Walther Katrin, Dogan Onugoren Müjgan, Buchfelder Michael, Gollwitzer Stephanie, Graf Wolfgang, Kasper Burkhard S, Kriwy Peter, Kurzbuch Katrin, Lang Johannes, Rössler Karl, Schwab Stefan, Schwarz Michael, Stefan Hermann, Hamer Hajo M
Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany.
Epilepsy Center, Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany.
Epilepsy Behav. 2018 Apr;81:94-100. doi: 10.1016/j.yebeh.2018.01.038. Epub 2018 Feb 14.
Only limited data exist on psychosocial long-term outcome after epilepsy surgery in patients with extratemporal epilepsy. The aim of this study was to investigate psychosocial outcome after extratemporal epilepsy surgery and to assess factors predicting favorable outcome.
Sixty-five out of 104 eligible patients who had undergone extratemporal epilepsy surgery at our epilepsy center between 1990 and 2015 (mean age: 42.2. years; 75% of the resections in the frontal lobe) completed a questionnaire asking about seizure status, employment status, marital and living situation, driving status, depressive symptoms, and quality of life (QOL). Follow-up was on average 9.2years after surgery (range: 1-26years).
Thirty-eight (58%) patients were free of disabling seizures (Engel class I), and 28 (43%) have not experienced any seizures after surgery (Engel class IA). Employment rate in the primary labor market remained at 45%, but more patients lost employment (14%) than gained employment (8%). Postoperative employment was predicted by preoperative employment (p=.007), seizure freedom (p=.025), older age at seizure onset (p=.018), younger age at follow-up (p=.035), and female gender (p=.048). Seizure-free patients were more likely to be driving; have a partner, particularly in males; and have lower depressive scores. Quality of life at follow-up was best predicted by employment (p=.012), partnership (p=.025), and seizure freedom (p=.025). In contrast, recurrence of seizures and early seizure onset were associated with poor psychosocial outcome, particularly in men.
The study provides support that extratemporal surgery can lead to improved QOL and favorable psychosocial outcome. Seizure freedom is important but not the only determinant of good psychosocial outcome.
关于颞叶外癫痫患者癫痫手术后心理社会长期预后的资料有限。本研究旨在调查颞叶外癫痫手术后的心理社会预后，并评估预测良好预后的因素。
1990年至2015年间在我们癫痫中心接受颞叶外癫痫手术的104例符合条件的患者中，65例（平均年龄：42.2岁；75%的切除术在额叶）完成了一份问卷，询问癫痫发作状况、就业状况、婚姻和生活状况、驾驶状况、抑郁症状和生活质量（QOL）。术后平均随访9.2年（范围：1 - 26年）。
38例（58%）患者无致残性癫痫发作（Engel I级），28例（43%）术后未经历任何癫痫发作（Engel IA级）。主要劳动力市场的就业率保持在45%，但失业的患者（14%）多于就业的患者（8%）。术前就业情况（p = 0.007）、癫痫发作缓解（p = 0.025）、癫痫发作起始时年龄较大（p = 0.018）、随访时年龄较小（p = 0.035）以及女性性别（p = 0.048）可预测术后就业情况。癫痫发作缓解的患者更有可能开车；有伴侣，尤其是男性；且抑郁评分较低。随访时的生活质量最佳预测因素为就业情况（p = 0.012）、伴侣关系（p = 0.025）和癫痫发作缓解（p = 0.025）。相比之下，癫痫复发和早期癫痫发作与不良的心理社会预后相关，尤其是在男性中。
该研究支持颞叶外手术可改善生活质量和心理社会预后。癫痫发作缓解很重要，但不是良好心理社会预后的唯一决定因素。
