TY - JOUR
T1 - Impact of resective epilepsy surgery on health-related quality of life in children with and without low intellectual ability
AU - Conway, Lauryn
AU - Widjaja, Elysa
AU - Smith, Mary Lou
N1 - Funding Information:
The study was funded by a grant from the Canadian Institutes of Health Research ( MOP-133708 ) to Dr. Widjaja and Dr. Smith and by funding to Dr. Smith from EpLink – The Epilepsy Research Program of the Ontario Brain Institute (OBI). The OBI is an independent nonprofit corporation, funded partially by the Ontario government. The opinions, results, and conclusions are those of the authors, and no endorsement by the Ontario Brain Institute is intended or should be inferred. Ms. Conway is supported by a doctoral fellowship from the Social Sciences and Humanities Research Council. We thank Hala Shamsi for her assistance with the database.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/6
Y1 - 2018/6
N2 - Objective: The current study examined pre- and postoperative health-related quality of life (HRQL) across children with and without low intellectual ability. We also aimed to clarify the literature on postsurgical change by assessing domain-specific HRQL pre- and postoperatively in children with drug-resistant epilepsy. Method: All patients (n = 111) underwent resective epilepsy surgery between 1996 and 2016 at the Hospital for Sick Children in Toronto, comparing baseline and 1-year follow-up HRQL with the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-76). At the group-level, postsurgical change in HRQL was examined through linear mixed-effects modeling. Clinically important change in HRQL at the individual level was quantified using a standard error of measurement (SEM)-based criterion, and estimates were stratified by intellectual ability. Results: Children with epilepsy and low intellectual ability had lower overall HRQL compared with those with normal intelligence (b = − 10.45, SE = 4.89, p = .035). No differences in change in HRQL related to intellectual level were found. In the broader sample, significant postoperative improvements were found for HRQL related to physical activity (b = 8.28, SE = 1.79, p < .001), social activity (b = 15.81, SE = 2.76, p < .001), and behavior (b = 4.34, SE = 1.35, p = .001). Postoperative improvements in physical and social HRQL were associated with better seizure control (p = .011). Conversely, cognitive and emotional domains of HRQL did not improve one year postoperatively, even in the presence of improved seizure control. Significance: Results suggest that children with low intellectual ability can expect to achieve similar improvements in HRQL after epilepsy surgery compared with those with normal intelligence. Further, while overall HRQL is shown to improve in children following epilepsy surgery, domain-specific change is nuanced and has important implications for health practitioners aiming to monitor treatment progress of patients.
AB - Objective: The current study examined pre- and postoperative health-related quality of life (HRQL) across children with and without low intellectual ability. We also aimed to clarify the literature on postsurgical change by assessing domain-specific HRQL pre- and postoperatively in children with drug-resistant epilepsy. Method: All patients (n = 111) underwent resective epilepsy surgery between 1996 and 2016 at the Hospital for Sick Children in Toronto, comparing baseline and 1-year follow-up HRQL with the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-76). At the group-level, postsurgical change in HRQL was examined through linear mixed-effects modeling. Clinically important change in HRQL at the individual level was quantified using a standard error of measurement (SEM)-based criterion, and estimates were stratified by intellectual ability. Results: Children with epilepsy and low intellectual ability had lower overall HRQL compared with those with normal intelligence (b = − 10.45, SE = 4.89, p = .035). No differences in change in HRQL related to intellectual level were found. In the broader sample, significant postoperative improvements were found for HRQL related to physical activity (b = 8.28, SE = 1.79, p < .001), social activity (b = 15.81, SE = 2.76, p < .001), and behavior (b = 4.34, SE = 1.35, p = .001). Postoperative improvements in physical and social HRQL were associated with better seizure control (p = .011). Conversely, cognitive and emotional domains of HRQL did not improve one year postoperatively, even in the presence of improved seizure control. Significance: Results suggest that children with low intellectual ability can expect to achieve similar improvements in HRQL after epilepsy surgery compared with those with normal intelligence. Further, while overall HRQL is shown to improve in children following epilepsy surgery, domain-specific change is nuanced and has important implications for health practitioners aiming to monitor treatment progress of patients.
KW - Developmental disability
KW - Domain-specific
KW - Pediatric epilepsy surgery
KW - Quality of life
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U2 - 10.1016/j.yebeh.2018.03.036
DO - 10.1016/j.yebeh.2018.03.036
M3 - Article
C2 - 29705622
AN - SCOPUS:85046090798
SN - 1525-5050
VL - 83
SP - 131
EP - 136
JO - Epilepsy and Behavior
JF - Epilepsy and Behavior
ER -