Quality of life of people with epilepsy following temporal lobectomy: a preliminary report

The impact of epilepsy surgery on cognition and behavior

Famous historical cases and current clinical experience clearly indicate that the success of epilepsy surgery cannot be judged with the basic algorithm "fewer seizures = better outcome." Many factors combine and entwine with the experience of medically intractable seizures to create associated patterns of behavior and cognition. Obtaining freedom from seizures does not automatically undo the historical tangle of these salient factors, many of which remain or are exacerbated after surgery. This review examines the preoperative, perioperative, and postoperative factors that influence postoperative cognition and behavior in adult patients with temporal lobe epilepsy. Consistent findings from group studies have long masked the considerable individual variations in cognitive and behavioral outcomes following surgery. Although more recent multivariate studies provide useful clinical data for prospective surgical candidates, comprehensive long-term follow-up studies are rare. We have certainly become more proficient at measuring both cognitive and behavioral outcomes following surgery, although the ecological validity of many follow-up measures, particularly in the cognitive domain, remains low. A reliance on test scores can mask significant differences in strategy, which can also be used as a sign of lateralized dysfunction. A shift away from the "can do versus can't do" approach to the assessment of cognitive strategies may hold the key to more meaningful pre- and postoperative cognitive assessments from the patient's perspective. Emergent functional imaging paradigms show much promise in this regard. A renewed focus on cognitive strategies may also be useful in planning postoperative rehabilitation programs. New directions for outcome research in epilepsy surgery are suggested with an emphasis on a patient-centered approach.

Normalization of Quality of Life Three Years after Temporal Lobectomy: A Controlled Study

PURPOSE

The goal of epilepsy surgery is not merely to control previously intractable seizures, but also to improve quality of life (QOL). Our goals were to assess, in our Middle Eastern population, the QOL of adults with temporal lobe epilepsy (TLE) 3 years after temporal lobectomy as compared with matched TLE patients who did not undergo surgery and with healthy individuals in the same community.

METHODS

Twenty consecutive TLE patients who underwent temporal lobectomy 3 years previously were matched in the following variables: age, sex, seizure frequency, seizure duration, age at onset of epilepsy, duration of epilepsy, and number of medications, with 17 TLE patients who underwent the presurgical evaluation and subsequent optimization of medical therapy but did not undergo surgery. They were also matched for age, sex, educational level, income, and residence with 20 healthy individuals. All groups were interviewed by using the ESI-55 questionnaire.

RESULTS

Compared with the nonsurgery group, QOL was significantly better in the surgery group (85% seizure free) in the well-being, functioning, and role-limitation domains. QOL was similar in the surgery and healthy control groups in all domains and scales. The nonsurgery group scored significantly lower than healthy controls in the functioning and role-limitation domains.

CONCLUSIONS

Intractable TLE was associated with marked impairments in QOL despite continued attempts to optimize medical therapy. Three years after temporal lobectomy QOL in our patient population achieved levels similar to those of matched healthy individuals. To our knowledge, this is the first study to report normalization of QOL after temporal lobectomy, in any population.

Gamma Knife Surgery in Mesial Temporal Lobe Epilepsy: A Prospective Multicenter Study

PURPOSE

This article is the first prospective documentation of the efficacy and safety of gamma knife surgery (GKS) in the treatment of drug-resistant epilepsies of mesial temporal lobe origin.

METHODS

From July 1996 to March 2000, three European centers selected 21 patients with mesial temporal lobe epilepsy (MTLE) for a temporal lobectomy. The preoperative investigations included video-EEG with foramen ovale electrodes, magnetic resonance imaging, neuropsychological testing, and the ESI-55 quality-of-life questionnaire. In place of a cortectomy, radiosurgical treatment was performed by using the Leksell Gamma Knife (LGK) at a dose of 24 +/- 1 Gy at the margin. The target included the anterior parahippocampal cortex and the basal and lateral part of the amygdala and anterior hippocampus (head and body). One patient (a heavy smoker) died of a myocardial infarction. Twenty patients were available for prospective evaluation. A minimum 2-year follow-up period included clinical, neuropsychological, and radiologic evaluations.

RESULTS

At each 6-month follow-up evaluation, the frequency of seizures was significantly smaller than that at the previous visit. The median seizure frequency of 6.16 the month before treatment was reduced to 0.33 at 2 years after treatment. At 2 years, 65% of the patients (13 of 20) were seizure free. Five patients had transient side effects, including depression, headache, nausea, vomiting, and imbalance. There was no permanent neurological deficit reported except nine visual field deficits. No neuropsychological deterioration was observed 2 years after treatment. The quality of life was significantly better than that before surgery.

CONCLUSIONS

The safety and efficacy of the radiosurgical treatment of MTLEs appears good in this group of patient over short-to-middle term. Delay of the seizure cessation was the major disadvantage of GKS. A longer follow-up period is required for confirmation of these results.

Effects of epilepsy surgery on quality of life: a controlled study in a Middle Eastern population

The purpose of this study was to investigate which areas of quality of life (QOL) change after epilepsy surgery and generate QOL data specific to the Lebanese population. The QOL of 20 consecutive patients 1 year after surgery was compared (using the ESI-55 scale) with that of 20 matched patients who underwent the same presurgical evaluation, but no surgery. Overall QOL improved in both groups, but was greater in the surgery group (85% seizure free as compared to 0% in nonsurgery group). Significant differences were noted within the "well-being" domain including health perception (5/9 items), energy-fatigue (2/4), and emotional well-being (2/5). Differences were less common in the "functioning" domain including physical (1/10 items), social (1/2), and cognitive (0/5) functioning scales, and in the role limitation domain (1/17 items). Our patients experienced, 1 year after epilepsy surgery, improvements similar to those reported in Western populations after a similar period: they had marked improvements in overall QOL, health perception, well-being, and cognitive functioning areas. They had less remarkable improvements in social functioning and role limitation areas.