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From the Department of Neurology (Dr. Spencer), Yale University School of Medicine, New Haven, CT; BIOS (Dr. Berg), NIU, DeKalb, IL; Department of Neurology (Dr. Vickrey), University of California, Los Angeles; Department of Neurology (Dr. Sperling), Thomas Jefferson University Medical School, Philadelphia, PA; Department of Neurology (Dr. Bazil), Columbia University Medical School, New York, NY; Departments of Neurology and Pediatrics (Dr. Shinnar), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology (Dr. Langfitt), University of Rochester School of Medicine, Rochester, NY; Minnesota Comprehensive Epilepsy Program (Dr. Walczak), Minneapolis; Department of Neurology (Dr. Pacia), New York University School of Medicine, New York; and Division of Statistics (Drs. Ebrahimi and Frobish), Northern Illinois University, Dekalb.
Address correspondence and reprint requests to Dr. Susan S. Spencer, Yale School of Medicine, P.O. Box 208018, New Haven, CT 06520-8018; e-mail: susan.spencer{at}yale.edu
Objective: To obtain prospective data regarding seizures, anxiety, depression, and quality of life (QOL) outcomes after resective epilepsy surgery.
Methods: The authors characterized resective epilepsy surgery patients prospectively at yearly intervals for seizure outcome, QOL, anxiety, and depression, using standardized instruments and patient interviews.
Results: Of 396 patients who underwent resective surgical procedures, 355 were followed for at least 1 year. Of these, 75% achieved a 1-year remission at some time during follow-up; patients with medial temporal (77%) were more likely than neocortical resections (56%) to achieve remission (p = 0.01). Relapse occurred in 59 (22%) patients who remitted, more often in medial temporal (24%) than neocortical (4%) resected patients (p = 0.02). QOL, anxiety, and depression all improved dramatically within 3 months after surgery (p < 0.0001), with no significant difference based on seizure outcome. After 3 months, QOL in seizure-free patients further improved gradually, and patients with seizures showed gradual declines. By 12 and 24 months, overall QOL and its epilepsy-targeted and physical health domains were significantly different in the two outcome groups. (Anxiety and depression scores also gradually diverged, with improvements in seizure-free and declines in continued seizure groups, but differences were not significant.)
Conclusion: Resective surgery for treatment of epilepsy significantly reduces seizures, most strikingly after medial temporal resection (77% 1 year remission) compared to neocortical resection (56% 1 year remission). Resective epilepsy surgery has a gradual but lasting effect on QOL, but minimal effects on anxiety and depression. Longer follow-up will be essential to determine ultimate seizure, QOL, and psychiatric outcomes of epilepsy surgery.
Received February 20, 2003. Accepted in final form July 18, 2003.
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