Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Epilepsia. 2014 Jun;55(6):886-92. doi: 10.1111/epi.12625. Epub 2014 Apr 15.
We examine improvement and worsening in quality of life (QOL) in terms of proportions achieving minimum clinically important change (MCID), and factors related to MCID, in patients with temporal lobe epilepsy randomized to medical or surgical treatment.
Eighty patients with temporal lobe epilepsy randomized to surgical (n(1) = 40) or medical (n(2) = 40) therapy were followed for 12 months, reporting QOL at baseline, and at 6 and 12 months. Previously established thresholds for MCID across various general and epilepsy-specific QOL instruments were used to determine meaningful improvement (positive MCID) or worsening (negative MCID). Generalized linear mixed-effects models were used to compare MCID in both groups.
At 6 months, 56.0% of patients in the surgical group achieved positive MCID on the Quality of Life in Epilepsy (QOLIE)-89, as compared to 11.0% of those in the medical group (p < 0.001). On the QOLIE-31, 62.0% of the surgical group and 17.0% of the medical group achieved positive MCID (p < 0.001). Substantially more medically treated patients exhibited clinically significant worsening in QOL, as compared with those surgically treated. The respective medical versus surgical proportions with worsening were 36.67% versus 13.8% in QOLIE31, 20% versus 15% in Health Utility Index-III (HUI-III), and 30% versus 19% in Short Form-36 (SF-36) Mental Composite Score (MCS). The number of patients who need to undergo surgery for one additional person to have a meaningful improvement in the QOLIE-31 is two (number needed to treat = 2). The results also favored surgery using the generic HUI-III instrument, but not with the mental of physical function subscales of the SF-36.
Significantly more patients in the surgical group achieved meaningful improvement in epilepsy-specific measures of QOL at 6 and 12 months compared to those in the medical group. Substantially more patients in the medical therapy group exhibited clinically significant worsening in their QOL assessed with epilepsy-specific and generic instruments. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
我们研究了在接受医学或手术治疗的颞叶癫痫患者中，根据达到最小临床重要变化（MCID）的比例以及与 MCID 相关的因素，在生活质量（QOL）方面的改善和恶化情况。
80 例随机分为手术组（n（1）=40）或药物组（n（2）=40）的颞叶癫痫患者随访 12 个月，分别在基线、6 个月和 12 个月报告 QOL。使用各种通用和癫痫特定 QOL 工具的先前确定的 MCID 阈值来确定有意义的改善（阳性 MCID）或恶化（阴性 MCID）。使用广义线性混合效应模型比较两组的 MCID。
在 6 个月时，手术组中有 56.0%的患者在癫痫生活质量问卷（QOLIE）-89 上达到阳性 MCID，而药物组仅为 11.0%（p<0.001）。在 QOLIE-31 上，手术组中有 62.0%的患者和药物组中有 17.0%的患者达到阳性 MCID（p<0.001）。与手术治疗相比，接受药物治疗的患者 QOL 明显恶化的比例显著更高。在 QOLIE31 中，药物治疗组与手术治疗组分别有 36.67%和 13.8%的患者出现临床显著恶化；在健康效用指数-III（HUI-III）中，分别有 20%和 15%的患者出现恶化；在 36 项简短健康调查量表（SF-36）精神综合评分（MCS）中，分别有 30%和 19%的患者出现恶化。需要手术治疗的患者数量为使 QOLIE-31 中的一个人有意义地改善，需要手术治疗的人数为 2（治疗需要数=2）。结果也有利于使用通用 HUI-III 仪器进行手术，但不利于使用 SF-36 的精神或身体功能子量表进行手术。
与药物治疗组相比，手术组在 6 个月和 12 个月时，在特定于癫痫的 QOL 测量中，有更多的患者达到了有意义的改善。在使用癫痫和通用工具评估 QOL 时，药物治疗组有更多的患者出现了临床显著的恶化。本文的幻灯片摘要可在支持信息部分下载。
