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 (%)