The Critical Need to Monitor Post-Epilepsy Surgery Quality of Life

Lara Jehi, MD, professor of neurology, Cleveland Clinic Epilepsy Center

Lara Jehi, MD

Earlier this year, Lara Jehi, MD, and colleagues published work in Epilepsia attempting to determine what measurement of seizure reduction should be used when attempting to predict the state of a patient’s quality of life after epilepsy surgery. All told, the group found that utilizing absolute seizure reduction is often insufficient, though relative reduction and complete seizure freedom were strong predictors.

As many clinicians in the epilepsy field have indicated to NeurologyLive, quality of life is an essential, but difficult metric to track in any instance. With no standardized way of measuring this efficiently and the general difficulty for patients in conveying the proper information to their physicians, it is understandably so. But in a post-surgical setting, especially after resective epilepsy surgery, many patients can have an improved quality of life despite continuing to have seizures, muddying the water even further.

Of the entire 550-patient cohort in this study, 27% reported having improved quality of life, as measured by Quality of Life in Epilepsy (QOLIE-10) score, despite experiencing persistent seizures. The average improvement in QOLIE-10 score was 5.3 points (95% CI, 4.1—6.5), while the mean absolute seizure frequency dropped from 1 per day to 0.1 per day (P <.001). The mean reduction in seizures was 73% (95% CI, 66&shy;—81). When comparing regression models in order to predict quality of life, the worst model provided occurred when using absolute seizure reduction.

To find out more, NeurologyLive reached out to Jehi, professor of neurology, Cleveland Clinic Epilepsy Center. She offered insight into this challenge for epileptologists and what the clinical impact of this work might be.

NeurologyLive: How important is it for physicians to monitor patients and their quality of life post-epilepsy surgery?

Lara Jehi, MD: Monitoring for quality of life is critical. From the patient's perspective, the success of surgery—or any intervention&mdash;is defined as “my life is better now than it was before the procedure.” As physicians, we are uncomfortable with vagueness and uncertainty, so we come up with various measures to objectify this commonsense statement and focus on disease characteristics that can be easily measured, like seizure-frequency, seizure types, and intervals between seizures.

We essentially focus on the trees because we can hold on to them and forget about the forest because it is too big. Quality of life is the forest.

What prompted this work and what should clinicians take away from these data?

The traditional measures of “success” of epilepsy surgery all define success as complete seizure-freedom postoperatively. In reality, though, any clinician can easily relate to situations where he/she had a patient who became seizure-free with surgery but yet was miserable with their outcome, while another patient continued to have seizures but was very satisfied with having had surgery.

Some epilepsies are devastating and may cause a tremendous seizure burden. Many such epilepsies arise from multiple brain regions—or from a “too large” brain region&mdash;making it impossible to essentially cure them with a brain resection. Yet, surgery can reduce the seizure burden and make these patients feel better. Our work in this study was done to provide some objective support to this idea that we can, in fact, help people with brain surgery, even if we don’t make them completely seizure-free.

Transcript edited for clarity.

REFERENCE

Sheikh S, Thompson N, Bingaman W, Gonzalez-Martinez J, Najm I, Jehi L. (Re)Defining success in epilepsy surgery: The importance of relative seizure reduction in patient-reported quality of life. Epilepsia. 2019;60(10):2078-2085. doi: 10.1111/epi.16327.