Social Outcome and Quality of Life after Epilepsy Surgery in Hippocampal Sclerosis
Keywords:
Temporal lobe epilepsy, Hippocampal sclerosis, Epilepsy surgery, Social outcome, Quality of lifeAbstract
Background: Quality of life is worse in patients with epilepsy as compared to that of general population. Although seizure freedom is the ultimate treatment goal in epilepsy surgery, patient’s expectations and improvement in quality of life may also include other social aspects such as education, employment, income, driving and social relationships.
Objective: To investigated social outcomes, quality of life, social factors influencing quality of life, presurgical patient’s expectation and patient’s satisfaction after temporal lobe epilepsy (TLE) surgery.
Methods: Seventy-three patients with medically refractory hippocampal sclerosis (HS) who underwent epilepsy surgery between January 2014 and December 2019 at King Chulalongkorn Memorial Hospital (KCMH) were evaluated. The socioeconomic data was collected from the subjects and their caregivers by a questionnaire–interview. All patients had completed at least 2-year postoperative follow-up.
Results: There were 27 males (37%) and 46 females (63%) with mean age of 35.82 ± 10.14 years at the time of surgery. Seventy-one (97%) patients underwent standard anterior temporal lobectomy. Sixty-six (90.41%) patients reported excellent seizure outcome (ILAE Class I). For social outcome, there were significant changes in driving status (45.21 vs 60.27%, p = 0.008) but there was no significant change in other aspects (education, employment, income, marital status) after surgery. All patients reported excellent postoperative quality of life. The factors which were associated with better quality of life following surgery were employment (p = 0.036) and ability to drive (p = 0.006). Sixty-four (88%) patients cited seizure control as their main expectation. Sixty-seven (91.78%) patients were satisfied with surgery and would suggest other patients to pursue similar surgical treatment.
Conclusions: Surgery for medically refractory temporal lobe epilepsy improves social outcomes in driving aspect. Gaining employment and ability to drive after surgery are important factors influencing better quality of life. Vocational and driving rehabilitation program should be included in comprehensive epilepsy treatment program in order to enhance postoperative quality of life in TLE patients.
Downloads
References
Blair RDG. Temporal lobe epilepsy semiology. Epilepsy Res Treat. 2012;2012:751510.
Blümcke I. Neuropathology of focal epilepsies: A critical review. Epilepsy Behav. 2009;15:34-9.
Berto P. Quality of Life in Patients with Epilepsy and Impact of Treatments. PharmacoEconomics 2002;20:1039-59.
Wiebe S, Blume WT, Girvin JP, Eliasziw M. A Randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001;345:311-8.
Engel J, McDermott MP, Wiebe S, Langfitt JT, Stern JM, Dewar S, et al. Early Surgical therapy for drugresistant temporal lobe epilepsy: a randomized trial. JAMA. 2012;307:922-30.
Hirsch LJ. Long-term outcome after epilepsy surgery: relapsing, remitting disorder? Epilepsy Curr. 2012;12:140-2.
Lindsten H, Stenlund H, Edlund C, Forsgren L. Socioeconomic prognosis after a newly diagnosed unprovoked epileptic seizure in adults: a population-based case–control study. Epilepsia. 2002;43:1239-50.
Gilliam F, Kuzniecky R, Faught E, Black L, Carpenter G, Schrodt R. Patient-validated content of epilepsyspecific quality-of-life measurement. Epilepsia. 1997;38:233-6.
Wo MCM, Lim KS, Choo WY, Tan CT. Employability among people with uncontrolled seizures: an interpretative phenomenological approach. Epilepsy Behav. 2015;45:21-30.
Hamiwka L, Macrodimitris S, Tellez-Zenteno JF, Metcalfe A, Wiebe S, Kwon C-S, et al. Social outcomes after temporal or extratemporal epilepsy surgery: a systematic review. Epilepsia. 2011;52:870-9.
Hoppe C, Elger CE, Helmstaedter C. Long-term memory impairment in patients with focal epilepsy. Epilepsia. 2007;48:26-9.
Edelvik A, Flink R, Malmgren K. Prospective and longitudinal long-term employment outcomes after resective epilepsy surgery. Neurology. 2015;85:1482-90.
George L, Iyer RS, James R, Sankara Sarma P, Radhakrishnan K. Employment outcome and satisfaction after anterior temporal lobectomy for refractory epilepsy: a developing country’s perspective. Epilepsy Behav. 2009;16:495-500.
Chin PS, Berg AT, Spencer SS, Sperling MR, Haut SR, Langfitt JT, et al. Employment outcomes following resective epilepsy surgery. Epilepsia.2007;48:2253-7.
Locharernkul C, Kanchanatawan B, Bunyaratavej K, Srikijvilaikul T, Deesudchit T, Tepmongkol S, et al. Quality of life after successful epilepsy surgery: evaluation by occupational achievement and income acquisition. J Med Assoc Thai. 2005;88 Suppl 4:S207-13.
Zarroli K, Tracy JI, Nei M, Sharan A, Sperling MR. Employment after anterior temporal lobectomy. Epilepsia. 2011;52:925-31.
Jones JE, Berven NL, Ramirez L, Woodard A, Hermann BP. Long-term Psychosocial Outcomes of Anterior Temporal Lobectomy. Epilepsia. 2002;43:896-903.
Winston GP. Epilepsy surgery, vision, and driving: what has surgery taught us and could modern imaging reduce the risk of visual deficits? Epilepsia. 2013;54:1877-88.
Shackleton DP, Kasteleijn–Nolst Trenité DGA, de Craen AJM, Vandenbroucke JP, Westendorp RGJ. Living with epilepsy. Neurology. 2003;61:64.
Carran MA, Kohler CG, O’Connor MJ, Cloud B, Sperling MR. Marital status after epilepsy surgery. Epilepsia. 1999;40:1755-60.
Wani RT. Socioeconomic status scales-modified Kuppuswamy and Udai Pareekh’s scale updated for 2019. J Family Med Prim Care. 2019;8:1846-9. 22. Pattanaphesaj J, Thavorncharoensap M. Measurement properties of the EQ-5D-5L compared to EQ-5D- 3L in the Thai diabetes patients. Health Qual Life Outcomes. 2015;13:14-.
Erickson JC, Ellenbogen RG, Khajevi K, Mulligan L, Ford GC, Jabbari B. Temporal lobectomy for refractory epilepsy in the U.S. Military. Mil Med. 2005;170:201-5.
Asztely F, Ekstedt G, Rydenhag B, Malmgren K. Long term follow-up of the first 70 operated adults in the Göteborg Epilepsy Surgery Series with respect to seizures, psychosocial outcome and use of antiepileptic drugs. J Neurol Neurosurg Psychiatry. 2007;78:605-9.
Ruengorn C, Awiphan R, Wongpakaran N, Wongpakaran T, Nochaiwong S, for the Health O, et al. Association of job loss, income loss, and financial burden with adverse mental health outcomes during coronavirus disease 2019 pandemic in Thailand: a nationwide cross-sectional study. Depress Anxiety. 2021;38:648-60.
Auriel E, Landov H, Blatt I, Theitler J, GandelmanMarton R, Chistik V, et al. Quality of life in seizurefree patients with epilepsy on monotherapy. Epilepsy Behav. 2009;14:130-3.
Lee S-A, Lee S-M, No Y-J. Factors contributing to depression in patients with epilepsy. Epilepsia. 2010;51:1305-8.
Tiamkao S, Sawanyawisuth K, Towanabut S, Visudhipun P. Seizure attacks while driving: quality of life in persons with epilepsy. Can J Neurol Sci. 2009;36:475-9.
Bower CM, Hays RD, Devinsky O, Spencer SS, Sperling MR, Haut S, et al. Expectations prior to epilepsy surgery: an exploratory comparison of men and women. Seizure. 2009;18:228-31.
Taylor DC, McMackin D, Staunton H, Delanty N, Phillips J. Patients’ aims for epilepsy surgery: Desires beyond seizure freedom. Epilepsia. 2001;42:629- 33.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles in this journal are copyrighted by the x may be read and used for academic purposes, such as teaching, research, or citation, with proper credit given to the author and the journal.use or modification of the articles is prohibited without permission.
statements expressed in the articles are solely the opinions of the authors.
authors are fully responsible for the content and accuracy of their articles.
other reuse or republication requires permission from the journal."
