Significant Health-Related Quality of Life Improvements in Pediatrics Seen Shortly After Epilepsy Surgery

Elysa Widjaja, MD, PhD

According to findings from a recently published prospective cohort study, children with drug-resistant epilepsy (DRE) who underwent epilepsy surgery had significant improvements in health-related quality of life (HRQOL) that occurred in the first year after surgery, with the largest improvement occurring in the first 6 months after surgery. Those on medical therapy remained unchanged over the 2-year follow-up while improvements for those who underwent surgery remained stable.

Led by Elysa Widjaja, MD, PhD, pediatric neuroradiologist, The Hospital for Sick Children, the study recruited patients with DRE from 8 epilepsy centers in Canada who underwent surgery (n = 111) or continued medical therapy (n = 154), with follow-ups at 6 months, 1 year, and 2 years. Analyzed from May 2014 to December 2021, data showed that HRQOL of surgical patients was 3.0 (95% CI, –0.7 to 6.8) points higher at 6-month, 4.9 (95% CI, 0.7-9.1) points higher at 1-year, and 5.1 (95% CI, 0.7-6.8) points higher at 2-year follow-ups compared with medical patients.

"Understanding the evolution of HRQOL after surgery compared with medical therapy is important in counseling children and parents and will contribute to informed decision-making on treatment options," Widjaja et al concluded. "By demonstrating that epilepsy surgery leads to improvement in seizure freedom and HRQOL in children, which has downstream effects such as better educational and vocational attainment and reduced health care resource utilization and health care cost, our study provided objective evidence to justify the high costs of surgery and to improve access to surgery."

HRQOL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55, an assessment that includes 4 domains of physical, cognitive, emotional, and social function. In the study, the patient cohort had a mean age of 11.0 (SD, 4.1) at baseline and more than half (56%) had daily or weekly seizures. Coming into the study, patients opting for surgery were more likely to have more frequent seizures, unilateral temporal seizures, or extratemporal seizures, while medical patients were more likely to have bilateral, multilobar, or unknown seizure focus.

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In addition to greater HRQOL scores observed at follow-ups, linear mixed models revealed that higher HRQOL was associated with older age of seizure onset, fewer antiseizure medications, and greater family resources at baseline. In sensitivity analyses, results were similar, with improvements in social functioning that occurred 6 months and 1 year after surgery that remained stable at 2 years after the procedure. There were no significant differences in cognitive, emotional, and physical functioning among surgical and medical patients.

Additional findings from sensitivity analyses revealed that 72% of children who underwent surgery were seizure-free by 2 years, compared with 33% of those on medical therapy. Notably, patients who were seizure-free reported significantly higher HRQOL than those who were not seizure-free throughout the follow-up, irrespective of surgical status.

In the limitations section of the study, the investigators wrote, "To our knowledge, this is the largest multicenter study evaluating the trajectory of HRQOL following pediatric epilepsy surgery compared with medical therapy. Although there were differences in a few clinical characteristics of surgical and medical patients at baseline, we have comprehensively adjusted for those variables that have been reported to influence HRQOL in the analysis. Furthermore, the 2 groups did not differ in their baseline HRQOL, which is one of the most important predictors of HRQOL at follow-up."

REFERENCE
1. Widjaja E, Puka K, Speechley KN, et al. Trajectory of health-related quality of life after pediatric epilepsy surgery. JAMA Netw Open. 2023;6(3):e234858. doi:10.1001/jamanetworkopen.2023.4858