Postoperative Evaluation of the Quality of Life, Depression, and Anxiety of Temporal Lobe Epilepsy Cohort: A Single Institute Experience in Indonesia

Abstract

Background: Besides seizure control, quality of life (QoL) should be considered as an equally important outcome for epilepsy surgery service providers. The paucity of QoL reports from developing countries has enlarged the representation gap between wealthy countries and countries with fewer resources. In this study, we evaluated postoperative QoL in the Indonesian drug-resistant epilepsy cohort where the epilepsy surgery service faces limited resource availability.Methods: We evaluated the QoL in patients with temporal lobe epilepsy who underwent surgery in our epilepsy surgery center in Semarang, Indonesia, from 2001 until 2015. The follow–up period started in 2018 through 2019. Postoperative QoL, depression, and anxiety were evaluated with self-reporting questionnaires including the Quality of Life in Epilepsy Inventory-31, Beck Depression Inventory-II, and Zung Self-Rating Anxiety Scales.Results: Forty returned questionnaires were included in the analysis (male 25, 62.5%; mean age 27.6 ± 9.05 years). The seizure-free cohort (n = 22, 55.0%) reported higher scores in most QoL dimensions particularly adjustment, overall QoL, and seizure worry compared to those with persistent seizures. The overall QoL level was correlated with seizure freedom and surgery type. QoL dimensions were negatively correlated with anxiety and depression levels.Conclusions: Postoperative seizure freedom was a major factor of postoperative QoL level. Besides seizure freedom, anxiety and depression levels were also negatively correlated with QoL levels in the Indonesian population.

Outlines to Initiate Epilepsy Surgery in Low- and Middle-Income Countries

“…The decision to stay with, reduce or discontinue ASM depends, at least in part, on patient preference [75], but patients should be fully informed of the steps taken and well monitored and counseled [90]. Notably, seizure freedom is the main factor for a positive assessment of the quality of life (QoL) [91][92][93][94][95] and by far the most important predictor for improvement in QoL after surgery [96], whereas continued medication is unrelated to this dimension [97].…”

“…In developing countries, epilepsy surgery offers the opportunity to reduce stigma and improve QoL [92,[97][98][99][100][101][102], also with a positive impact on patients with low resources and precarious social circumstances [103]. Sustained and meaningful improvements in QoL, as patients hope for from surgical interventions, are mainly achieved within the first two years after surgery [91,97].…”

“…Patients hope to gain remission of disease burden through surgical epilepsy intervention, but patients who undergo surgical resection are prone to psychiatric disorders in the postsurgical period, either as an exacerbation of a known psychiatric diagnosis or the development of a new disorder. These postsurgical psychiatric disorders can significantly affect the QoL and overshadow a positive outcome of surgical seizure treatment [92,111]. Surgical intervention may also have a positive impact on existing depression and anxiety in some cases [112], but unrealistic expectations have a negative impact on patient's QoL rating [96].…”

What is the role of screening instruments in the management of psychiatric comorbidities in epilepsy? Tools and practical tips for the most common comorbidities: Depression and anxiety

“…PWE experiencing depression and/or anxiety report lower health-related quality of life, lower social functioning, and higher rates of global healthcare utilization despite higher rates of missed follow up visits [13] , [20] , [21] , [22] , [23] , [24] , [25] . Both depression and anxiety are associated with increased likelihood of drug resistant epilepsy and increased ASM adverse effects [26] , [27] , [28] , [29] .…”