Introduction: Pediatric epilepsy surgery is an underutilized treatment modality for select patients with debilitating, medication-resistant seizures. Previous publications have studied seizure freedom as the main outcome of epilepsy surgery. However, there has been no systematic assessment of the postoperative life quality for these children. The objective of this research was to estimate the quality of life (QOL) long-term outcomes after surgery for intractable epilepsy in pediatric patients.
Methods: A systematic search of the PubMed and Cochrane databases was performed. Studies reporting questionnaire-assessed QOL at least twelve months postoperatively were included. QOL means and standard deviations were compared between surgically and medically managed patients, between the pre- and postoperative state of each patient, and were further stratified into patients achieving seizure freedom, and those who did not. Meta-analysis was performed using fixed effects models for weighted mean differences (WMD), 95% confidence intervals (CI) and sensitivity analyses. Funnel plots and Begg’s tests were utilized to detect publication bias.
Results: The search yielded 18 retrospective studies, reporting 890 surgical patients. Following epilepsy surgery, children had significant QOL improvement compared to their preoperative state (WMD: 16.71, 95% CI: 12.19-21.22, P<.001) and better QOL than matched medically-treated controls (WMD: 12.42, 95% CI: 6.25-18.58, P<.001). Patients achieving total seizure freedom after surgery had significant postoperative QOL improvement (WMD: 16.12, 95% CI: 7.98-24.25, P<.001), but patients not achieving seizure freedom did not achieve statistical significance (P=.79).
Conclusions: Epilepsy surgery can effectively improve QOL in children with medication-resistant seizures. Seizure freedom was associated with the greatest improvement in life quality.
Patient Care: To date, this is the first systematic assessment of quality of life outcomes after epilepsy surgery in children. Since the goal of these procedures is to ultimately provide a better life for pediatric patients, we show here that epilepsy surgery is an effective means to that end. Currently, surgical means are possibly underutilized, and our research could be a stepping stone for epilepsy surgery to be more well-utilized for the select patient population it is indicated for.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the importance of pediatric epilepsy surgery for quality of life improvement.
2) Discuss, in small groups how practice can be changed to provide improvements in quality of life through surgery.