Mood, anxiety, and incomplete seizure control affect quality of life after epilepsy surgery.
OBJECTIVE
We examined the complex relationship between depression, anxiety, and seizure control and quality of life (QOL) outcomes after epilepsy surgery.


METHODS
Seven epilepsy centers enrolled 373 patients and completed a comprehensive diagnostic workup and psychiatric and follow-up QOL evaluation. Subjects were evaluated before surgery and then at 3, 6, 12, 24, 48, and 60 months after surgery. Standardized assessments included the Quality of Life in Epilepsy Inventory-89, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). A mixed-model repeated-measures analysis was used to analyze associations of depression, anxiety, seizure outcome, and seizure history with overall QOL score and QOL subscores (cognitive distress, physical health, mental health, epilepsy-targeted) prospectively.


RESULTS
The groups with excellent and good seizure control showed a significant positive effect on the overall QOL compared to the groups with fair and poor seizure control. The BDI and BAI scores were both highly and negatively associated with overall QOL; increases in BDI and BAI scores were associated with decreased overall QOL score.


CONCLUSIONS
Depression and anxiety are strongly and independently associated with worse QOL after epilepsy surgery. Interestingly, even partial seizure control, controlling for depression and anxiety levels, improved QOL. Management of mood and anxiety is a critical component to postsurgical care.
From the Department of Neurology (H.H.), Yale University School of Medicine, New Haven, CT; New York University School of Medicine (K.B., O.D.); Department of Psychology (L.Y.A.), New York University, New York; Yale University School of Public Health (X.C., J.D.), New Haven, CT; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Epilepsy Center; Department of Pediatrics (A.T.B.), Northwestern Memorial Feinberg School of Medicine, Chicago, IL; University of California at Los Angeles (B.G.V.); Thomas Jefferson University Medical School (M.R.S.), Philadelphia, PA; Montefiore Medical Center (S.S.), Albert Einstein College of Medicine, New York; University of Rochester School of Medicine (J.T.L.), NY; Minnesota Comprehensive Epilepsy Program (T.S.W.), St. Paul, MN; and Columbia University Medical School (C.W.B.), New York, NY.
Hamada
H
Hamid
Karen
K
Blackmon
Xiangyu
X
Cong
James
J
Dziura
Lauren Y
LY
Atlas
Barbara G
BG
Vickrey
Anne T
AT
Berg
Carl W
CW
Bazil
John T
JT
Langfitt
Thaddeus S
TS
Walczak
Michael R
MR
Sperling
Shlomo
S
Shinnar
Orrin
O
Devinsky
D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000523:psychology*; D003863:Depression / Q000209:etiology / Q000523:psychology*; D004827:Epilepsy / Q000523:psychology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D012640:Seizures / Q000523:psychology* / Q000601:surgery; D016896:Treatment Outcome