Jessica Winslow1, Bo Hu2, George Tesar3, Lara Jehi4. 1. Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: jwinslow.ccf@gmail.com. 2. Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: hub@ccf.org. 3. Psychiatry and Psychology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: tesarg@ccf.org. 4. Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: jehil@ccf.org.
Abstract
OBJECTIVE: This study investigated self-reported longitudinal quality of life (QOL) and symptoms of depression and anxiety in patients who had resective surgery. The study characterized the extent, sustainability, and longitudinal trajectory of psychosocial postsurgical outcomes. METHODS: This retrospective study included adults who underwent resective epilepsy surgery in Cleveland Clinic Epilepsy Center between 2008 and 2013. Clinic visits were between October 2007 and December 2014. Data studied were from visits prior to surgery, early postsurgery follow-up (mean: 0.9 years; range: 0.5 to 3.4), and most recent follow-up (mean: 3.2 years; range: 0.8 to 6.9). Patient demographics, clinical features, and surgical factors were collected. Analysis focused on self-reported quality of life (QOLIE-10), depression (PHQ-9), and anxiety (GAD-7). RESULTS: The study included 229 adults, of whom 178 had complete follow-up with data from all three time points. Following surgery, scores on Quality of life in epilepsy inventory (QOLIE-10), Patient health questionnaire (PHQ-9), and General anxiety disorder (GAD-7) improved significantly with time. After adjusting for gender, age, marital status, and type of surgery using linear modeling, the mean QOLIE-10 score decreased by 1.157 points/year, mean PHQ-9 score by 0.331 points/year, and mean GAD-7 score by 0.299 points/year. Improvement in QOL continued to be observed throughout the follow-up duration, whereas both depression and anxiety improved the most within the first postoperative year and then stabilized. Seizure freedom was strongly correlated with improved QOL (p = 0.001), while depressive symptoms showed a nonstatistically significant correlation with worse QOL (p = 0.07). Patients who underwent frontal resection had significantly superior QOL and depression symptom improvement compared with temporal resections during full data analysis (QOLIE-10, p = 0.024; PHQ-9, p = 0.027), but only significant depression symptom improvement on secondary analysis of complete follow-up patients only (PHQ, p = 0.040; QOL, p = 0.104). SIGNIFICANCE: This study provides a longitudinal perspective of QOL and psychological symptoms in patients with postresective epilepsy with a cohort with 38% extratemporal cases. Results illustrate positive trajectory of psychosocial outcomes postsurgery with early QOL and mood improvement, and years of further QOL gains. Frontal lobe surgery patients may have superior improvement in some psychosocial measures compared with temporal lobe surgery patients.
OBJECTIVE: This study investigated self-reported longitudinal quality of life (QOL) and symptoms of depression and anxiety in patients who had resective surgery. The study characterized the extent, sustainability, and longitudinal trajectory of psychosocial postsurgical outcomes. METHODS: This retrospective study included adults who underwent resective epilepsy surgery in Cleveland Clinic Epilepsy Center between 2008 and 2013. Clinic visits were between October 2007 and December 2014. Data studied were from visits prior to surgery, early postsurgery follow-up (mean: 0.9 years; range: 0.5 to 3.4), and most recent follow-up (mean: 3.2 years; range: 0.8 to 6.9). Patient demographics, clinical features, and surgical factors were collected. Analysis focused on self-reported quality of life (QOLIE-10), depression (PHQ-9), and anxiety (GAD-7). RESULTS: The study included 229 adults, of whom 178 had complete follow-up with data from all three time points. Following surgery, scores on Quality of life in epilepsy inventory (QOLIE-10), Patient health questionnaire (PHQ-9), and General anxiety disorder (GAD-7) improved significantly with time. After adjusting for gender, age, marital status, and type of surgery using linear modeling, the mean QOLIE-10 score decreased by 1.157 points/year, mean PHQ-9 score by 0.331 points/year, and mean GAD-7 score by 0.299 points/year. Improvement in QOL continued to be observed throughout the follow-up duration, whereas both depression and anxiety improved the most within the first postoperative year and then stabilized. Seizure freedom was strongly correlated with improved QOL (p = 0.001), while depressive symptoms showed a nonstatistically significant correlation with worse QOL (p = 0.07). Patients who underwent frontal resection had significantly superior QOL and depression symptom improvement compared with temporal resections during full data analysis (QOLIE-10, p = 0.024; PHQ-9, p = 0.027), but only significant depression symptom improvement on secondary analysis of complete follow-up patients only (PHQ, p = 0.040; QOL, p = 0.104). SIGNIFICANCE: This study provides a longitudinal perspective of QOL and psychological symptoms in patients with postresective epilepsy with a cohort with 38% extratemporal cases. Results illustrate positive trajectory of psychosocial outcomes postsurgery with early QOL and mood improvement, and years of further QOL gains. Frontal lobe surgery patients may have superior improvement in some psychosocial measures compared with temporal lobe surgery patients.
Authors: Jaivir S Rathore; Lara E Jehi; Youran Fan; Sima I Patel; Nancy Foldvary-Schaefer; Maya J Ramirez; Robyn M Busch; Nancy A Obuchowski; George E Tesar Journal: Epilepsy Behav Date: 2014-07-26 Impact factor: 2.937
Authors: Carla Pauli; Marcelo Liborio Schwarzbold; Alexandre Paim Diaz; Maria Emilia Rodrigues de Oliveira Thais; Charles Kondageski; Marcelo Neves Linhares; Ricardo Guarnieri; Bianca de Lemos Zingano; Juliana Ben; Jean Costa Nunes; Hans Joachim Markowitsch; Peter Wolf; Samuel Wiebe; Katia Lin; Roger Walz Journal: Epilepsia Date: 2017-03-23 Impact factor: 5.864