Predictors of meaningful improvement in quality of life after temporal lobe epilepsy surgery: A prospective study.
To investigate prospectively the independent predictors of a minimum clinically important change (MCIC) in quality of life (QOL) after anterior temporal lobectomy (ATL) for drug-resistant mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) in Brazilian patients.



Multiple binary logistic regression analysis was performed to identify the clinical, demographic, radiologic, and electrophysiologic variables independently associated with MCIC in the Quality of Life in Epilepsy-31 Inventory (QOLIE-31) overall score 1 year after ATL in 77 consecutive patients with unilateral MTLE-HS.



The overall QOLIE-31 score and all its subscale scores increased significantly (p < 0.0001) 1 year after ATL. In the final logistic regression model, absence of presurgical diagnosis of depression (adjusted odds ratio [OR] 4.4, 95% confidence interval [CI] 1.1-16.1, p = 0.02) and a complete postoperative seizure control (adjusted OR 4.1, 95% CI 1.2-14.5, p = 0.03) were independently associated with improvement equal to or greater than the MCIC in QOL after ATL. The overall model accuracy for MCIC improvement in the QOL was 85.6%, with a 95.2% of sensitivity and 46.7% of specificity.



These results in Brazilian patients reinforce the external validation of previous findings in Canadian patients showing that presurgical depression and complete seizure control after surgery are independent predictors for meaningful improvement in QOL after ATL, and have implications for the surgical management of MTLE patients.
Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.|Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.
Carla
C
Pauli
Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.|Psychiatric Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil.
Marcelo Liborio
ML
Schwarzbold
Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.|Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.|Psychiatric Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil.
Alexandre Paim
AP
Diaz
Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.
Maria Emilia Rodrigues
MER
de Oliveira Thais
Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.|Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.|Department of Surgery, HU, UFSC, Florianópolis, Santa Catarina, Brazil.
Charles
C
Kondageski
Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.|Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.|Department of Surgery, HU, UFSC, Florianópolis, Santa Catarina, Brazil.
Marcelo Neves
MN
Linhares
Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.|Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.|Psychiatric Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil.
Ricardo
R
Guarnieri
Center for Epilepsy Surgery of Santa Catarina State (CEPESC), Governador Celso Ramos Hospital (HGCR), Florianópolis, Santa Catarina, Brazil.|Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.
Bianca
B
de Lemos Zingano
Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.
Juliana
J
Ben
Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.|Laboratory of Neuropathology, Pathology Division, HU, UFSC, Florianópolis, Santa Catarina, Brazil.
Jean Costa
JC
Nunes
University of Bielefeld, Bielefeld, Germany.
Hans Joachim
HJ
Markowitsch
Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.|Neurology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil.|Danish Epilepsy Centre, Dianalund, Denmark.
Peter
P
Wolf
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Samuel
S
Wiebe
Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.|Neurology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil.
Katia
K
Lin
Center for Applied Neurosciences (CeNAp), University Hospital (HU), Federal University of Santa Catarina State (UFSC), Florianópolis, Santa Catarina, Brazil.|Neurology Division, Department of Internal Medicine, HU, UFSC, Florianópolis, Santa Catarina, Brazil.
Roger
R
Walz
D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000523:psychology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000523:psychology; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D012598:Sclerosis; D055815:Young Adult
Epilepsy surgery; Mesial temporal lobe epilepsy; Predictors; Quality of life