Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.
Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
JAMA Netw Open. 2023 Mar 1;6(3):e234858. doi: 10.1001/jamanetworkopen.2023.4858.
Health-related quality of life (HRQOL) is regarded as a key outcome for evaluating treatment efficacy. However, it is uncertain how HRQOL evolves after epilepsy surgery compared with medical therapy, such as whether it continues to improve over time, improves and then remains stable, or deteriorates after a period of time.
To assess trajectory of HRQOL over 2 years in children with drug-resistant epilepsy (DRE) treated with surgery compared with medical therapy.
DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study assessing HRQOL longitudinally over 2 years. Participants were children recruited from 8 epilepsy centers in Canada from 2014 to 2019 with suspected DRE aged 4 to 18 years who were evaluated for surgery. Data were analyzed from May 2014 to December 2021.
Epilepsy surgery or medical therapy.
HRQOL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55. HRQOL and seizure frequency were assessed at baseline, 6-month, 1-year, and 2-year follow-ups. Clinical, parent, and family characteristics were assessed at baseline. A linear mixed model was used to evaluate HRQOL over time, adjusting for baseline clinical, parent, and family characteristics.
There were 111 surgical and 154 medical patients (mean [SD] age at baseline was 11.0 [4.1] years; 118 [45%] were female). At baseline, HRQOL was similar among surgical and medical patients. HRQOL of surgical patients was 3.0 (95% CI, -0.7 to 6.8) points higher at 6-month, 4.9 (95% CI, 0.7 to 9.1) points higher at 1-year, and 5.1 (95% CI, 0.7 to 9.5) points higher at 2-year follow-ups compared with medical patients. Surgical patients experienced greater improvements in social functioning relative to medical patients, but not for cognitive, emotional, and physical functioning. At 2-year follow-up, 72% of surgical patients were seizure-free, compared with 33% of medical patients. Seizure-free patients reported higher HRQOL than those who were not.
This study provided evidence on the association between epilepsy surgery and children's HRQOL, with improvement in HRQOL occurring within the first year and remaining stable 2 years after surgery. By demonstrating that surgery improved seizure freedom and HRQOL, which has downstream effects such as better educational attainment, reduced health care resource utilization, and health care cost, these findings suggest that the high costs of surgery are justified, and that improved access to epilepsy surgery is necessary.
健康相关生活质量（HRQOL）被认为是评估治疗效果的关键指标。然而，尚不确定癫痫手术后 HRQOL 的变化情况，例如其是否会随着时间的推移持续改善，是先改善然后保持稳定，还是在一段时间后恶化。
评估与药物治疗相比，接受手术治疗的耐药性癫痫（DRE）儿童在 2 年内的 HRQOL 轨迹。
设计、设置和参与者：这是一项前瞻性队列研究，在 2 年内纵向评估 HRQOL。参与者是 2014 年至 2019 年期间从加拿大 8 个癫痫中心招募的疑似 DRE 儿童，年龄在 4 至 18 岁，接受手术评估。数据分析时间为 2014 年 5 月至 2021 年 12 月。
癫痫手术或药物治疗。
使用儿童癫痫生活质量问卷（QOLCE-55）测量 HRQOL。在基线、6 个月、1 年和 2 年随访时评估 HRQOL 和癫痫发作频率。在基线时评估临床、父母和家庭特征。使用线性混合模型，根据基线临床、父母和家庭特征，评估 HRQOL 随时间的变化情况。
手术组有 111 例，药物治疗组有 154 例（基线时平均[SD]年龄为 11.0[4.1]岁；118[45%]为女性）。在基线时，手术组和药物治疗组的 HRQOL 相似。与药物治疗组相比，手术组在 6 个月时 HRQOL 高出 3.0（95%CI，-0.7 至 6.8）分，在 1 年时高出 4.9（95%CI，0.7 至 9.1）分，在 2 年时高出 5.1（95%CI，0.7 至 9.5）分。手术组患者在社会功能方面的改善优于药物治疗组，但在认知、情绪和身体功能方面没有改善。在 2 年随访时，72%的手术组患者无癫痫发作，而药物治疗组为 33%。无癫痫发作的患者报告的 HRQOL 高于有癫痫发作的患者。
本研究提供了癫痫手术与儿童 HRQOL 之间关联的证据，HRQOL 的改善发生在手术后的第一年，并且在手术后 2 年内保持稳定。通过证明手术可以改善癫痫发作的频率和 HRQOL，这会产生诸如更好的教育程度、减少卫生保健资源的利用和卫生保健成本等下游影响，这些发现表明手术的高成本是合理的，并且需要更好地获得癫痫手术治疗。
