Longitudinal trajectory of quality of life and psychological outcomes following epilepsy surgery.
Longitudinal trajectory of quality of life and psychological outcomes following epilepsy surgery.
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DOI：
10.1016/j.yebeh.2020.107283
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Jehi L
中科院分区：
文献类型：
--
作者：
Winslow J;Hu B;Tesar G;Jehi L
这项研究调查了切除手术患者的自我报告的纵向生活质量(QOL)以及抑郁和焦虑症状。这项研究描述了手术后心理社会结果的范围、可持续性和纵向轨迹。这项回顾性研究包括2008至2013年间在克利夫兰临床癫痫中心接受癫痫切除手术的成年人。就诊时间为2007年10月至2014年12月。研究的数据来自手术前的访问，术后早期的随访(平均：0.9年；范围：0.5到3.4)，以及最近的随访(平均：3.2年；范围：0.8到6.9)。收集了患者的人口统计学、临床特征和手术因素。分析的重点是自我报告的生活质量(QOLIE-10)、抑郁(PHQ-9)和焦虑(GAD-7)。这项研究包括229名成年人，其中178人对所有三个时间点的数据进行了完整的跟踪调查。术后，癫痫生活质量量表(QOLIE-10)、患者健康问卷(PHQ-9)和一般焦虑症(GAD-7)的得分随着时间的推移显著改善。使用线性模型调整了性别、年龄、婚姻状况和手术类型后，QOLIE-10的平均得分下降了1.157分/年，PHQ-9的平均得分下降了0.331分/年，GAD-7的平均得分下降了0.299分/年。在整个随访期间，生活质量持续改善，而抑郁和焦虑在术后第一年内改善最多，然后稳定下来。癫痫发作自由与改善的生活质量密切相关(p=0.001.0 5)，而抑郁症状与恶化的生活质量无统计学意义相关(p=0.0 7)。在全数据分析中，接受额叶切除术的患者的生活质量和抑郁症状的改善明显优于颞叶切除术(Qolie-10，p=0.024；phq-9，p=0.027)，但只有在完全随访患者的二次分析中才有显著的抑郁症状改善(phq，p=0.040；QOL，p=0.104)。这项研究提供了一个关于术后癫痫患者生活质量和心理症状的纵向视角，队列中有38%的患者是临床期外的。结果表明，术后早期生活质量和情绪改善，以及多年生活质量进一步提高，对心理社会结果的影响是积极的。额叶手术患者在某些心理社会维度上可能比颞叶手术患者有更好的改善。
This study investigated self-reported longitudinal quality of life (QOL) and symptoms of depression and anxiety in patients who had resective surgery. The study characterized the extent, sustainability, and longitudinal trajectory of psychosocial postsurgical outcomes. This retrospective study included adults who underwent resective epilepsy surgery in Cleveland Clinic Epilepsy Center between 2008 and 2013. Clinic visits were between October 2007 and December 2014. Data studied were from visits prior to surgery, early postsurgery follow-up (mean: 0.9 years; range: 0.5 to 3.4), and most recent follow-up (mean: 3.2 years; range: 0.8 to 6.9). Patient demographics, clinical features, and surgical factors were collected. Analysis focused on self-reported quality of life (QOLIE-10), depression (PHQ-9), and anxiety (GAD-7). The study included 229 adults, of whom 178 had complete follow-up with data from all three time points. Following surgery, scores on Quality of life in epilepsy inventory (QOLIE-10), Patient health questionnaire (PHQ-9), and General anxiety disorder (GAD-7) improved significantly with time. After adjusting for gender, age, marital status, and type of surgery using linear modeling, the mean QOLIE-10 score decreased by 1.157 points/year, mean PHQ-9 score by 0.331 points/year, and mean GAD-7 score by 0.299 points/year. Improvement in QOL continued to be observed throughout the follow-up duration, whereas both depression and anxiety improved the most within the first postoperative year and then stabilized. Seizure freedom was strongly correlated with improved QOL (p = 0.001), while depressive symptoms showed a nonstatistically significant correlation with worse QOL (p = 0.07). Patients who underwent frontal resection had significantly superior QOL and depression symptom improvement compared with temporal resections during full data analysis (QOLIE-10, p = 0.024; PHQ-9, p = 0.027), but only significant depression symptom improvement on secondary analysis of complete follow-up patients only (PHQ, p = 0.040; QOL, p = 0.104). This study provides a longitudinal perspective of QOL and psychological symptoms in patients with postresective epilepsy with a cohort with 38% extratemporal cases. Results illustrate positive trajectory of psychosocial outcomes postsurgery with early QOL and mood improvement, and years of further QOL gains. Frontal lobe surgery patients may have superior improvement in some psychosocial measures compared with temporal lobe surgery patients.
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