Edelvik Anna, Taft Charles, Ekstedt Gerd, Malmgren Kristina
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
Epilepsia. 2017 Oct;58(10):1706-1715. doi: 10.1111/epi.13874. Epub 2017 Aug 24.
To evaluate health-related quality of life (HRQOL) and emotional well-being in resective epilepsy surgery and nonoperated patients at long-term follow-up.
This is a prospective cohort study where patients undergoing presurgical work-up during 1995-1998 completed the Short-Form Health Survey (SF-36) and the Hospital Anxiety and Depression scale (HAD) at baseline, and 2 and 14 years after resective surgery or presurgical evaluation (nonoperated patients). SF-36 scores were compared to a normative population. Proportions of patients reaching HRQOL changes of minimum clinically important difference (MCID) were calculated.
At 14-year follow-up, operated patients scored equal to or better than the normative sample on all SF-36 domains except Social Functioning and Mental Health. Physical component summary (PCS) was better and mental component summary (MCS) was worse than for the normative sample. Nonoperated patients scored worse than the normative sample on five of eight domains, and on PCS and MCS. Change in seizure status from 2 to 14 years did not affect PCS or MCS means. Improvement reaching MCID from baseline to long-term was seen in 50% (PCS) and 47% (MCS) of operated and in 33% (PCS) and 38% (MCS) of nonoperated patients. Worsening was seen in 18% (PCS) and 22% (MCS) of operated and in 38% (PCS) and 38% (MCS) of nonoperated patients. Differences between groups were nonsignificant. HAD scores did not differ between groups, and the numbers of possible or probable cases were low. Patient satisfaction with surgery was higher in operated seizure-free patients. Only 5% of all operated patients considered surgery not to be overall beneficial.
At the group level, HRQOL was stable 14 years after surgery compared to after 2 years. Social Functioning and Mental Health were still below, but other domains were similar to the normative sample. Individual patterns did not follow seizure outcome changes, indicating that multiple factors are important for long-term HRQOL.
评估接受切除性癫痫手术患者和未接受手术患者在长期随访中的健康相关生活质量（HRQOL）和情绪健康状况。
这是一项前瞻性队列研究，1995 - 1998年期间接受术前检查的患者在基线时、切除性手术后2年和14年以及术前评估后2年和14年（未接受手术患者）完成了简短健康调查问卷（SF - 36）和医院焦虑抑郁量表（HAD）。将SF - 36评分与正常人群进行比较。计算达到最小临床重要差异（MCID）的HRQOL变化的患者比例。
在14年随访时，除社会功能和心理健康外，接受手术的患者在所有SF - 36领域的得分等于或优于正常样本。身体成分总结（PCS）优于正常样本，而心理成分总结（MCS）则较差。未接受手术的患者在八个领域中的五个领域以及PCS和MCS方面的得分低于正常样本。从2年到14年癫痫发作状态的变化未影响PCS或MCS均值。接受手术的患者中，从基线到长期达到MCID改善的比例为50%（PCS）和47%（MCS），未接受手术的患者中这一比例为33%（PCS）和38%（MCS）。接受手术的患者中18%（PCS）和22%（MCS）以及未接受手术的患者中38%（PCS）和38%（MCS）出现恶化。组间差异无统计学意义。两组间HAD评分无差异，可能或疑似病例数较少。癫痫发作已控制的接受手术患者对手术的满意度更高。所有接受手术的患者中只有5%认为手术总体上没有益处。
在组水平上，与术后2年相比，术后14年HRQOL稳定。社会功能和心理健康仍低于正常样本，但其他领域与正常样本相似。个体模式并未随癫痫发作结果变化，表明多种因素对长期HRQOL很重要。
