How Much Improvement in Quality of Life Must Patients Have for Epilepsy Therapies to Be Worthwhile?
Abstract number :
2.206
Submission category :
Year :
2000
Submission ID :
2559
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Samuel Wiebe, Suzan M Matijevic, Univ of Western Ontario, London, ON, Canada; London Health Science Ctr, London, ON, Canada.
RATIONALE: There is no notion of how much improvement in quality of life (QOL) patients must have for surgery or other epilepsy therapies to be judged worthwhile. This is referred to as minimum clinically important change (MCIC). We hypothesised that patients can specify MCICs afforded by different therapies; that a moderate amount of improvement (4 in scale 1-7) is considered as MCIC in general; and that more intensive therapies (surgery) require larger MCICs than less intensive therapies (antiepileptic drugs (AEDs)). METHODS: We drew upon 2 cohorts: 1) Temporal lobe epilepsy surgery patients, and 2) Outpatients contemplating a change of AEDs. MCIC afforded by surgery and AEDs was rated by patients from 1 = none, to 7 = a very great deal better. Surgical patients also self-rated change in overall QOL, seizure severity, work/social activities, general health and drug adverse effects at 9, 12 and 24 months after surgery. RESULTS: MCICs from AEDs were higher in outpatients (5 = a good deal better) than in surgical patients (3 = somewhat better), especially in work/social activities (p = 0.04). Outpatients' MCICs from AEDs were also higher than surgical patients MCICs from surgery, particularly in work/social activities and overall QOL (p = 0.002). Overall, MCIC from surgery was 3 (somewhat better), which is lower than observed, self-rated improvement (5.5). Surgical patients had similar MCICs from surgery and AEDs (3 to 4). CONCLUSIONS: We confirmed that epilepsy patients can specify various MCICs for different therapies. Overall, MCIC ranges from 3 to 5. However, MCICs seem more dependent on patient population than on type of intervention. Outpatients with milder epilepsy require higher MCICs than surgical candidates with more severe epilepsy. Outpatients specify particularly high MCICs for work/social activities. Contrary to our hypothesis, surgical candidates require similar MCICs from surgery and AEDs (3 to 4). Surgical patients' self-rated postoperative improvement significantly exceeded their specified MCIC for surgery in all areas, eg., overall QOL, general health perception, seizure severity, work/social activities, and drug adverse events.