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

Bengi Kansu, Owen Pickrell Orcid Logo, Arron S. Lacey Orcid Logo, Ffion Edwards, Georgiana Samolia, Mark Rees, Robert Elwes, Richard Hatfield, William Gray, Khalid Hamandi

Epilepsy & Behavior, Volume: 111, Start page: 107196

Swansea University Authors: Owen Pickrell Orcid Logo, Arron S. Lacey Orcid Logo, Mark Rees

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DOI (Published version): 10.1016/j.yebeh.2020.107196

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 o...

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Published in: Epilepsy & Behavior
ISSN: 1525-5050
Published: Elsevier BV 2020
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URI: https://cronfa.swan.ac.uk/Record/cronfa54431
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Lacey</name><active>true</active><ethesisStudent>true</ethesisStudent></author><author><sid>10f39a4e9c2ee00d453cd84c10667ac8</sid><ORCID/><firstname>Mark</firstname><surname>Rees</surname><name>Mark Rees</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2020-06-10</date><deptcode>FGMHL</deptcode><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 &lt; 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 &lt; 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.</abstract><type>Journal Article</type><journal>Epilepsy &amp; Behavior</journal><volume>111</volume><journalNumber/><paginationStart>107196</paginationStart><paginationEnd/><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1525-5050</issnPrint><issnElectronic/><keywords>Refractory epilepsy; Epilepsy surgery; Seizure cessation; Quality of life; Long-term outcomes</keywords><publishedDay>1</publishedDay><publishedMonth>10</publishedMonth><publishedYear>2020</publishedYear><publishedDate>2020-10-01</publishedDate><doi>10.1016/j.yebeh.2020.107196</doi><url/><notes/><college>COLLEGE NANME</college><department>Medicine, Health and Life Science - Faculty</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>FGMHL</DepartmentCode><institution>Swansea University</institution><apcterm/><funders/><projectreference/><lastEdited>2022-12-05T12:55:44.3230116</lastEdited><Created>2020-06-10T16:06:54.0852237</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Bengi</firstname><surname>Kansu</surname><order>1</order></author><author><firstname>Owen</firstname><surname>Pickrell</surname><orcid>0000-0003-4396-5657</orcid><order>2</order></author><author><firstname>Arron S.</firstname><surname>Lacey</surname><orcid>0000-0001-7983-8073</orcid><order>3</order></author><author><firstname>Ffion</firstname><surname>Edwards</surname><order>4</order></author><author><firstname>Georgiana</firstname><surname>Samolia</surname><order>5</order></author><author><firstname>Mark</firstname><surname>Rees</surname><orcid/><order>6</order></author><author><firstname>Robert</firstname><surname>Elwes</surname><order>7</order></author><author><firstname>Richard</firstname><surname>Hatfield</surname><order>8</order></author><author><firstname>William</firstname><surname>Gray</surname><order>9</order></author><author><firstname>Khalid</firstname><surname>Hamandi</surname><order>10</order></author></authors><documents><document><filename>54431__17581__158937c9323541589d7af7dbafa1672d.pdf</filename><originalFilename>54431.pdf</originalFilename><uploaded>2020-06-26T09:15:18.0608469</uploaded><type>Output</type><contentLength>355531</contentLength><contentType>application/pdf</contentType><version>Accepted Manuscript</version><cronfaStatus>true</cronfaStatus><embargoDate>2021-06-15T00:00:00.0000000</embargoDate><documentNotes>Released under the terms of a Creative Commons Attribution Non-Commercial No Derivatives License (CC-BY-NC-ND).</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language></document></documents><OutputDurs/></rfc1807>
spelling 2022-12-05T12:55:44.3230116 v2 54431 2020-06-10 Long-term outcomes after epilepsy surgery, a retrospective cohort study linking patient-reported outcomes and routine healthcare data 1c3044b5ff7a6552ff5e8c9e3901c807 0000-0003-4396-5657 Owen Pickrell Owen Pickrell true false 7af5c8bdd1197f85720e4f3d65e803eb 0000-0001-7983-8073 Arron S. Lacey Arron S. Lacey true true 10f39a4e9c2ee00d453cd84c10667ac8 Mark Rees Mark Rees true false 2020-06-10 FGMHL 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. Journal Article Epilepsy & Behavior 111 107196 Elsevier BV 1525-5050 Refractory epilepsy; Epilepsy surgery; Seizure cessation; Quality of life; Long-term outcomes 1 10 2020 2020-10-01 10.1016/j.yebeh.2020.107196 COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University 2022-12-05T12:55:44.3230116 2020-06-10T16:06:54.0852237 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Bengi Kansu 1 Owen Pickrell 0000-0003-4396-5657 2 Arron S. Lacey 0000-0001-7983-8073 3 Ffion Edwards 4 Georgiana Samolia 5 Mark Rees 6 Robert Elwes 7 Richard Hatfield 8 William Gray 9 Khalid Hamandi 10 54431__17581__158937c9323541589d7af7dbafa1672d.pdf 54431.pdf 2020-06-26T09:15:18.0608469 Output 355531 application/pdf Accepted Manuscript true 2021-06-15T00:00:00.0000000 Released under the terms of a Creative Commons Attribution Non-Commercial No Derivatives License (CC-BY-NC-ND). true eng
title Long-term outcomes after epilepsy surgery, a retrospective cohort study linking patient-reported outcomes and routine healthcare data
spellingShingle Long-term outcomes after epilepsy surgery, a retrospective cohort study linking patient-reported outcomes and routine healthcare data
Owen Pickrell
Arron S. Lacey
Mark Rees
title_short Long-term outcomes after epilepsy surgery, a retrospective cohort study linking patient-reported outcomes and routine healthcare data
title_full Long-term outcomes after epilepsy surgery, a retrospective cohort study linking patient-reported outcomes and routine healthcare data
title_fullStr Long-term outcomes after epilepsy surgery, a retrospective cohort study linking patient-reported outcomes and routine healthcare data
title_full_unstemmed Long-term outcomes after epilepsy surgery, a retrospective cohort study linking patient-reported outcomes and routine healthcare data
title_sort Long-term outcomes after epilepsy surgery, a retrospective cohort study linking patient-reported outcomes and routine healthcare data
author_id_str_mv 1c3044b5ff7a6552ff5e8c9e3901c807
7af5c8bdd1197f85720e4f3d65e803eb
10f39a4e9c2ee00d453cd84c10667ac8
author_id_fullname_str_mv 1c3044b5ff7a6552ff5e8c9e3901c807_***_Owen Pickrell
7af5c8bdd1197f85720e4f3d65e803eb_***_Arron S. Lacey
10f39a4e9c2ee00d453cd84c10667ac8_***_Mark Rees
author Owen Pickrell
Arron S. Lacey
Mark Rees
author2 Bengi Kansu
Owen Pickrell
Arron S. Lacey
Ffion Edwards
Georgiana Samolia
Mark Rees
Robert Elwes
Richard Hatfield
William Gray
Khalid Hamandi
format Journal article
container_title Epilepsy & Behavior
container_volume 111
container_start_page 107196
publishDate 2020
institution Swansea University
issn 1525-5050
doi_str_mv 10.1016/j.yebeh.2020.107196
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description 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.
published_date 2020-10-01T04:07:58Z
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