Elsharkawy Alaa Eldin, May Theodor, Thorbecke Rupprecht, Koch-Stoecker Steffi, Villagran Antonia, Urak Lydia, Pfäfflin Margarete, Pannek Heinz, Pietilä Terttu A, Ebner Alois
Department of Presurgical Evaluation, Bethel Epilepsy Center, Germany.
Epilepsy Res. 2009 Oct;86(2-3):191-9. doi: 10.1016/j.eplepsyres.2009.06.008. Epub 2009 Jul 24.
To find determinants of quality of life (QOL) in long-term follow-up after temporal lobe epilepsy (TLE) surgery in adults.
The QOLIE-31 questionnaire was sent to 400 of 524 patients who were operated on for refractory TLE between 1991 and 2003 in the Bethel Epilepsy Centre fulfilling the inclusion criteria of this study. Mainly patients with severe cognitive deficits and patients with progressive brain disorders were excluded. There were 222/400 patients who replied to the QOLIE-31 questionnaire and 147/222 of these patients replied to an additional questionnaire.
Univariate analyses showed that seizure freedom, presence of auras, intake of antiepileptic drugs (AEDs), severity of AED side effects, and driving a car were significantly correlated with all subscales of QOLIE-31. Furthermore, employment status, psychiatric problems, tumors and hippocampus sclerosis pathology, the presence of a partner, age at reply, age at surgery and medical co-morbidities were significantly correlated with some subscales of the QOLIE-31. Multivariate analyses (stepwise regression analyses) revealed that especially the time since the last seizure and the severity of AED side effects had a strong impact on QOL. However, aura at last follow-up, psychiatric treatment and employment were seen in the multivariate analyses as significant predictors of some QOL subscales as well. Most subscales of QOL showed a steep, non-linear increase within the first years of seizure freedom and remained relatively stable except for cognitive function which showed continuous improvement parallel to seizure freedom. For patients who were seizure free since surgery, side effects of AED and/or psychiatric treatment were the strongest determinants of QOL.
Duration of seizure freedom and AED side effects have the strongest impact on QOL in the long-term follow-up. Therefore it is important not only to register intake of AEDs but also to assess side effects of AEDs. Persistence of auras also had an impact on different facets of QOL, but was significantly correlated with intake of AEDs. Apart from factors directly related to epilepsy QOL was dependent of psychosocial factors as employment status, psychiatric complications, and driving a car underlining the necessity of postoperative rehabilitation in this group.
探寻成人颞叶癫痫（TLE）手术后长期随访中生活质量（QOL）的决定因素。
向1991年至2003年期间在伯特利癫痫中心接受难治性TLE手术且符合本研究纳入标准的524例患者中的400例发送了QOLIE - 31问卷。主要排除了有严重认知缺陷的患者和患有进行性脑部疾病的患者。有222/400例患者回复了QOLIE - 31问卷，其中147/222例患者回复了另一问卷。
单因素分析显示，无癫痫发作、先兆的存在、抗癫痫药物（AED）的服用、AED副作用的严重程度以及驾驶汽车与QOLIE - 31的所有子量表显著相关。此外，就业状况、精神问题、肿瘤和海马硬化病理、伴侣的存在、回复时的年龄、手术时的年龄以及合并症与QOLIE - 31的某些子量表显著相关。多因素分析（逐步回归分析）显示，尤其是自上次发作以来的时间和AED副作用的严重程度对生活质量有强烈影响。然而，在多因素分析中，最后一次随访时的先兆、精神治疗和就业也被视为一些生活质量子量表的重要预测因素。生活质量的大多数子量表在无癫痫发作的头几年呈陡峭的非线性上升，除认知功能随着无癫痫发作持续改善外，其余相对稳定。对于手术后无癫痫发作的患者，AED的副作用和/或精神治疗是生活质量的最强决定因素。
在长期随访中，无癫痫发作的持续时间和AED副作用对生活质量影响最大。因此，不仅要记录AED的服用情况，还要评估AED的副作用，这很重要。先兆的持续存在也对生活质量的不同方面有影响，但与AED的服用显著相关。除了与癫痫直接相关的因素外，生活质量还取决于社会心理因素，如就业状况、精神并发症和驾驶汽车，这突出了该组患者术后康复的必要性。
