Quality of life long after temporal lobe epilepsy surgery.

OBJECTIVES: To identify variables independently associated with a meaningful improvement in QOL long after surgical treatment of drug-resistant MTLE-HS patients. MATERIAL & METHODS: We prospectively evaluated 72 consecutive MTLE-HS surgically treated patients and analyzed pre and post-surgical variables independently associated with a meaningful improvement in QOL evaluated by the Quality of Life in Epilepsy-31 (QOLIE-31) overall score, and its domain scores determined at follow-up after 36 to 131 months (mean 93 months) after surgery. RESULTS: The mean overall QOLIE-31 score and its subdomain scores improved significantly after surgery (p < 0.01), and 55 patients (76.4%) had a meaningful QOL improvement. Being seizure-free (Engel IA) after surgery showed a non-significant association (OR 2.63, CI 95% 0.53 to 13.05, p = 0.23) and lower depressive symptoms a significant association (OR 4.15, CI 95% 1.19 to 14.53, p = 0.03) with meaningful improvement of QOL. CONCLUSIONS: Patients with MTLE-HS who underwent epilepsy surgery show a sustained, meaningful improvement in their QOL. Pre-surgical variables do not predict long-term QOL improvement after surgery. Lower levels of depressive symptoms at postoperative evaluation are associated with meaningful QOL improvement.

Decline in word-finding: The objective cognitive finding most relevant to patients after mesial temporal lobe epilepsy surgery.

PURPOSE: The purpose of this study was to investigate the following: i) the objective impairment in neuropsychological tests that were associated with the subjective perception of cognitive function decline in Brazilian patients who underwent mesial temporal lobe epilepsy (MTLE) surgery and ii) the predictive variables for those impaired objective neuropsychological tests. METHODS: Forty-eight adults with MTLE (27 right HS and 23 male) were divided according to their perception of changes (Decline or No-decline) of cognitive function domain of the QOLIE-31 questionnaire applied before and 1year after the ATL. The mean (SD) of changes in the raw score difference of the neuropsychological tests before and after the ATL was compared between Decline and No-decline groups. Receiver Operating Characteristic curves, sensitivity, specificity, and predictive values were used to assess the optimum cutoff points of neuropsychological test score changes to predict patient-reported subjective cognitive decline. KEY FINDINGS: Six (12.5%) patients reported a perception of cognitive function decline after ATL. Among the 25 cognitive tests analyzed, only changes in the Boston Naming Test (BNT) were associated with subjective cognitive decline reported by patients. A reduction of ≥8 points in the raw score of BNT after surgery had 91% of sensitivity and 45% specificity for predicting subjective perception of cognitive function decline by the patient. Left side surgery and age older than 40years were more associated with an important BNT reduction with overall accuracy of 91.7%, 95% predictive ability for no impairment, and 75% for impairment of cognitive function. SIGNIFICANCE: Impairment in word-finding seems to be the objective cognitive finding most relevant to Brazilian patients after mesial temporal lobe epilepsy surgery. Similar to American patients, the side of surgery and age are good predictors for no decline in the BNT, but shows a lower accuracy to predict its decline. If replicated in other populations, the results may have wider implications for the surgical management of patients with drug-resistant MTLE.

Predictors of meaningful improvement in quality of life after temporal lobe epilepsy surgery: A prospective study.

OBJECTIVES: To investigate prospectively the independent predictors of a minimum clinically important change (MCIC) in quality of life (QOL) after anterior temporal lobectomy (ATL) for drug-resistant mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) in Brazilian patients. METHODS: Multiple binary logistic regression analysis was performed to identify the clinical, demographic, radiologic, and electrophysiologic variables independently associated with MCIC in the Quality of Life in Epilepsy-31 Inventory (QOLIE-31) overall score 1 year after ATL in 77 consecutive patients with unilateral MTLE-HS. RESULTS: The overall QOLIE-31 score and all its subscale scores increased significantly (p < 0.0001) 1 year after ATL. In the final logistic regression model, absence of presurgical diagnosis of depression (adjusted odds ratio [OR] 4.4, 95% confidence interval [CI] 1.1-16.1, p = 0.02) and a complete postoperative seizure control (adjusted OR 4.1, 95% CI 1.2-14.5, p = 0.03) were independently associated with improvement equal to or greater than the MCIC in QOL after ATL. The overall model accuracy for MCIC improvement in the QOL was 85.6%, with a 95.2% of sensitivity and 46.7% of specificity. SIGNIFICANCE: These results in Brazilian patients reinforce the external validation of previous findings in Canadian patients showing that presurgical depression and complete seizure control after surgery are independent predictors for meaningful improvement in QOL after ATL, and have implications for the surgical management of MTLE patients.

Cuidados de enfermagem ao paciente no perioperatório de cortico-amigdalo-hipocampectomía / Nursing care for patients in the perioperative cortico-amygdalo-hippocampectomy

Este artigo teve como objetivo construir e apresentar um plano de cuidados pré e pós-operatórios para pacientes submetidos à cirurgia de cortico-amígdalo-hipocampectomia (AHC) para ser implementado em uma unidade de internação cirúrgica de um Hospital Universitário do Sul do Brasil. Trata-se de um relato de experiência desenvolvida durante o Estágio Supervisionado de Enfermagem por graduandos de enfermagem. Construiu-se um plano com 26 cuidados de enfermagem para pacientes submetidos à cirurgia de AHC, que foi validado por profissionais experts da área. Realizaram-se encontros expositivos e dialogados com a equipe de enfermagem para esclarecer e desmistificar a epilepsia, suas diferentes apresentações de crises e possibilidades de tratamento, bem como apresentar o plano de cuidados elaborado. Essa experiência contribuiu com a formação profissional dos estudantes, assim como forneceu subsídios para a implementação da sistematização da assistência de enfermagem a este paciente específico, considerando o cuidado sistematizado uma ferramenta fundamental no trabalho do enfermeiro.

Este artículo tiene como objetivo construir y presentar un plan de cuidados pre y posoperatorios para pacientes sometidos a la cirugía de cortico-amígdalo-hipocampectomía (AHC), también llamada Cirugía de la epilepsia, para ser implementado en una unidad de internación quirúrgica de un hospital universitario del Sur de Brasil. Se trata de un relato de experiencia del proceso de elaboración y socialización desarrollado durante la Práctica Supervisada de Enfermería por académicos de enfermería. Se construyó un plan de 26 cuidados de enfermería destinados a pacientes sometidos a la cirugía AHC, el cual obtuvo la validación de profesionales experts del área. Se realizaron reuniones de exposición y diálogo con el equipo de enfermería para aclarar y desmitificar la epilepsia, sus diferentes presentaciones de crisis y posibilidades de tratamiento; así mismo, se presentó el Plan de Cuidados. Esta experiencia contribuyó a la formación académica, así como a la concesión de subvenciones para la ejecución de la sistematización de los cuidados de enfermería específicos para estos pacientes, teniendo en cuenta que el cuidado sistemático es una herramienta fundamental en el trabajo de enfermería.

The objective of this article is to build and to present the process of pre and postsurgical care plans for patients who underwent cortico-amygadalo-hippocampectomy surgeries (AHC), to be implemented in a surgical unit at University Hospital, in the South of Brazil. It was an activity developed by nursing students during the Nursing Supervised Training. It was built a plan with 26 nursing care for patients who underwent AHC surgeries and it was validated by experts in that area. Subsequently, several meetings with presentations and dialogues were held along with the nursing staff, in order to clarify and demystify epilepsy; different presentations of crises and possibilities of treatment as well as the developed care plan presentation. This experience contributed to the academic training, as well as providing subsidies for the implementation of the systematization of nursing care specific to this patient, considering the importance of a systematic care in the nursing work.

Predictors of quality of life in patients with refractory mesial temporal lobe epilepsy.

PURPOSE: The identification of variables associated with health-related quality of life (HRQoL) in patients with mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) would improve surgical decision-making and post-operatory follow-up in this group of patients. METHODS: We analyzed the independent association between the Quality of Life in Epilepsy Inventory-31 (QOLIE-31) of 81 consecutive patients with refractory MTLE-HS. The clinical, demographic, radiological and electrophysiological variables were analyzed by multiple linear regression analysis. KEY FINDINGS: Approximately 36% (adjusted R(2)=0.36; R coefficient=0.66) of the QOLIE-31 overall score variance was explained by the history of initial precipitant injury, family history of epilepsy, disease duration, age of epilepsy onset, seizure frequency and presence of psychiatric axis-II diagnosis. The variance of QOLIE-31 sub-scales was: seizure worry=7%; overall QOL=11%; emotional well-being=32%; energy/fatigue=38%; cognitive function=13%; medication effects=7%; social function=13% (R coefficient between 0.30 and 0.65). SIGNIFICANCE: The pre-surgical variables studied had relatively low prediction capacity for the overall QOLIE-31 score and its sub-scales in this set of Brazilian patients with refractory MTLE-HS.

Epilepsy and occupational accidents in Brazil: a national statistics study.

Epilepsy may restrict the patient's daily life. It causes lower quality of life and increased risk for work-related accidents (WRA). The aim of this study is to analyze the implantation of the Epidemiologic and Technical Security System Nexus (ETSSN) and WRA patterns among patients with epilepsy. Data regarding WRA, between 1999 and 2008, on the historical database of WRA Infolog Statistical Yearbook from Brazilian Ministry of Social Security were reviewed. There was a significant increase of reported cases during the ten year period, mainly after the establishment of the ETSSN. The increased granted benefits evidenced the epidemiologic association between epilepsy and WRA. ETSSN possibly raised the registration of occupational accidents and granted benefits. However, the real number of WRA may remain underestimated due to informal economy and house workers' accidents which are usually not included in the official statistics in Brazil.