Quality of life linked more to seizures than memory after epilepsy surgery

Surgery for intractable temporal lobe epilepsy can eliminate seizures in 60 to 85% of people with significant improvement in their quality of life, comments Dr John Langfitt (University of Rochester, New York) and colleagues in their paper published in Neurology. However, the authors note that some patients experience continued seizures, memory decline, or both.To investigate the quality of life impact of surgery and possible unfavourable outcomes Dr Langfitt's group enrolled 138 patients. All participants had received surgery for temporal lobe epilepsy and were followed for five years.Overall, 56% of patients were free of seizures after surgery with a further 26% free of seizures at either two or five years after surgery, but not both. The remaining 18% still had seizures at both two and five years after the surgery (n=25/138).Annual assessments of health-related quality of life improved in patients who were in remission at the two year or five year follow-up, regardless of memory outcome. For patients continuing to experience seizures but without memory loss, quality of life scores remained stable (n=14/138). However, for those with continuing seizures and memory loss quality of life scores declined (n=11/138).The authors point out that these 11 patients had baseline characteristics predictive of poor seizure or memory outcome, such as; dominant hemisphere resection, lower baseline IQ, later age of epilepsy onset and shorter duration of epilepsy.Langfitts group concludes, "After temporal resection, health-related quality of life improves or remains stable in seizure-free patients despite memory decline, but [quality of life] declines when persistent seizures are accompanied by memory decline".The authors suggest that these findings may be useful in counselling patients about the potential risks and benefits of surgery. "It also suggests that patients at high risk for these negative outcomes should be counselled carefully before surgery and followed closely in the postoperative period, as they may be at increased risk for poor adjustment due to negative outcomes," they add.Reference...