Quality of life after surgery for intractable partial epilepsy in children: a cohort study with controls.
OBJECTIVE
Investigate if quality of life (QOL) normalizes on long-term follow-up after surgery for partial epilepsy in children.


METHODS
This is a cohort study with controls in which a consecutive cohort of nineteen 2-14-year-old children who underwent focal resections for intractable partial seizures between 1996 and 2006, were matched with 19 non-surgery intractable partial epilepsy patients, and with 19 healthy subjects. The two epilepsy groups were matched for age, sex, socio-economic status (SES), cognitive level, seizure type, and seizure frequency. The healthy group was matched with the two epilepsy groups for age, sex, SES, and cognitive level. QOL was assessed using the QOLCE (Quality of Life in Childhood Epilepsy Questionnaire).


RESULTS
In the surgery group (follow-up 3.84+/-2.26 years), 78.9% had Engel class-I versus 21.1% in non-surgery (p=0.01) (follow-up 3.44+/-2.95 years). Surgery patients were similar to healthy subjects in the social, emotional, cognitive, behavioral, and overall QOL (p>0.05) but had lower scores in the total QOL, physical, and health domains (p<0.05). Surgery patients scored better than non-surgery in the behavioral domain and the HASES (Hague Side Effects Scale) score (p<0.05). Non-surgery patients scored worse than healthy in total QOL, physical, behavioral, health, and overall QOL (p<0.05). IQ, HASS (Hague Seizure Severity Scale), and HASES scores were positively associated with total QOL score (p<0.05). Subgroup analysis on seizure-free surgery patients showed that they did not differ from healthy subjects in any of QOL domains (p>0.05, power>0.8).


CONCLUSIONS
Our data indicate that epilepsy surgery for partial seizures in children is associated with better QOL as compared to children with intractable epilepsy who are not operated on, and suggest that in those who achieve seizure freedom normal QOL may at least potentially be possible.
Mikati
Mohamad A
MA
Department of Pediatrics and Adolescent Medicine, Adult and Pediatric Epilepsy Program, American University of Beirut Medical Center, Beirut, Lebanon. mohamad.mikati@duke.edu
Ataya
Nour
N
Ferzli
Jessica
J
Kurdi
Rana
R
El-Banna
Diana
D
Rahi
Amal
A
Shamseddine
Alhan
A
Sinno
Durriyah
D
Comair
Youssef
Y
D000293:Adolescent; D000704:Analysis of Variance; D001921:Brain / Q000601:surgery*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004828:Epilepsies, Partial / Q000601:surgery*; D006801:Humans; D019635:Neurosurgical Procedures; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome