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Worsening of quality of life after epilepsy surgery

Effect of seizures and memory decline

From the Department of Neurology (J.T.L.), University of Rochester, NY; the Departments of Neurosurgery (M.W.), Psychiatry and Epidemiology (D.V.C.), and Neurology (S.S.S.), Yale University, New Haven, CT; the Department of Neurology (M.J.H.), Columbia University, New York, NY; Minnesota Comprehensive Epilepsy Program (T.S.W.), Minneapolis; the Department of Biology (A.T.B.), Northern Illinois University, DeKalb; the Department of Neurology, University of California Los Angeles (B.G.V.); the Department of Neurology (W.B.B.), New York University, New York; the Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA; and the Department of Neurology (D.M.), Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.

Address correspondence and reprint requests to Dr. John T. Langfitt, University of Rochester, 601 Elmwood Avenue, Box 673, Rochester, NY 14642 john_langfitt{at}urmc.rochester.edu

Background: Surgery for intractable temporal lobe epilepsy usually controls seizures and improves health-related quality of life (HRQOL), but some patients experience continued seizures, memory decline, or both. The relative impact of these unfavorable outcomes on HRQOL has not been described.

Methods: We studied seizure control, memory change, and HRQOL among 138 patients in the Multicenter Study of Epilepsy Surgery (MSES), an ongoing, prospective study of epilepsy surgery outcomes. Seizure remission at 2 years and 5 years was prospectively determined based upon regularly scheduled follow-up calls to study patients throughout the follow-up period. HRQOL was assessed annually using the Quality of Life in Epilepsy Inventory (QOLIE-89). Memory decline was determined by change in verbal delayed recall from baseline to the 2- or 5-year follow-up.

Results: HRQOL improved in patients who were in remission at the 2-year or 5-year follow-up, regardless of memory outcome. Among those not in remission at both 2 and 5 years (25/138, 18%), HRQOL remained stable when memory did not decline (14/138, 10%), but HRQOL declined when memory did decline (11/138, 8%). These 11 patients had baseline characteristics predictive of poor seizure or memory outcome. Declines were most apparent on HRQOL subscales assessing memory, role limitations, and limitations in work, driving, and social activities.

Conclusions: After temporal resection, health-related quality of life (HRQOL) improves or remains stable in seizure-free patients despite memory decline, but HRQOL declines when persistent seizures are accompanied by memory decline. These results may be useful in presurgical counseling and identifying patients at risk for poor psychosocial outcome following surgery.

Editorial, see page 1967

Presented in part at the annual meeting of the American Epilepsy Society; Washington, DC; December 2005.

Supported by RO1 NS32375 (National Institute of Neurological Disorders and Stroke) and RO1 HS09986 (Agency for Healthcare Research and Quality).

Disclosure: The authors report no conflicts of interest.

Received November 6, 2006. Accepted in final form March 1, 2007.

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