Study illustrates QOL benefits of epilepsy surgery in children

A joint Australian-US study has shown that epilepsy surgery improves the QOL of children rendered seizure-free.The prospective study included 35 children recruited from two Sydney hospitals (Sydney Children's Hospital and Childrens Hospital at Westmead) and one hospital in the United States (Miami Children's Hospital). Parents of the children completed the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE) before the operation and again 6 to 18 months after surgery. The QOLCE is a parent-rating instrument developed by the authors to assess aspects such as physical function, social function, emotional wellbeing, cognition and behaviour. At each assessment, parents also indicated the severity and frequency of their child's seizures.After surgery, 20 patients became seizure-free, four patients experienced a reduction in seizure frequency and severity, one patient experienced a reduction in severity, and the remainder either experienced an increase in seizure frequency of no change in frequency and/or severity. To analyse the effect of the surgery outcome on the patient's quality of life, the patients were divided into two groups: those who were rendered seizure-free and those who continued to have seizures. The authors found that quality of life improved to a greater extent in children rendered seizure-free compared to those with persistent seizures. They found that the difference was significant for overall QOL score and for the various subscales. Areas where improvement was particularly noted included attention, language, social interactions, social activities, stigma, anxiety, control/helplessness, self-esteem, physical restrictions, energy/fatigue, behaviour, and general health.The authors note that changes in quality of life scores were restricted to those children who experienced seizure freedom as a result of surgery, which is consistent with data on adults. They explain, "Children who continued to experience seizures postoperatively did not show any significant improvements despite 5 of the 15 children in this group experiencing a reduction in seizure burden. Studies on adults have found that seizure freedom is necessary to improve QUL and that reduction without absence of seizures postoperatively is insufficient for improving QOL."Reference...