Renato Endler Iachinski1, Murilo Sousa de Meneses2, Cristiane Andréia Simão3, Samanta Fabricio Blattes da Rocha4, Flávia de Oliveira Braga1, Pedro André Kowacs5. 1. Neurology Department, Curitiba Neurology Institute, Curitiba, Brazil. 2. Epilepsy Surgery Unit, Curitiba Neurology Institute, Curitiba, Brazil. 3. Epilepsy Clinic and Video-EEG Monitoring Unit, Curitiba Neurology Institute, Curitiba, Brazil. 4. Epilepsy Surgery Unit, Curitiba Neurology Institute, Curitiba, Brazil; Epilepsy Clinic and Video-EEG Monitoring Unit, Curitiba Neurology Institute, Curitiba, Brazil; Neuropsychology Unit, Curitiba Neurology Institute, Curitiba, Brazil. 5. Neurology Department, Curitiba Neurology Institute, Curitiba, Brazil; Epilepsy Surgery Unit, Curitiba Neurology Institute, Curitiba, Brazil; Epilepsy Clinic and Video-EEG Monitoring Unit, Curitiba Neurology Institute, Curitiba, Brazil. Electronic address: pkowacs@gmail.com.
Abstract
PURPOSE: The aim of this study was to investigate not only the effectiveness of epilepsy surgery in improving seizure control but also patient satisfaction with the result of the procedure in a sample of patients operated on at a specialized epilepsy unit. METHODS: Patients with temporal lobe epilepsy who had undergone epilepsy surgery (temporal lobectomy/amygdalohippocampectomy) were interviewed in a standardized telephone survey about their satisfaction with the results of the surgery. The morbidity of the surgery was also analyzed retrospectively. The initial study population consisted of 6 amygdalohippocampectomy and 102 temporal lobectomy patients and was reduced to a final sample consisting of 4 amygdalohippocampectomy and 67 lobectomy patients, as the other patients were not available for interview. Surgical results were based on the Engel classification, and satisfaction with the surgery was assessed by asking patients to rate their result and state whether they would make the same decision (to be operated on) again. RESULTS: A significant number of patients classified as Engel I or II, who considered the surgical outcome good or excellent, said they would have the surgery again (p<0.001). Left temporal lobectomy patients whose results fell in the Engel III/IV bracket were less satisfied (p=0.001) than right temporal lobectomy patients with the same Engel classifications (0.048). Left temporal lobectomy patients who were classified as Engel class III and IV were less likely to have the surgery again if they had the choice (p=0.016). DISCUSSION: Patient satisfaction with the results of epilepsy surgery may depend not only on achieving seizure control but also on the temporal lobe resected. Since worse results were associated with lower satisfaction rates only for left temporal resection patients, it is possible that the cognitive consequences of this procedure compound the worse surgical result, leading to decreased satisfaction.
PURPOSE: The aim of this study was to investigate not only the effectiveness of epilepsy surgery in improving seizure control but also patient satisfaction with the result of the procedure in a sample of patients operated on at a specialized epilepsy unit. METHODS:Patients with temporal lobe epilepsy who had undergone epilepsy surgery (temporal lobectomy/amygdalohippocampectomy) were interviewed in a standardized telephone survey about their satisfaction with the results of the surgery. The morbidity of the surgery was also analyzed retrospectively. The initial study population consisted of 6 amygdalohippocampectomy and 102 temporal lobectomy patients and was reduced to a final sample consisting of 4 amygdalohippocampectomy and 67 lobectomy patients, as the other patients were not available for interview. Surgical results were based on the Engel classification, and satisfaction with the surgery was assessed by asking patients to rate their result and state whether they would make the same decision (to be operated on) again. RESULTS: A significant number of patients classified as Engel I or II, who considered the surgical outcome good or excellent, said they would have the surgery again (p<0.001). Left temporal lobectomy patients whose results fell in the Engel III/IV bracket were less satisfied (p=0.001) than right temporal lobectomy patients with the same Engel classifications (0.048). Left temporal lobectomy patients who were classified as Engel class III and IV were less likely to have the surgery again if they had the choice (p=0.016). DISCUSSION: Patient satisfaction with the results of epilepsy surgery may depend not only on achieving seizure control but also on the temporal lobe resected. Since worse results were associated with lower satisfaction rates only for left temporal resection patients, it is possible that the cognitive consequences of this procedure compound the worse surgical result, leading to decreased satisfaction.
Authors: J S Gofshteyn; T Le; S Kessler; R Kamens; C Carr; W Gaetz; L Bloy; T P L Roberts; E S Schwartz; E D Marsh Journal: Epilepsy Res Date: 2019-06-17 Impact factor: 3.045