05) It is concluded that CBT can be applied for the patients with GAD as a useful psychological treatment. In general, CBT can improve QOL and decrease worry in patients with GAD.

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Health-related quality of life burden in scleroderma patients treated with two different intravenous iloprost regimens

Reumatismo ◽

10.4081/reumatismo.2019.1190 ◽

2019 ◽

Vol 71 (2) ◽

pp. 62-67

Author(s):

T. Schioppo ◽

L. Scalone ◽

P. Cozzolino ◽

L. Mantovani ◽

G. Cesana ◽

...

Keyword(s):

Quality Of Life ◽

Randomized Study ◽

Digital Ulcers ◽

Health Related Quality ◽

Utility Index ◽

Related Quality ◽

Health Related ◽

The Mean

Systemic sclerosis (SSc)-related Raynaud’s phenomenon (RP) and digital ulcers (DU) can impair health-related quality of life (HRQoL). The aim of our study was to estimate HRQoL in SSc patients treated with two different intravenous (IV) iloprost (ILO) regimens and in patients not treated with IV ILO. 96 consecutive SSc patients were enrolled in a pragmatic, prospective and non-randomized study, and divided into 3 groups: not requiring therapy with IV ILO (N=52), IV ILO once monthly (N=24) or IV ILO for 5 consecutive days every 3 months (N=20). Patients were followed up for three months. We assessed HRQoL using the generic preference-based questionnaire EQ-5D-5L. We conducted multiple regression analyses to estimate, in each treatment group, the mean general health (GH) and the mean utility index of the EQ-5D-5L, adjusting for possible confounders. The mean adjusted utility index and GH score, after three months’ follow-up, were not different in the three groups: IV ILO was able to make patients requiring IV ILO similar to those not requiring it. Moreover, there was no difference in this model between the two ILO regimens (1 day monthly vs 5 consecutive days every 3 months). The two different IV ILO regimens (the most appropriate regimen was decided according to patients’ characteristics and needs) were able to stabilize HRQoL in RP secondary to SSc non-adequately controlled by oral therapy.

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Adherence to Gluten-Free Diet in Coeliac Paediatric Patients Assessed through a Questionnaire Positively Influences Growth and Quality of Life

Nutrients ◽

10.3390/nu12123802 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3802

Author(s):

Deianira Pedoto ◽

Riccardo Troncone ◽

Margherita Massitti ◽

Luigi Greco ◽

Renata Auricchio

Keyword(s):

Quality Of Life ◽

Influencing Factors ◽

Average Length ◽

Study Data ◽

Gluten Free Diet ◽

Gluten Free ◽

Diet Adherence ◽

School Career

Assessment of adherence to gluten-free diet (GFD) represents the cornerstone in the management of coeliac disease. The primary aim of this study was to assess diet adherence through a questionnaire adapted to children. The secondary aim was to identify influencing factors and outcomes related to diet adherence. In this study, data about diagnosis, education, quality of life (QoL) and anti-transglutaminase (anti-TG2) titers of 160 coeliac children were collected. For the assessment of diet adherence, all participants completed the questionnaire modified from Leffler et al. (2009), while a random sample of 37 also underwent an extensive dietary interview. According to the questionnaire, diet adherence was excellent in 95 (59.4%), fair in 46 (28.8%) and low in 19 (11.9%) patients. Children diagnosed with biopsy showed better adherence than those with a biopsy-sparing approach (p = 0.036). Adherence to GFD tended to worsen during the follow up, with the average length of follow up being associated with lower scores of diet adherence (p = 0.009). Moreover, adherence to GFD decreased throughout school career, dropping from elementary until high school (p = 0.037). A positive correlation was observed between adherence to GFD and growth percentiles, which increased when higher scores of adherence were achieved. Diet adherence positively correlated with QoL (p = 0.001). In conclusion, the questionnaire displayed good sensitivity in detecting problems in diet adherence, being useful as a screening tool. Better comprehension of influencing factors and outcomes may allow the development of new strategies to improve diet adherence.

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P101 The leeds paediatric brain arteriovenous malformation (BAVM) outcomes

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.158 ◽

2019 ◽

Vol 90 (3) ◽

pp. e49.1-e49

Author(s):

N Kalra ◽

SP Solanki ◽

AK Tyagi

Keyword(s):

Quality Of Life ◽

Functional Outcomes ◽

Cohort Analysis ◽

Paediatric Population ◽

Healthy Children ◽

Hrqol Score ◽

Related Quality ◽

The Mean

ObjectivesThe commonest cause of stroke in a paediatric population is a ruptured brain ateriovenous malformation (bAVM). We aim to assess the functional outcomes of patients who have undergone operative intervention at our unit for ruptured and non-ruptured bAVMs.DesignA single centre retrospective cohort analysis of paediatric bAVM patients.Subjects10 paediatric patients at time of surgery between January 2007 – December 2017 mean age at follow up 15.9 years, range 2–26 years, mean time to follow up 6.3 years, range 1.5–11.2 years.MethodsPatients with bAVMs were identified via the paediatric neurovascular database. They were contacted via telephone and the Paediatric Quality of Life (PedsQL) questionnaire administered via parent proxy if the patient was under 18, and by the patient if above 18. Functional outcomes were assessed using the PedsQL questionnaire score and converted in to a health-related quality of life (HRQOL) score.Results10 patients underwent resection of their bAVMS, 9 survived and 7 were contactable. The mean HRQOL score 88.9 points, range 65.2–100. Only one patient had a HRQOL score below the mean of a child with chronic disease.ConclusionsThe mean HRQOL outcome score of operated paediatric bAVM was similar to that of healthy children. Patients having bAVM surgery within our unit have had a good functional outcome. Although there are small numbers in this series, there is a low incidence of operated paediatric bAVMs. Our findings suggests that such operations should be undertaken in units with expertise.

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