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Outcomes 200942
EpilepsyAs a result of Cleveland Clinic Epilepsy Center’s commitment to the comprehensive care of patients with epilepsy, and our
belief that the disease burden extends beyond a “seizure count,” we are integrating various measures of overall health with
every outpatient visit. The same detailed assessment is provided to both the large group of patients treated with anti-epileptic
medications alone and to the smaller group with refractory seizures who undergo epilepsy surgery.
Improvement in Quality of Life in Adult Epilepsy Patients
1, a 10-item, validated, patient-completed
P
50
40
30
20
10
0Initial Follow-up
Visit
QOLIE-10 ScoreQuality of Life
Improved
Quality of Life in Adult Patients Treated with Medications Only (N = 362)
43Neurological Institute
P
Epilepsia.
50
40
30
20
10
0Before After
Surgery
QOLIE-10 ScoreQuality of Life
Improved
Quality of Life in Adult Patients Following Epilepsy Surgery (N = 154)
Outcomes 200944
EpilepsyImprovement in Seizure Severity in Adult Epilepsy Patients
2, a validated, patient-completed
questionnaire developed to quantify the patient’s own perception of change in seizure severity. severe seizures. Again, seizure severity improved in both the medical and surgical groups.
P
Seizure Severity in Adult Patients Treated with Medications Only (N = 238)
100
80
60
40
20
0Initial Follow-up
Visit
LSSS ScoreSeizure Severity
Improved
45Neurological Institute
Seizure Severity in Adult Patients Following Epilepsy Surgery (N = 151)
100
80
60
40
20
0Before After
Surgery
LSSS ScoreSeizure Severity
Improved
surgery, with 65 percent of patients being completely seizure-free at the last follow-up, based on at least six months
Outcomes 200946
EpilepsyImprovement in Depression in Adult Epilepsy Patients
3, which represents a validated, patient-completed
medical and surgical groups.
P25th and 75th quartiles. The main improvement was observed in patients with moderate to severe depression at their
Depressive Symptoms in Adult Patients Treated with Medications Only (N = 556)
20
10
0
27
Initial
Visit
Follow-up
PHQ-9 ScoreDepression
Improved
47Neurological Institute
P
J Gen Intern Med. 2001
Depressive Symptoms in Adult Patients Following Epilepsy Surgery (N = 68)
20
10
0
27
Before
Surgery
After
PHQ-9 ScoreDepression
Improved
Outcomes 200948
EpilepsyImprovement in Anxiety in Adult Epilepsy Patients
, which represents a patient-completed
Pfollow-up ranged from 3.0 to 10.0 months.
Arch Intern Med.
Anxiety Symptoms in Adult Patients Treated with Medications Only (N = 270)
20
10
0
GAD-7 ScoreAnxiety
ImprovedInitial
Visit
Follow-up
49Neurological Institute
Change in Driving Status in Adult Epilepsy Patients
Driving Status in Adult Patients Treated with Medications Only (N = 454)
80
60
40
20
0
Initial Follow-up
Visit
Patients Driving (%)
Driving
Not Driving
PDriving Status in Adult Patients Following Epilepsy Surgery (N = 112)
100
80
60
40
20
0
Before
Surgery
After
Patients Driving (%)
Driving
Not Driving
Outcomes 200950
EpilepsyImprovement in Seizure Severity in Pediatric Epilepsy Patients
2
severe seizures.
Seizure Severity in Pediatric Patients Treated with Medications Only (N = 387)
100
80
60
40
20
0Initial
Visit
Follow-up
LSSS Score
Seizure Severity
Improved
P <
51Neurological Institute
Seizure Severity in Pediatric Patients Following Epilepsy Surgery (N = 28)
70
60
50
40
30
20
10
0
Before After
Surgery
LSSS ScoreSeizure Severity
Improved
Encouraging treatment outcomes were
observed in our pediatric epilepsy patients.
underwent epilepsy surgery,
seizure severity dropped
Pthe median and the 25th and
75th quartiles.
Outcomes 20095252
EpilepsyImprovement in Healthcare Utilization in Pediatric Epilepsy Patients
0.5
0.4
0.3
0.2
0.1
0
Rescue Meds
99N =
ER Visits
99
Hospitalizations
103
Average Number over Three Months
Initial Visit
Last Follow-up Visit
Healthcare Utilization in Pediatric Patients Treated with Medications Only
October 2008 – December 2009
Neurological Institute 53
School and Work Status of Pediatric Epilepsy Patients Following Epilepsy Surgery (N = 18)
Improvement in Functional Outcome in Pediatric Epilepsy Patients
12
9
6
3
0
School Work
Days Missed
Number of Days
Initial Visit
Last Follow-up Visit
Outcomes 200954
100
80
60
40
20
0
0 1 2 3 4 5 6 7 8 9 10 11 12
Years from Surgery
Seizure-free (%)
Pediatric Epilepsy Patients
Combined Cohort
Adult Epilepsy Patients
EpilepsySeizure Freedom Following Epilepsy Surgery
the following curves. Whenever possible, our data were compared with national published data. We used the widely accepted 5
Long-Term Seizure Freedom in Adult and Pediatric Patients Following Epilepsy Surgery (N = 1,418)
Neurological Institute 55
6. Erickson JC, Ellenbogen RG, Khajevi K, Mulligan L, Ford GC, Jabbari B. Temporal lobectomy for refractory epilepsy in the U.S. military. Mil Med. 2005;170:201-205; 7. Spencer SS, Berg AT, Vickrey BG, et al. Predicting long-term seizure outcome after resective epilepsy
surgery: the multicenter study. Neurology. 2005;65:912-918; 8. Kelley K, Theodore WH. Prognosis 30 years after temporal lobectomy. Neurology. 2005;64:1974-1976; 9. Yoon HH, Kwon HL, Mattson RH, Spencer DD, Spencer SS. Long-term seizure outcome in patients
initially seizure-free after resective epilepsy surgery. Neurology. 2003;61:445-450; 10. Foldvary N, Nashold B, Mascha E, et al. Seizure
outcome after temporal lobectomy for temporal lobe epilepsy: a Kaplan-Meier survival analysis. Neurology. 2000;54:630-634;
11. Salanova V, Markand O, Worth R. Longitudinal follow-up in 145 patients with medically refractory temporal lobe epilepsy treated
surgically between 1984 and 1995. Epilepsia. 1999;40:1417-1423; 12. Sperling MR, O’Connor MJ, Saykin AJ, Plummer C. Temporal
lobectomy for refractory epilepsy. JAMA. 1996;276:470-475.
The graph illustrates the percent of adult and pediatric patients who were seizure-free up to 10 years following a temporal
lobe resection. National averages represent a weighted average of recent studies conducted in the United States.6-12
Time from Surgery 1 Year 2 Years 5 Years 10 Years 15 Years
% Seizure-free (Cleveland Clinic) 77% 72% 63% 57% 40%
% Seizure-free (national average) 72% 54% 59% 51% None available
100
80
60
40
20
0
0 1 2 3 4 5 6 7 8 9 10
Years from Surgery
Seizure-free (%)
Cleveland Clinic Epilepsy Center
National Average
Long-Term Seizure Freedom Following Temporal Lobe Surgery (N = 750)
Surgical Dates: 1996 – 2009
Outcomes 200956
EpilepsyLong-Term Seizure Freedom Following Frontal Lobe Surgery (N = 304)
lobe epilepsy operated on between 1997 and 2009.
100
80
60
40
20
0
0 1 2 3 4 5 6 7 8 9 10
Years from Surgery
Seizure-free (%)
57Neurological Institute
Long-Term Seizure Freedom Following Posterior Quadrant Resection (N = 96)
patients with medically refractory epilepsy between 1997 and 2009.
100
80
60
40
20
0
0 1 2 3 4 5 6 7 8
Years from Surgery
Seizure-free (%)
Outcomes 200958
EpilepsyLong-Term Seizure Freedom Following Hemispherectomy (N = 190)
following a hemispherectomy. Thirteen of the patients were adults and the remaining 177 were children
100
80
60
40
20
0
0 1 2 3 4 5 6 7 8
Years from Surgery
Seizure-free (%)
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