Abstracts

Given the elevated incidence of behavioral and adjustment problems in epilepsy relative to other chronic pediatric disorders, health-related quality of life (QL) is an important domain to assess. Furthermore, the use of surgical interventions to improve QL through reduced seizure frequency makes it a pertinent outcome to measure. Though QL has been evaluated following focal resection surgery in some samples, it has not been investigated in children receiving hemispherectomy or hemispherotomy (HE). When reported, cognitive and psychosocial outcomes appear mixed, but previous studies have used neither standardized measures of QL nor appropriate control groups. This study describes post-operative QL in a sample of HE patients using standardized instruments with established reliability and validity and appropriate surgical and non-surgical epilepsy controls. Participants in the current study included a group (N=14) of hemispherectomy / hemispherotomy (HE) patients, groups of temporal (N=16) and frontal (N=10) resection patients, as well as non-surgical pediatric epilepsy cases (N=84). Parents of all participants completed the Impact of Childhood Illness Scale (ICI) and the Hague Restrictions in Epilepsy Scale (HARCES), at least 1 year post-operatively for surgical patients. On these scales, a lower score signifies a higher QOL. Generally speaking, temporal lobe resection patients had the lowest ICI and HARCES scores. HE patients had lower HARCES scores than frontal resection and non-surgical control patients, but all three groups showed similar ICI scores. In all surgical groups, post-operative seizure frequency (Engels classification) was moderately correlated with ICI scores and HARCES scores. HE patients in our study had similar ICI QL scores to surgical and non-surgical controls, and [italic]fewer[/italic] physical difficulties on the HARCES than non-surgical and frontal resection patients. This suggests that parents of HE patients perceive their children to have similar QL to other children with epilepsy. For all surgical patients, residual seizure frequency emerged as an important correlate of poor QL, and for all patients (including non-surgical cases), duration of illness was related to worse QL. These findings suggest that continued seizure activity has a significant negative impact on QL. (Supported by B.C. Medical Services Foundation and the Vancouver Foundation grants to the second author.)