Trajectory of Health-Related Quality of Life after Pediatric Epilepsy Surgery

Elysa Widjaja, Klajdi Puka, Kathy N. Speechley, Mark A. Ferro, Mary B. Connolly, Philippe Major, Anne Gallagher, Salah Almubarak, Simona Hasal, Rajesh Ramachandrannair, Andrea Andrade, Qi Xu, Edward Leung, O. Carter Snead, Mary Lou Smith

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5 Scopus citations

Abstract

IMPORTANCE Health-related quality of life (HRQOL) is regarded as a key outcome for evaluating treatment efficacy. However, it is uncertain how HRQOL evolves after epilepsy surgery compared with medical therapy, such as whether it continues to improve over time, improves and then remains stable, or deteriorates after a period of time. OBJECTIVE To assess trajectory of HRQOL over 2 years in children with drug-resistant epilepsy (DRE) treated with surgery compared with medical therapy. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study assessing HRQOL longitudinally over 2 years. Participants were children recruited from 8 epilepsy centers in Canada from 2014 to 2019 with suspected DRE aged 4 to 18 years who were evaluated for surgery. Data were analyzed from May 2014 to December 2021. EXPOSURES Epilepsy surgery or medical therapy. MAIN OUTCOMES AND MEASURES HRQOL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55. HRQOL and seizure frequency were assessed at baseline, 6-month, 1-year, and 2-year follow-ups. Clinical, parent, and family characteristics were assessed at baseline. A linear mixed model was used to evaluate HRQOL over time, adjusting for baseline clinical, parent, and family characteristics. RESULTS There were 111 surgical and 154 medical patients (mean [SD] age at baseline was 11.0 [4.1] years; 118 [45%] were female). At baseline, HRQOL was similar among surgical and medical patients. HRQOL of surgical patientswas 3.0 (95%CI, -0.7 to 6.8) points higher at 6-month, 4.9 (95%CI, 0.7 to 9.1) points higher at 1-year, and 5.1 (95%CI, 0.7 to 9.5) points higher at 2-year follow-ups compared with medical patients. Surgical patients experienced greater improvements in social functioning relative to medical patients, but not for cognitive, emotional, and physical functioning. At 2-year follow-up, 72%of surgical patients were seizure-free, compared with 33%of medical patients. Seizure-free patients reported higher HRQOL than those who were not. CONCLUSIONS AND RELEVANCE This study provided evidence on the association between epilepsy surgery and children's HRQOL, with improvement in HRQOL occurring within the first year and remaining stable 2 years after surgery. By demonstrating that surgery improved seizure freedom and HRQOL, which has downstream effects such as better educational attainment, reduced health care resource utilization, and health care cost, these findings suggest that the high costs of surgery are justified, and that improved access to epilepsy surgery is necessary.

Original languageEnglish (US)
Article numbere234858
JournalJAMA network open
Volume6
Issue number3
DOIs
StatePublished - Mar 27 2023

ASJC Scopus subject areas

  • General Medicine

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