Social Determinants of Neuropsychological Outcome and Quality of Life in Pediatric Epilepsy Surgery Open Access

Abstract

Introduction: Epilepsy affects approximately 6 in 1,000 children in the United States and occurs more frequently in lower-income families. Although antiseizure medications control seizures in most patients, about 30% develop drug-resistant epilepsy (DRE). For these patients, surgery is the most effective treatment. While seizure outcomes after surgery are well characterized, less is known about postsurgical neuropsychological and quality-of-life (QOL) outcomes and the social determinants of health (SDOH) that may influence them. This study evaluates associations between SDOH, neuropsychological outcomes, and QOL after pediatric epilepsy surgery.

Methods: All DRE patients at Children’s Healthcare of Atlanta (CHOA) who underwent tissue- destroying epilepsy surgery between 2014–2023 and were 4–18 years old at surgery were included. Retrospective electronic medical record extraction captured demographics, epilepsy characteristics, surgical variables, and pre- and postoperative neuropsychological evaluations. SDOH and QOL data were collected prospectively via guardian phone survey using a custom SDOH questionnaire and the validated QOLCE-16 (Quality of Life in Childhood Epilepsy) instrument. Univariate analyses assessed associations between SDOH variables and neuropsychological and QOL outcomes.

Results: Of 163 surgical patients, 88 met inclusion criteria. The SDOH/QOL survey response rate was 43/88 (48.9%) with median follow-up of 4.6 years (IQR 1.86–8.19). Median time to postoperative neuropsychological evaluation was 12.9 months (IQR 8.61–22.00). Median household income was $107,500 (IQR $55,000–$200,000). 42% had private insurance and 58% had public or no insurance. 13/39 (33%) fathers and 24/43 (56%) mothers had a bachelor’s degree or higher. Median baseline seizure frequency was 1.0/day (IQR 0.3–3.0). Surgical procedures included resections (81%), ablations (15%), and disconnections (4%), most commonly in the frontal (38%) and temporal (38%) lobes; 56% were right-sided. At 1 year, 62.7% were seizure free and 85% had reduced seizure frequency; 40% reduced antiseizure medications. Median QOLCE-16 score was 52 (IQR 39–70). No SDOH variables or age were associated with neuropsychological or QOL outcomes. In post-hoc analysis, seizure freedom at 1 year was associated with significantly higher QOL (59.4 (95% CI: 45.3-79.7) vs. 41.4 (95% CI: 33.6-48.4) p = 0.006) but not neuropsychological outcomes (p = 0.198).

Conclusion: Postoperative QOL appears primarily associated with seizure freedom, while SDOH were not associated with neuropsychological outcomes or QOL after pediatric epilepsy surgery. 

Table of Contents

INTRODUCTION, 1

BACKGROUND, 3

METHODS, 5

RESULTS, 9

DISCUSSION, 12

TABLES/FIGURES, 17

REFERENCES, 32

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Surgery Psychology, Clinical Biology, Neuroscience
Keyword	Quality of life Social determinants of health Neuroscience Pediatrics Epilepsy Neurosurgery
Committee Chair / Thesis Advisor	Jordan Kempker, Emory University Amita Manatunga, Emory University
Committee Members	Carla Ammons, Emory University Daniel Drane, Emory University Donald Bearden, University of Tennessee

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