Long-term seizure and quality of life outcomes of an epilepsy surgery program in Cape Town, South Africa

Abstract

Objective: To determine long-term seizure and quality-of-life related outcomes of an epilepsy surgery (ES) program in South Africa.

Methods: This was a retrospective cohort and prospective quality-of-life study of adults who underwent ES between July 2007 and July 2022 at a privately-owned hospital in Cape Town. Of 602 ES performed, 375 were included. These had initial ES at the center, were ≥ 18 years old at time of ES and had adequate electronic medical records. The QOLIE-10 score measured post-surgery quality-of-life outcomes among 211 patients contactable post-ES.

Results: Of 375 ES, the median (IQR) age at time of ES was 37 (28-47) years, and median (IQR) duration between diagnosis and surgery was 16.6 (7.8-27.7) years. Majority had temporal lobe ES (TLE-S) (75 %). Surgical complications were mild; 1 % had intra-operative and 7 % early post-operative complications. Seizure-freedom rates were 70 % in year one, 55 % at two years (p < 0.01) and 51 % beyond two years (p = 0.4). Only the total number of pre-surgery anti-seizure medications (ASM) showed a reduced likelihood of a good outcome (aOR 0.56, CI 0.37-0.85, p = 0.006). Increased EEG-monitoring duration or the presence of an MRI lesion did not predict a good outcome. The survey was answered at a median of 6.8 years post-surgery; 78 % reported reduced seizure frequency/severity, 62 % were seizure-free and 21 % were off all ASM. The median (IQR) QOLIE-10 score was good at 1.8 (1.4-2.5).

Interpretation: Seizure and patient-reported outcomes at this single center with limited human resource were comparable to higher-resourced settings. A similar model could be attempted in other resource-constrained centers.