TY - JOUR
T1 - Quality of Life after Epilepsy Surgery in Children
T2 - A Systematic Review and Meta-Analysis
AU - Maragkos, Georgios A.
AU - Geropoulos, Georgios
AU - Kechagias, Konstantinos
AU - Ziogas, Ioannis A.
AU - Mylonas, Konstantinos S.
N1 - Publisher Copyright:
© 2018 by the Congress of Neurological Surgeons.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - BACKGROUND: Pediatric epilepsy surgery is a treatment modality appropriate for select patients with debilitating medication-resistant seizures. Previous publications have studied seizure freedom as the main outcome of epilepsy surgery. However, there has been no systematic assessment of the postoperative life quality for these children. OBJECTIVE: To estimate the quality of life (QOL) long-term outcomes after surgery for intractable epilepsy in pediatric patients. METHODS: A systematic search of the PubMed and Cochrane databases was performed. Studies reporting questionnaire-assessed QOL at least 12 months postoperatively were included. QOL means and standard deviations were compared between surgically and medically managed patients, between the preoperative and postoperative state of each patient, and were further stratified into patients achieving seizure freedom, and those who did not. Meta-analysis was performed using fixed effects models for weighted mean differences (WMD), 95% confidence intervals (CI) and sensitivity analyses. Funnel plots and Begg's tests were utilized to detect publication bias. RESULTS: The search yielded 18 retrospective studies, reporting 890 surgical patients. Following epilepsy surgery, children had significant QOL improvement compared to their preoperative state (WMD: 16.71, 95% CI: 12.19-21.22, P <. 001) and better QOL than matched medically treated controls (WMD: 12.42, 95% CI: 6.25-18.58, P <. 001). Patients achieving total seizure freedom after surgery had significant postoperative QOL improvement (WMD: 16.12, 95% CI: 7.98-24.25, P <. 001), but patients not achieving seizure freedom did not achieve statistical significance (P =. 79). CONCLUSION: Epilepsy surgery can effectively improve QOL in children with medication-resistant seizures, through seizure freedom, which was associated with the greatest improvement in life quality.
AB - BACKGROUND: Pediatric epilepsy surgery is a treatment modality appropriate for select patients with debilitating medication-resistant seizures. Previous publications have studied seizure freedom as the main outcome of epilepsy surgery. However, there has been no systematic assessment of the postoperative life quality for these children. OBJECTIVE: To estimate the quality of life (QOL) long-term outcomes after surgery for intractable epilepsy in pediatric patients. METHODS: A systematic search of the PubMed and Cochrane databases was performed. Studies reporting questionnaire-assessed QOL at least 12 months postoperatively were included. QOL means and standard deviations were compared between surgically and medically managed patients, between the preoperative and postoperative state of each patient, and were further stratified into patients achieving seizure freedom, and those who did not. Meta-analysis was performed using fixed effects models for weighted mean differences (WMD), 95% confidence intervals (CI) and sensitivity analyses. Funnel plots and Begg's tests were utilized to detect publication bias. RESULTS: The search yielded 18 retrospective studies, reporting 890 surgical patients. Following epilepsy surgery, children had significant QOL improvement compared to their preoperative state (WMD: 16.71, 95% CI: 12.19-21.22, P <. 001) and better QOL than matched medically treated controls (WMD: 12.42, 95% CI: 6.25-18.58, P <. 001). Patients achieving total seizure freedom after surgery had significant postoperative QOL improvement (WMD: 16.12, 95% CI: 7.98-24.25, P <. 001), but patients not achieving seizure freedom did not achieve statistical significance (P =. 79). CONCLUSION: Epilepsy surgery can effectively improve QOL in children with medication-resistant seizures, through seizure freedom, which was associated with the greatest improvement in life quality.
KW - Children
KW - Epilepsy
KW - Meta-analysis
KW - Pediatric
KW - Quality of life
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85076336144&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyy471
DO - 10.1093/neuros/nyy471
M3 - Review article
C2 - 30335182
AN - SCOPUS:85076336144
SN - 0148-396X
VL - 85
SP - 741
EP - 749
JO - Neurosurgery
JF - Neurosurgery
IS - 6
ER -