Long-Term Seizure, Quality of Life, Depression, and Verbal Memory Outcomes in a Controlled Mesial Temporal Lobe Epilepsy Surgical Series Using Portuguese-Validated Instruments
Long-Term Seizure, Quality of Life, Depression, and Verbal Memory Outcomes in a Controlled Mesial Temporal Lobe Epilepsy Surgical Series Using Portuguese-Validated Instruments
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DOI：
10.1016/j.wneu.2017.05.004
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发表时间：
2017-08-01
影响因子：
2
通讯作者：
Casulari, Luiz Augusto
中科院分区：
文献类型：
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作者：
Dias, Luis Augusto;de Angelis, Geisa;Casulari, Luiz Augusto
目的：我们旨在与接受术前评估的类似患者组相比，评估接受内侧颞叶癫痫治疗的患者的长期手术结果。方法：由独立神经心理学家对患者进行访谈，包括社会人口学调查问卷和贝克抑郁量表 II、不良事件概况、癫痫生活质量 - 31 和 Rey 听觉语言学习测试的验证版本。结果：71 名患者接受了颞叶癫痫治疗。接受手术并对 20 名接受内侧颞叶癫痫术前评估的患者进行了访谈。经过 81 个月的平均术后随访，根据 Engel 分类，44% 的手术患者癫痫发作完全缓解，根据国际抗癫痫联盟分类，68% 的患者癫痫发作完全缓解。手术组的抑郁症患病率（P = 0.002）和药物相关不良反应（P = 0.002）显着较低。失业率有所改善（P = 0.02），但驾驶或教育方面却没有改善。 76% 的手术病例和 65% 的对照病例的言语记忆回忆延迟受损（P = 0.32）。关于 Epilepsy-31 的生活质量，无论随访时间长短，手术患者的总分均较高（平均值为 75.44 vs 平均值为 60.08；P < 0.001），除认知功能领域外的所有得分均较高。癫痫控制、贝克抑郁评分和不良事件严重程度解释了手术组生活质量差异的 73%。 结论：我们的研究发现，尽管手术治疗有效，但其对社会指标的影响不大。此外，自我报告的生活质量不仅取决于癫痫控制，还取决于抑郁症状和抗癫痫药物负担。
OBJECTIVE: We aimed to evaluate long-term surgical outcomes in patients treated for mesial temporal lobe epilepsy compared with a similar group of patients who underwent a preoperative evaluation.METHODS: Patient interviews were conducted by an independent neuropsychologist and included a sociodemographic questionnaire and validated versions of the Beck Depression Inventory-II, Adverse Events Profile, Quality of Life in Epilepsy-31, and Rey Auditory Verbal Learning Test.RESULTS: Seventy-one patients who underwent surgery and 20 who underwent mesial temporal lobe epilepsy preoperative evaluations were interviewed. After an 81month mean postoperative follow-up, 44% of the surgical patients achieved complete seizure relief according to the Engel classification and 68% according to the International League Against Epilepsy classification. The surgical group had a significantly lower prevalence of depression (P = 0.002) and drug-related adverse effects (P = 0.002). Improvement on unemployment (P = 0.02) was achieved but not on driving or education. Delayed verbal memory recall was impaired in 76% of the surgical and 65% of the control cases (P = 0.32). Regarding the Quality of Life in Epilepsy-31, the operated patients scored higher in their total score (mean, 75.44 vs. mean, 60.08; P < 0.001) and in all but the cognitive functioning domain irrespective of the follow-up length. Seizure control, Beck Depression Score, and Adverse Events Profile severity explained 73% of the variance in the surgical group quality of life.CONCLUSIONS: Our study found that, although surgical treatment was effective, its impact on social indicators was modest. Moreover, the self-reported quality of life relied not only on seizure control but also on depressive symptoms and antiepileptic drug burden.