Predictors of meaningful improvement in quality of life after temporal lobe epilepsy surgery: A prospective study

• DOI: 10.1111/epi.13721
• Publication Date: 2017-03-24T06:46:15Z
• Authors: Carla Pauli; Marcelo Liborio S...; Alexandre Paim Diaz; Maria Emilia Rodr...; Charles Kondageski; Marcelo Neves Lin...; Ricardo Guarnieri; Bianca de Lemos Z...; Juliana Ben; Jean Costa Nunes; Hans Joachim Mark...; Peter Wolf; Samuel Wiebe; Katia Lin; Roger Walz
• Keywords: Quality of life; Adult; Male; Drug Resistant Epilepsy; Psychometrics; Hippocampus; Young Adult; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Epilepsy surgery; Outcome Assessment, Health Care; Humans; Prospective Studies; Depressive Disorder; Sclerosis; Predictors; Mesial temporal lobe epilepsy; Anterior Temporal Lobectomy; 3. Good health; Epilepsy, Temporal Lobe; Quality of Life; Female; Follow-Up Studies

SummaryObjectivesTo investigate prospectively the independent predictors of a minimum clinically important change (MCIC) in quality of life (QOL) after anterior temporal lobectomy (ATL) for drug‐resistant mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE‐HS) in Brazilian patients.MethodsMultiple binary logistic regression analysis was performed to identify the clinical, demographic, radiologic, and electrophysiologic variables independently associated with MCIC in the Quality of Life in Epilepsy‐31 Inventory (QOLIE‐31) overall score 1 year after ATL in 77 consecutive patients with unilateral MTLE‐HS.ResultsThe overall QOLIE‐31 score and all its subscale scores increased significantly (p < 0.0001) 1 year after ATL. In the final logistic regression model, absence of presurgical diagnosis of depression (adjusted odds ratio [OR] 4.4, 95% confidence interval [CI] 1.1–16.1, p = 0.02) and a complete postoperative seizure control (adjusted OR 4.1, 95% CI 1.2–14.5, p = 0.03) were independently associated with improvement equal to or greater than the MCIC in QOL after ATL. The overall model accuracy for MCIC improvement in the QOL was 85.6%, with a 95.2% of sensitivity and 46.7% of specificity.SignificanceThese results in Brazilian patients reinforce the external validation of previous findings in Canadian patients showing that presurgical depression and complete seizure control after surgery are independent predictors for meaningful improvement in QOL after ATL, and have implications for the surgical management of MTLE patients.