The effect of epilepsy surgery on productivity: A systematic review and meta-analysis

Surgical Treatments, Devices, and Nonmedical Management of Epilepsy

OBJECTIVE

Many patients with epilepsy are unable to achieve optimal seizure control with medical therapy. This article focuses on surgical approaches, dietary therapies, and seizure detection devices.

LATEST DEVELOPMENTS

For more than a century, resective epilepsy surgery has been a treatment option for some patients with drug-resistant epilepsy. Other surgical options have emerged for patients for whom resection is not possible or is associated with unacceptable risks, including minimally invasive epilepsy surgery and neurostimulation therapies. Dietary therapies, such as the ketogenic diet, can also help improve seizure control, especially in children. For patients with ongoing nocturnal convulsive seizures, seizure detection devices can alert caregivers and potentially reduce the risk of sudden unexpected death in epilepsy (SUDEP).

ESSENTIAL POINTS

Patients with drug-resistant epilepsy should be referred to comprehensive epilepsy centers to determine if they qualify for nonpharmacologic treatment options to reduce the risk of seizures and premature death and improve quality of life.

Determinants of health-related quality of life of patients with focal epilepsy: A systematic literature review

OBJECTIVE

Focal epilepsy can have significant negative impacts on a person's health-related quality of life (HRQoL). Although studies have been published on HRQoL in persons with focal epilepsy (PWFE), determinants of HRQoL have not been comprehensively examined. This systematic literature review (SLR) queried existing literature to identify aspects associated with HRQoL in PWFE without focus on resective epilepsy surgery, with an interest in identifying modifiable determinants for medical/nonmedical interventions.

METHODS

This SLR was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted in PubMed and Google Scholar for articles published from January 1, 1900, to February 19, 2023, reporting on the association between HRQoL or employability and a range of demographic, psychosocial, or epilepsy-related factors and comorbidities in PWFE.

RESULTS

A total of 879 abstracts were identified, with 126 manuscripts reviewed and 37 studies selected for inclusion that quantified the relationship between HRQoL and the variable of interest by multivariate (N = 21) or univariate only (N = 15) methods; 10 multivariate models also included univariate data. In adjusted models, the most commonly examined determinants of HRQoL included depression (n = 15/21), number of antiseizure medications (ASMs; n = 13/21), seizure frequency (continuous seizure count, n = 11/21; seizure freedom, n = 5/21), anxiety (n = 10/21), duration of disease (n = 9/21), and cognition (n = 9/21). Depression, anxiety, and cognition were frequently seen as significant contributors to HRQoL when studied (14/15 [93%], 9/10 [90%], and 7/9 [78%], respectively). Among concepts studied less frequently, ASM severity/adverse event burden was significant each time examined (in 5/19 studies). Attainment of seizure freedom and employability was significant 75% (n = 3/4) and 72% (n = 5/7) of the time, respectively.

SIGNIFICANCE

Poor HRQoL in PWFE can be attributed to a multitude of factors, including depression, anxiety, factors in disease management, and employability. An unmet need remains in addressing elements associated with poor HRQoL in this population.

Presenteeism in people with previous and current epilepsy: Determinants and psychosocial associations

OBJECTIVE

We examined people with epilepsy (PWE) regarding presenteeism, an aspect of reduced work productivity due to health-related issues despite physical presence, with a focus on epilepsy treatment and psychosocial factors.

METHODS

We used data from 32,000 participants aged 16-83 years old that were obtained through a 2024 nationwide internet survey. The Work Functioning Impairment Scale, which measures "presenteeism," was used to compare participants with and without a history of epilepsy. Odds ratios for presenteeism were calculated using univariable and multivariable analyses with two models based on sociodemographic and health-related variables. Propensity score matching was applied to equate groups with and without epilepsy in health-related variables.

RESULTS

Among 29,268 participants with valid responses, those with current epilepsy (n = 351) and in remission (n = 429) exhibited significantly higher presenteeism (p < 0.0001) and psychological distress (p < 0.0001) versus participants without epilepsy (n = 28,488). Multivariable analysis confirmed current epilepsy was independently associated with higher presenteeism (odds ratio: 2.61; 95 % confidence interval: 2.05-3.33, p < 0.0001) in the sociodemographic model. After propensity score matching of 277 non-epilepsy and epilepsy participants, presenteeism remained significantly higher in current epilepsy patients versus those without (44.0 % vs. 28.2 %, p < 0.0001). When further adjusted for psychological disorders, the difference in presenteeism became negligible (46.2 % vs. 44.0 %, p = 0.716).

SIGNIFICANCE

This cross-sectional study confirms significant presenteeism in PWE, which persists even in remission cases. This suggests that multiple causal conditions, rather than epileptic activity itself, affect presenteeism. As the epilepsy effect on presenteeism substantially decreases when accounting for psychological disorders, addressing these disorders may promote social productivity in PWE.

Thalamic stereoelectroencephalography for neuromodulation target selection: Proof of concept and review of literature of pulvinar direct electrical stimulation

In patients with drug-resistant epilepsy (DRE) who are not candidates for resective surgery, various thalamic nuclei, including the anterior, centromedian, and pulvinar nuclei, have been extensively investigated as targets for neuromodulation. However, the therapeutic effects of different targets for thalamic neuromodulation on various types of epilepsy are not well understood. Here, we present a 32-year-old patient with multifocal bilateral temporoparieto-occipital epilepsy and bilateral malformations of cortical development (MCDs) who underwent bilateral stereoelectroencephalographic (SEEG) recordings of the aforementioned three thalamic nuclei bilaterally. The change in the rate of interictal epileptiform discharges (IEDs) from baseline were compared in temporal, central, parietal, and occipital regions after direct electrical stimulation (DES) of each thalamic nucleus. A significant decrease in the rate of IEDs (33% from baseline) in the posterior quadrant regions was noted in the ipsilateral as well as contralateral hemisphere following DES of the pulvinar. A scoping review was also performed to better understand the current standpoint of pulvinar thalamic stimulation in the treatment of DRE. The therapeutic effect of neuromodulation can differ among thalamic nuclei targets and epileptogenic zones (EZs). In patients with multifocal EZs with extensive MCDs, personalized thalamic targeting could be achieved through DES with thalamic SEEG electrodes.