A glance at Quality-of-Life Post-Epilepsy Surgery: A Meta-Analysis and Systematic Review

Abstract

Background: One of the most important outcomes of the epilepsy management is seizure freedom and improved quality of life (QoL). This meta-analysis and systemic review aim to compute the changes in QoL in the adults having drug resistant epilepsy further undergoing surgery. Thus, this also helps in exploring the various factors affecting the QoL with the changes in QoL. Methods: We analyzed the data using the various clinical trial medical databases and PubMed. Most of the studies had the pre- and post-operative seizure outcomes and the mean changes in pre- and post-operative QoL scores were analyzed. The literature search showed a total of 1336 studies were available after the initial search out of which 1259 were excluded. Once the abstract screening was done 77 studies were selected, going through the full text, 43 remained. We applied the language filter and also age range of the patients (19-44 years), yielded in 31 studies. Results: Four studies were included (n = 4 / 31, 12.9%) in the QOLIE-10 metanalysis. Overall preoperative QOLIE-10 score was 25.49 (19.38 – 31.60 with 95% CI) and overall postoperative QOLIE-10 score was 19.56 (12.95 – 26.16 with 95% CI). Eleven studies were included (n=11/31, 35.4%) in the QOLIE-31 metanalysis. Overall preoperative QOLIE-31 score was 43.89 (31.32 – 56.46 with 95% CI) and overall postoperative QOLIE-31 was 59.31 (45.09 – 73.54 with 95% CI). The change in QOLIE-31 was 12.28 (3.09 – 21.48 with 95% CI). Seven studies were included (n = 7/31, 22.5%) in the QOLIE-89 meta-analysis. Overall preoperative QOLIE-89 score was 49.26 (39.77 – 58.74 with 95% CI) and overall postoperative QOLIE-89 score was 58.87 (51.15 – 66.60 with 95% CI). Post operative change in QOLIE-89 was 11.04 (-0.20 – 22.27 with 95% CI). Individual studies show that better preoperative quality of life is linked to not having mood disorders before surgery, better cognitive function pre-surgery, fewer prior attempts at antiseizure medications, and higher levels of conscientiousness and openness. Additionally, being employed before and after surgery and not taking antidepressants post-surgery are associated with improved outcomes. Conclusion: This study indicates that epilepsy surgery can significantly enhance quality of life, with specific clinicodemographic factors influencing these improvements. However, the findings are limited by considerable variability between studies and a high risk of bias.