Long-term seizures and quality of life after epilepsy surgery compared with matched controls

Abstract

Objective: We compared long-term seizure outcome and health-related quality of life (HRQoL) of patients who underwent epilepsy surgery and matched medically treated nonsurgical controls with intractable epilepsy.

Methods: Medically treated controls were identified for patients operated on for epilepsy between January 1, 1949 and December 31, 1992. We used a matched cohort design, matching for age, sex, and seizure type. The analysis was based on 70 complete matching pairs. HRQoL was assessed with the Quality of Life in Epilepsy Inventory 89 questionnaire an average of 15 years after surgery.

Results: Among surgery patients, 48% were seizure-free during the previous year compared with 19% of the controls (P = 0.0004). Fewer surgery patients used antiepileptic drugs (70%) than controls (93%). The odds of being seizure-free were higher for surgery patients in total and in subgroups divided according to length of follow-up. The mean HRQoL for surgery patients was higher in five of the 17 Quality of Life in Epilepsy Inventory 89 dimensions and worse in none. Among patients with more than 7 years of follow-up, HRQoL was better in three dimensions and worse in none. Among patients with 7 years of follow-up or less, HRQoL was better in two dimensions and worse in the language dimension of the Quality of Life in Epilepsy Inventory 89.

Conclusion: After an average of more than 15 years of follow-up, epilepsy surgery patients had fewer seizures, used less antiepileptic medication, and had better HRQoL in several dimensions of the Quality of Life in Epilepsy Inventory 89 instrument than matched medically treated controls with refractory epilepsy, although possibly at a slight disadvantage in the language dimension among those with 7 years of follow-up or less.