Quality of life pre and post epilepsy surgery

The aim of this work was to assess the health-related quality of life (HRQL ) of patients pre and post surgical treatment for epilepsy. A total of 145 patients were interviewed during their pre-surgical assessment on the telem etry unit, Queen Square. The HRQL assessment comprised the quality of life assessment schedule (QOLAS), the EuroQol EQ-5D and the epilepsy surgery inv entory (ESI-55). A total of 40 patients were followed up, of which 22 had u ndergone surgery and achieved 75% or greater reduction in seizures. The QOL AS scores for the patients who achieved 75% or greater seizure reduction po st-op were significantly lower (i.e. improved HRQL) compared to baseline. T he descriptive data suggest that the EQ-5D may not be capturing all of the QOL issues of relevance to patients with chronic, intractable epilepsy and the EQ-5D may not be valid for this group. Most patients queried the visual analogue scale (VAS) which asks for an overall rating of the respondent's self-perceived health. The most frequent comments, from 42% of patients, wa s that 'health' did not include their epilepsy. Despite this, the group who se seizures were reduced had significantly higher VAS scores at follow-up. We can conclude that the VAS is sensitive to clinical change. The baseline EQ-5D utility and follow-up scores were compared. There were no significant changes in QOL scores for either group. The patients who achieved 75% or g reater reduction in seizures post-op scored significantly higher (i.e. bett er QOL) on 2/3 composite scores of the ESI-55 at follow-up. The QOLAS, the EQ-5D VAS and the ESI-55 were sensitive to clinically defined outcome. The results for the EQ-5D profile and the EQ-5D utility suggest that the EQ-5D is not a valid and responsive instrument for use in patients with intractab le epilepsy. (C) 2000 Published by Elsevier Science B.V. All rights reserve d.