Markand O N, Salanova V, Whelihan E, Emsley C L
Department of Neurology, Division of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Epilepsia. 2000 Jun;41(6):749-59. doi: 10.1111/j.1528-1157.2000.tb00238.x.
A prospective study to investigate health-related quality of life (HRQOL) outcome in patients with temporal lobe epilepsy treated with anterior temporal lobectomy (ATL).
The majority of the patients with medically refractory focal epilepsy had Quality of Life in Epilepsy-89 (QOLIE-89) assessment at the time of prolonged video/EEG monitoring as part of their presurgical evaluation. Thirty-seven patients who were not treated surgically constituted the control group, and 53 patients who underwent ATL made up the surgery group. Both control and surgery groups had HRQOL assessment repeated at approximately 1-and 2-year intervals. Repeated measures analysis of variance (ANOVA) was used to test for differences between the two groups.
For the overall score and almost every scale, the surgery group had a higher baseline mean than the control group. Because of this baseline difference, change scores were used in further analysis. The overall score and 10 of 17 scales in QOLIE-89 showed significant HRQOL improvement after ATL, and the improvement was significant relative to score changes of the nonsurgical comparison group. Scores improved in overall QOL, emotional well-being, attention/concentration, language, social isolation, health perception, role limitations-physical, work/drive/social, health discouragement, and seizure worry. For the first five scales, there was group-time interaction; the improvement was significantly more on the 2-year than on the 1-year follow-up. When the surgery patients were divided into four categories (class IA-, completely seizure free; class IA+, seizure free with aura; class II, rare seizures; class III, worthwhile improvement in seizure control; and class IV, no improvement), the improved HRQOL in the surgery group was almost entirely contributed by the class IA- outcome patients who were totally seizure free. The class IA+ patients with continuing aurae and class II/III/IV patients had no significant improvement in their overall HRQOL scores at 1-or 2-year follow-up.
Overall score and 10 of the 17 scales of QOLIE-89 significantly improved in patients with medically refractory temporal lobe epilepsy after ATL. For some scales, there was delay in the improvement to manifest. The HRQOL improvement was related to achieving an entirely seizure-free status (i.e., no seizures or aurae postoperatively).
一项前瞻性研究，旨在调查接受前颞叶切除术（ATL）治疗的颞叶癫痫患者的健康相关生活质量（HRQOL）结果。
大多数药物难治性局灶性癫痫患者在进行长时间视频/脑电图监测时进行了癫痫生活质量-89（QOLIE-89）评估，作为其术前评估的一部分。37例未接受手术治疗的患者组成对照组，53例接受ATL手术的患者组成手术组。对照组和手术组均在大约1年和2年的间隔时间重复进行HRQOL评估。采用重复测量方差分析（ANOVA）来检验两组之间的差异。
对于总体评分和几乎每个量表，手术组的基线均值均高于对照组。由于存在这种基线差异，在进一步分析中使用了变化分数。QOLIE-89的总体评分和17个量表中的10个显示，ATL术后HRQOL有显著改善，且相对于非手术比较组的评分变化，这种改善具有显著性。总体生活质量、情绪健康、注意力/集中力、语言能力、社交孤立感、健康认知、身体角色限制、工作/驾驶/社交、健康沮丧感和癫痫担忧等方面的评分有所改善。对于前五个量表，存在组-时间交互作用；在2年随访时的改善明显大于在1年随访时的改善。当将手术患者分为四类（IA-类，完全无癫痫发作；IA+类，有先兆的无癫痫发作；II类，罕见癫痫发作；III类，癫痫控制有显著改善；IV类，无改善）时，手术组HRQOL的改善几乎完全由完全无癫痫发作的IA-类结局患者贡献。有持续先兆的IA+类患者以及II/III/IV类患者在1年或2年随访时的总体HRQOL评分无显著改善。
药物难治性颞叶癫痫患者在接受ATL术后，QOLIE-89的总体评分和17个量表中的10个有显著改善。对于某些量表，改善的显现存在延迟。HRQOL的改善与实现完全无癫痫发作状态（即术后无癫痫发作或先兆）有关。
