“There is an abundance of research data indicating that seizure freedom after pediatric epilepsy surgery improves HRQOL,” Elysa Widjaja, MD, PhD, MPH, notes. “This includes a recent study from our group demonstrating that HRQOL improved in the first year after epilepsy surgery and remained stable 2 years after surgery in children with drug-resistant epilepsy, while HRQOL remained unchanged over the 2-year follow-up in the medical treatment group.”
There is limited data, however, on the preoperative predictors of HRQOL following epilepsy surgery in children, she continues. “Understanding the preoperative predictors of HRQOL after epilepsy surgery will help identify potential target for interventions preoperatively,” Dr. Widjaja says.
For a study published in Seizure, the researchers sought to identify preoperative predictors of HRQOL 2 years after epilepsy surgery among children with drug-resistant epilepsy. The multicenter prospective cohort study examined characteristics of the children, caregivers, and family members, including demographics, clinical variables, and symptoms of anxiety or depression among caregivers. Investigators used the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55 to evaluate HRQOL preoperatively and 2 years after surgery.
Age & Pre-Op HRQOL Impact Post-Op HRQOL
The analysis included 95 children (mean age, 11.4; 62% boys). Mean QOLCE scores in the study population were higher after surgery than before surgery (65.6 vs 57.4; Figure).
In univariable regression, fewer antiseizure medications (P=0.019), older age at the time of seizure onset (P<0.001), higher HRQOL before surgery (P<0.001), more family resource (P<0.001), better familial relationships (P=0.017), and fewer family demands (P<0.001) were all associated with higher HRQOL following surgery. Multivariable regression demonstrated that older age at the time of seizure onset (P=0.003) and greater preoperative HRQOL (P<0.001) were associated with greater HRQOL following epilepsy surgery. The findings related to age “could be due to potential developmental and cognitive advantages that arise with age,” Dr. Widjaja says. “Older children may have better coping mechanisms, heightened social skills, and greater cognitive abilities compared with younger children, which lead to better adjustment and adaptation to life after surgery, ultimately yielding better HRQOL and social and cognitive outcomes. It is also possible that those with older age at seizure onset are less likely to have severe epilepsy syndromes and, as a result, better cognitive function and HRQOL preoperatively.”
Further, “children with higher preoperative HRQOL may have had better overall functioning prior to surgery, which could indicate they were better equipped to adapt and recover following surgery,” she continues.
Include HRQOL in Presurgical Evaluation
The impact of HRQOL before surgery on HRQOL after surgery illustrates “the importance of optimizing preoperative HRQOL to achieve the best possible HRQOL outcome after epilepsy surgery,” Dr. Widjaja says.
“The epilepsy surgery team should consider assessing HRQOL as part of the presurgical evaluation and institute interventions such as cognitive behavioral therapy and social skills training to optimize children’s HRQOL preoperatively.”
The finding that caregiver and family factors were “less important” in influencing a child’s HRQOL following surgery also indicates a need for further research, according to Dr. Widjaja. “The present study considered child HRQOL outcome after epilepsy surgery,” she says. “However, the impact of epilepsy surgery and changes in children’s HRQOL after surgery on longitudinal parent and family characteristics remain to be elucidated. Future studies should evaluate the influence of epilepsy surgery on parents’ outcomes and family functioning to determine whether epilepsy surgery has a positive impact on parent anxiety and depressive symptoms and family resources.”