Impact of epilepsy surgery on seizure control and quality of life: A 26-year follow-up study
Impact of epilepsy surgery on seizure control and quality of life: A 26-year follow-up study
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DOI：
10.1111/j.1528-1167.2011.03398.x
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发表时间：
2012-04-01
期刊：
影响因子：
5.6
通讯作者：
Smyth, Matthew D.
中科院分区：
文献类型：
--
作者：
Mohammed, Hussan S.;Kaufman, Christian B.;Smyth, Matthew D.
目的：癫痫手术相对于药物治疗的短期疗效和安全性已经确定，但仍未得到充分利用。缺乏关于癫痫手术后长期癫痫控制率和生活质量结果的数据。这项研究是迄今为止最长的随访研究，平均随访时间为 26 年。 方法：我们研究了 1967 年至 1990 年间接受 Sidney Goldring 博士的癫痫手术的患者的癫痫发作和与健康相关的生活质量结果。回顾性临床图表审查收集了围手术期数据，并通过调查获得了随访数据。使用恩格尔分类系统评估癫痫结果。主要发现：在 361 名患者中，117 名 (32.4%) 完成了随访访谈。 56 名患者 (48%) 为 Engel I 级。该队列的癫痫患者平均总体生活质量 (QOLIE-31) 问卷评分为 68.2 +/- 16。80% 的患者报告他们的总体生活质量现在比手术前更好。无癫痫发作与更好的生活质量相关。我们没有观察到术后并发症与长期结果之间存在统计学上的显着关联。接受颞叶切除术的患者比接受其他类型手术的患者获得了更好的癫痫结果。不稳定性癫痫发作和双侧手术与较差的恩格尔分级结果相关。意义：我们的研究表明，癫痫手术的有益效果可持续数十年，并且这些有益效果与生活质量的改善相关。其耐久性的确认使我们乐观地认为现代癫痫手术的结果将会更好，并且我们目前对这种治疗方式的热情并没有错。
Purpose: The short-term efficacy and safety of epilepsy surgery relative to medical therapy has been established, but it remains underutilized. There is a lack of data regarding the long-term seizure-control rates and quality of life outcomes after epilepsy surgery. This study represents the longest follow-up study to date, with a mean follow-up duration of 26 years.Methods: We studied the seizure and health-related quality of life outcomes of patients who underwent epilepsy surgery by Dr. Sidney Goldring from 1967 to 1990. Retrospective clinical chart reviews gathered perioperative data and surveys obtained follow-up data. Seizure outcome was evaluated using the Engel classification system.Key Findings: Of 361 patients, 117 (32.4%) completed follow- up interviews. Fifty-six patients (48%) were Engel class I. Mean overall Quality of Life in Epilepsy (QOLIE-31) questionnaire score for the cohort was 68.2 +/- 16. Eighty percent of patients reported their overall quality of life now as being better than before surgery. Seizure freedom was associated with better quality of life. We did not observe a statistically significant association between postoperative complications and long-term outcome. Patients who underwent temporal lobe resection achieved better seizure outcomes than those who underwent other types of procedures. Astatic seizures and bilateral surgery were associated with aworse Engel class outcome.Significance: Our study demonstrates that the beneficial effects of epilepsy surgery are sustained over decades, and that these beneficial effects are correlated with an improved quality of life. The confirmation of its durability makes us optimistic that the outcomes from modern epilepsy surgery will be even better and that our present enthusiasm for this treatment modality is not misplaced.