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Long-term outcomes after epilepsy surgery, a retrospective cohort study linking patient-reported outcomes and routine healthcare data

Kansu, Bengi, Pickrell, William O., Lacey, Arron S., Edwards, Ffion, Samolia, Georgiana, Rees, Mark I., Elwes, Robert, Hatfield, Richard, Gray, William ORCID: https://orcid.org/0000-0001-7595-8887 and Hamandi, Khalid 2020. Long-term outcomes after epilepsy surgery, a retrospective cohort study linking patient-reported outcomes and routine healthcare data. Epilepsy and Behavior 111 , 107196. 10.1016/j.yebeh.2020.107196

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Abstract

Objective The objective of the study was to assess the long-term outcomes of epilepsy surgery between 1995 and 2015 in South Wales, UK, linking case note review, postal questionnaire, and routinely collected healthcare data. Method We identified patients from a departmental database and collected outcome data from patient case notes, a postal questionnaire, and the QOLIE-31-P and linked with Welsh routinely collected data in the Secure Anonymised Information Linkage (SAIL) databank. Results Fifty-seven patients were included. Median age at surgery was 34 years (11–70), median: 24 years (2–56) after onset of habitual seizures. Median follow-up was 7 years (2–19). Twenty-eight (49%) patients were free from disabling seizures (Engel Class 1), 9 (16%) experienced rare disabling seizures (Class 2), 13 (23%) had worthwhile improvements (Class 3), and 7 (12%) had no improvement (Class 4). There was a 30% mean reduction in total antiepileptic drug (AED) load at five years postsurgery. Thirty-eight (66.7%) patients experienced tonic–clonic seizures presurgery verses 8 (14%) at last review. Seizure-free patients self-reported a greater overall quality of life (QOL; QOLIE-31-P) when compared with those not achieving seizure freedom. Seizure-free individuals scored a mean of 67.6/100 (100 is best), whereas those with continuing seizures scored 46.0/100 (p < 0.006). There was a significant decrease in the median rate of hospital admissions for any cause after epilepsy surgery (9.8 days per 1000 patient days before surgery compared with 3.9 after p < 0.005). Significance Epilepsy surgery was associated with significant improvements in seizures, a reduced AED load, and an improved QOL that closely correlated with seizure outcomes and reduced hospital admission rates following surgery. Despite this, there was a long delay from onset of habitual seizures to surgery. The importance of long-term follow-up is emphasized in terms of evolving medical needs and health and social care outcomes.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Cardiff University Brain Research Imaging Centre (CUBRIC)
Medicine
Neuroscience and Mental Health Research Institute (NMHRI)
Psychology
Publisher: Elsevier
ISSN: 1525-5050
Date of First Compliant Deposit: 20 November 2020
Date of Acceptance: 25 May 2020
Last Modified: 09 Nov 2022 22:11
URI: https://orca.cardiff.ac.uk/id/eprint/136472

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