Predictors of long-term quality of life after pediatric epilepsy surgery.
OBJECTIVE
This study examined the influence of seizures, antiepileptic drugs (AEDs), intelligence quotient (IQ), and symptoms of depression and anxiety on health-related quality of life (HRQOL) 4-11 years after pediatric epilepsy surgery.


METHODS
Participants were 109 patients with childhood-onset intractable epilepsy; 71 had undergone surgery on average 6.9 years before this study. Patients and their parents completed questionnaires assessing HRQOL and internalizing behavior, a measure of depression and anxiety symptoms.


RESULTS
Similar rates of recent seizure freedom were found for surgical and nonsurgical patients, although surgical patients had achieved seizure freedom sooner and with fewer AEDs. Few differences were found between surgical and nonsurgical patients. Differences emerged when comparing patients with continued seizures and those who had been seizure-free in the 12 months preceding the study. Almost all HRQOL ratings were enhanced in seizure-free patients. Internalizing behavior (anxiety/depression) mediated the relationship between seizure freedom and better HRQOL, where seizure freedom led to better ratings of anxiety/depression, which in turn led to better ratings of HRQOL. AED use was found to be associated with social functioning, medication effects, and seizure worry. IQ and duration of follow-up were not found to independently influence HRQOL.


CONCLUSIONS
The findings highlight the integral role of depression and anxiety symptoms in determining HRQOL; seizure control seems to play a secondary role. This study expands this relationship to individuals who have a history of intractable childhood epilepsy. The findings highlight the importance of managing depression and anxiety in improving the HRQOL and reducing seizure burden on patients.
Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Klajdi
http://orcid.org/0000-0001-7763-988X
K
Puka
Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.|Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada.|Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
Mary Lou
ML
Smith
D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D004827:Epilepsy / Q000188:drug therapy / Q000523:psychology* / Q000601:surgery*; D005260:Female; D006304:Health Status; D006801:Humans; D007361:Intelligence Tests; D008137:Longitudinal Studies; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D009493:Neurosurgery; D010290:Parents / Q000523:psychology; D011237:Predictive Value of Tests; D011788:Quality of Life / Q000523:psychology*; D012044:Regression Analysis; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
D000927:Anticonvulsants
Affective disorders; Children; Internalizing symptoms; Outcome; Quality of life