Langfitt J T, Westerveld M, Hamberger M J, Walczak T S, Cicchetti D V, Berg A T, Vickrey B G, Barr W B, Sperling M R, Masur D, Spencer S S
Department of Neurology, University of Rochester, Rochester, NY 14642, USA.
Neurology. 2007 Jun 5;68(23):1988-94. doi: 10.1212/01.wnl.0000264000.11511.30.
Surgery for intractable temporal lobe epilepsy usually controls seizures and improves health-related quality of life (HRQOL), but some patients experience continued seizures, memory decline, or both. The relative impact of these unfavorable outcomes on HRQOL has not been described.
We studied seizure control, memory change, and HRQOL among 138 patients in the Multicenter Study of Epilepsy Surgery (MSES), an ongoing, prospective study of epilepsy surgery outcomes. Seizure remission at 2 years and 5 years was prospectively determined based upon regularly scheduled follow-up calls to study patients throughout the follow-up period. HRQOL was assessed annually using the Quality of Life in Epilepsy Inventory (QOLIE-89). Memory decline was determined by change in verbal delayed recall from baseline to the 2- or 5-year follow-up.
HRQOL improved in patients who were in remission at the 2-year or 5-year follow-up, regardless of memory outcome. Among those not in remission at both 2 and 5 years (25/138, 18%), HRQOL remained stable when memory did not decline (14/138, 10%), but HRQOL declined when memory did decline (11/138, 8%). These 11 patients had baseline characteristics predictive of poor seizure or memory outcome. Declines were most apparent on HRQOL subscales assessing memory, role limitations, and limitations in work, driving, and social activities.
After temporal resection, health-related quality of life (HRQOL) improves or remains stable in seizure-free patients despite memory decline, but HRQOL declines when persistent seizures are accompanied by memory decline. These results may be useful in presurgical counseling and identifying patients at risk for poor psychosocial outcome following surgery.
顽固性颞叶癫痫手术通常能控制癫痫发作并改善健康相关生活质量（HRQOL），但部分患者仍有癫痫持续发作、记忆力减退或两者皆有。这些不良后果对HRQOL的相对影响尚未见描述。
我们在癫痫手术多中心研究（MSES）中对138例患者的癫痫控制情况、记忆力变化及HRQOL进行了研究，MSES是一项正在进行的关于癫痫手术结局的前瞻性研究。通过在整个随访期定期致电研究患者，前瞻性地确定患者在2年和5年时的癫痫缓解情况。每年使用癫痫生活质量量表（QOLIE - 89）评估HRQOL。记忆力减退通过从基线到2年或5年随访时言语延迟回忆的变化来确定。
在2年或5年随访时缓解的患者，无论记忆力结果如何，其HRQOL均有所改善。在2年和5年时均未缓解的患者中（25/138，18%），记忆力未减退时HRQOL保持稳定（14/138，10%），但记忆力减退时HRQOL下降（11/138，8%）。这11例患者具有癫痫发作或记忆力结局不佳的基线特征。在评估记忆力、角色限制以及工作、驾驶和社交活动限制的HRQOL子量表上，下降最为明显。
颞叶切除术后，无癫痫发作的患者尽管记忆力减退，但健康相关生活质量（HRQOL）改善或保持稳定，而癫痫持续发作伴有记忆力减退时HRQOL下降。这些结果可能有助于术前咨询以及识别术后心理社会结局不佳风险的患者。
