McLachlan R S, Rose K J, Derry P A, Bonnar C, Blume W T, Girvin J P
Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada.
Ann Neurol. 1997 Apr;41(4):482-9. doi: 10.1002/ana.410410411.
We conducted a prospective study over 24 months to compare health-related quality of life in surgically and medically treated patients with intractable temporal lobe epilepsy. Seizure frequency and health-related quality of life were assessed in 81 patients before and 6, 12, and 24 months after treatment. Using the Epilepsy Surgery Inventory 55 (ESI-55), we compared (1) different seizure outcome groups and (2) temporal lobectomy with continuing medical management. Follow-up was satisfactory in 72 patients (89%), 51 treated with temporal lobectomy and 21 with no surgery. Pretreatment seizures and health-related quality of life were comparable in the two groups. Seizure outcome was significantly better at 6, 12, and 24 months after surgery. At 24 months, seizure-free patients and those with at least a 90% reduction in seizure frequency reported significant improvements in health-related quality of life (on 5 of 10 subscales and overall Epilepsy Surgery Inventory 55 scale). Deterioration in quality of life occurred with less than 90% seizure reduction. Only one Epilepsy Surgery Inventory 55 subscale at 6 months and two subscales at 12 months showed a significant difference. Patients with good seizure outcome experience improved health-related quality of life after treatment. Since temporal lobectomy results in considerably better seizure control than continued medical management, the findings support surgery as the preferred treatment, although changes in health-related quality of life may not be evident until the second postoperative year.
我们进行了一项为期24个月的前瞻性研究，以比较手术治疗和药物治疗的顽固性颞叶癫痫患者的健康相关生活质量。在81例患者治疗前以及治疗后6个月、12个月和24个月评估癫痫发作频率和健康相关生活质量。使用癫痫手术量表55（ESI-55），我们比较了（1）不同的癫痫发作结果组，以及（2）颞叶切除术与持续药物治疗。72例患者（89%）随访情况良好，其中51例行颞叶切除术，21例未手术。两组治疗前的癫痫发作情况和健康相关生活质量具有可比性。术后6个月、12个月和24个月时癫痫发作结果明显更好。在24个月时，无癫痫发作的患者以及癫痫发作频率至少降低90%的患者在健康相关生活质量方面（在10个分量表中的5个以及癫痫手术量表55总分量表上）报告有显著改善。癫痫发作减少少于90%时生活质量会恶化。仅在6个月时有1个ESI-55分量表以及在12个月时有2个分量表显示出显著差异。癫痫发作结果良好的患者治疗后健康相关生活质量得到改善。由于颞叶切除术在控制癫痫发作方面比持续药物治疗效果好得多，这些发现支持手术作为首选治疗方法，尽管健康相关生活质量的改善可能直到术后第二年才明显。
