(Abst. 3.249 ), 2013
LONG-TERM POST-OPERATIVE PSYCHOSOCIAL OUTCOMES AFTER RESECTIVE SURGERY FOR EPILEPSY
Authors: V. Wasade, R. Tahir, L. R. Schultz, B. Smith, K. Elisevich, J. Schwalb, M. Spanaki
Resective surgery is an effective treatment for refractory epilepsy with commonly reported seizure and psychosocial outcomes for 2-5 years post-surgery. In this study, which is an extension of our previous study (AES 2012, platform C.07) we present post-surgical psychosocial outcomes in patients with long-term follow up and correlate those with seizure outcomes and site of surgery.
We identified epilepsy patients who had resections at the Henry Ford Epilepsy Program between 1993 and 2011. We collected demographics, age at epilepsy onset and surgery, seizure frequency before surgery, and pathology. We conducted phone surveys from May 2012 to January 2013 to assess current seizure frequency and psychosocial metrics (driving, employment and use of anti-depressants). We used Engel’s classification for post surgical outcomes. We applied McNemar’s, chi-square, two sample t-tests and Wilcoxon two sample tests to assess the differences.
We identified 470 patients with resective surgery, 50 (11%) of whom deceased since the surgery. Of the remaining 420, 253 (60%) were contacted. Mean age at the time of the survey was 46.2±13.3 y, at epilepsy onset was 15.7±13.9 y and at surgery 35.7±13.3 y. The mean delay between epilepsy onset and surgery was 20.5±13.2 y, and follow up was obtained at 10.6 ± 5.0 y (27% patients had follow up of 15 years or longer). Of the 253 patients surveyed, 82 patients (32%) were seizure free and 189 (75%) had a favorable outcome (Class I and II) (table 1). Temporal resection was done in 215 patients (85%) with significant favorable outcomes (78% temporal vs 58% extratemporal, p=0.01). Compared to before surgery, patients were more likely to be currently driving (51% vs 35%, p<0.001), but were less likely to be currently working full-time (23% vs 42%, p<0.001). After surgery more patients used anti-depressants (30% vs 22%, p=0.013).The difference in current full-time employment was significantly higher in temporal resections compared to extratemporal (45% vs 26%, p=0.006). Patients with favorable outcomes were more likely to be currently driving (65% vs 11%, p<0.001), currently employed (28% vs 8%, p<0.001) and less likely to be currently taking anti-depressants (24% vs 47%, p<0.001) compared to those without favorable outcomes. Regardless the site of surgery, 92% considered epilepsy surgery worthwhile. There was a significant difference in satisfaction with surgery between those with and without favorable outcomes (98% vs 74%, p<0.001).
Our study shows that resective epilepsy surgery not only yields favorable postsurgical seizure outcomes but psychosocial outcomes, as well. Following surgery, more patients were able to drive, and those with favorable seizure outcomes were more likely to be employed full-time and less likely to be taking anti-depressants. Overall, the great majority of patients expressed satisfaction in having epilepsy surgery.
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