Surgery for drug-resistant epilepsy may improve quality of life

Undergoing epilepsy surgery appears to yield clinically meaningful gains in quality of life (QoL), according to the results of a meta-analysis.

Researchers searched multiple online databases for studies that assessed changes in QoL among adults with drug-resistant epilepsy (DRE) who underwent surgery for their condition. The initial search yielded 3,774 titles and abstracts, of which 16 studies met the inclusion criteria.

All the included studies reported pre- and postepilepsy surgery QoL scores in adults with DRE via validated instruments. The total population consisted of 1,182 unique patients. Six studies were included in the QOLIE-31 (Quality of Life in Epilepsy Inventory-31 item) meta-analysis, while four studies were included in the QOLIE-89 meta-analysis.

Pooled data showed that the postoperative change in raw score was 20.5 for QOLIE-31 (95 percent confidence interval [CI] 10.9–30.1; I²= 95.5 percent) and 12.1 for QOLIE-89 (95 percent CI, 8.0–16.1; I²= 55.0 percent). These numbers translated to clinically meaningful QoL improvements.

Meta-regression of studies involving cohorts with higher proportions of patients with favourable seizure outcomes showed an even higher postoperative QOLIE-31 score as well as change in pre- and postoperative QOLIE-31 score.

At an individual study level, several factors were associated with improved postoperative QoL. These included preoperative absence of mood disorders, better preoperative cognition, fewer trials of antiseizure medications before surgery, high levels of conscientiousness and openness to experience at the baseline, engagement in paid employment before and after surgery, and not being on antidepressants following surgery.

The study was limited by the existence of substantial heterogeneity between individual studies as well as high risk of bias.