Quality-of-Life Outcomes in Adults Following Epilepsy Surgery

People with epilepsy often report the negative impact of their condition on many aspects of quality of life (QOL). While surgical intervention is aimed at reducing or stopping seizures, there is an implicit assumption among both patients and physicians that successful surgery will result in beneficial changes in quality-of-life measures (see Chap. 16). This chapter reviews the quality-of-life (QOL) outcome literature in epilepsy surgery. The majority of studies in this field have utilized follow-up intervals of no more than 1–2 years. The literature is diverse and a wide range of surgical procedures, QOL measures, sample sizes, ages at onset, follow-up intervals, and controlled versus noncontrolled study designs have been reported. Improvements in QOL do not automatically accompany seizure freedom, in the short term at least. Psychiatric comorbidities, employment status, ability to drive, and antiepileptic drug (AED) cessation appear to be better predictors of health-related quality-of-life measures than seizure freedom alone. Improvements in QOL measures may be more common following right versus left temporal lobe resections. There is a complex relationship between measures of cognitive decline and seizure freedom following surgery with respect to their impact on QOL measures. At present, little is known about the impact of surgery at different stages in adulthood. It is likely that QOL changes are different for those who have surgery in the 20s compared to those in middle age or later. Future research in this area should incorporate standardized measures of seizure outcome and QOL measures with normative data. Studies must also employ valid measures that capture meaningful change in QOL from the patient’s perspective at different time points after epilepsy surgery. It is likely that meaningful changes in QOL will take many years to develop after surgery, particularly for those patients who have lived most of their lives with epilepsy. Outcome studies with follow-up periods of 12–24 months are likely to underestimate the benefits of seizure freedom conferred by surgery. Only studies with longer-term follow-ups are able to accurately measure the impact in this domain.