Long-term quality of life after surgical treatment of drug resistant epilepsy in children

Abstract

Background: Epilepsy exerts a particularly deleterious effect on the developing brain, often leading to severe mental retardation and even death. Most patients may be controlled by pharmacotherapy, but in a significant proportion of drug-resistant cases surgical treatment may prove beneficial. Aim of study: to assess long-term quality of life in children operated on for drug-resistant epilepsy and key factors affecting it. Method: single-center, retrospective, questionnaire-based study. Material: 200 children operated on for drug-resistant epilepsy.

Results and Conclusions: (1) Surgical treatment of drug-resistant epilepsy is generally effective, with almost 40 % of patients completely seizure-free; (2) Most patients (62%) are satisfied with their quality of life, with most of them reporting improvement after surgery. (3) Basic parameters defining quality of life (general health status, social relations, autonomy, behavior, academic achievements) score favorably in most patients operated on for drug-resistant epilepsy. (4) Factors affecting quality of life include: elimination of seizures (therefore surgery should be as effective as possible), age of onset of epilepsy (age under 3 is an unfavorable prognostic factor), duration of seizures prior to surgery (less than 2 years is a favorable prognostic factor – surgical treatment should be considered as early as possible), a definite and amenable to excision epileptogenic focus (focal seizures are prognostically more favorable than generalized ones) and co-existing chronic disease. (5) Factors NOT affecting quality of life include: a history of perinatal trauma and severity and frequency of seizures prior to surgery (justifying surgical treatment even in the most severe cases).