Abstracts

Rationale: People with seizures have a lower quality of life (QOL) compared to people with other chronic disease. Depression and anxiety scores strongly correlate with QOL scores in cross-sectional studies. However, the relationship between depression and anxiety symptoms and QOL outcomes after epilepsy surgery has not been explored with a prospective, longitudinal design. Methods: The design, measures, and subject recruitment of the Epilepsy Surgery Multicenter Study has been detailed elsewhere. Briefly, 7 tertiary epilepsy centers enrolled 396 patients and completed a comprehensive diagnostic workup that included a comprehensive medical history and physical exam; neuropsychological, neuroimaging and neurophysiology testing; and a psychiatric as well as quality of life evaluation. Subjects were evaluated prior to surgery, then at 3, 6, 12, 48, and 60 months after surgery. Standardized, assessments included The Quality of Life in Epilepsy Inventory-89 (HRQOL) and Beck Depression (BDI) and Anxiety (BAI) Inventories. Seizure outcome was classified into one of four categories: "excellent" for subjects seizure free (and no auras) for all five years, "good" for two consecutive years but not all five, "fair" if subjects were seizure free for one year but never two consecutive years, and "poor" if subjects never had a one year period of seizure freedom. A mixed-model repeated-measures analysis was used to analyze the association between depression, anxiety, seizure outcome, seizure history, and overall HRQOL scores over time. A separate analysis was completed for each of the four HRQOL subscales (cognitive distress, physical health, mental health, epilepsy-targeted). Each model included gender, race, education, duration of seizure history, laterality of seizure focus, resection location, BDI and BAI scores, and time as fixed effects, as well as random intercept and slope. Results: All four subscores of QOL improved over time (p<0.0001). Excellent and good seizure control had a significant positive impact on the overall QOL compared to fair and poor seizure control; interestingly, there was no difference in change in overall QOL over time between the fair and poor groups. The time and seizure control interaction was marginally significant (p=0.0606). Subjects who had left-sided resections showed a significantly lower rate of improvement in overall QOL score compared to those with right-sided resection. The BDI and BAI scores were strongly negatively associated with overall QOL; increases in BDI and BAI scores were associated with decreased overall QOL score. This association appeared to be driven by the cognitive subscore and the association was not significant in the other subscores. Duration of seizure history, gender, race, education and temporal versus extratemporal resection did not show significant association with overall QOL. Conclusions: Depression and anxiety are strongly and independently associated with worse QOL post epilepsy surgery. Management of mood and anxiety is a critical component to post-surgical care.