Title UTJECAJ NEUROKIRURŠKOG LIJEČENJA NA KVALITETU
ŽIVOTA BOLESNIKA S FARMAKOREZISTENTNOM
EPILEPSIJOM
Title (english) THE IMPACT OF NEUROSURGICAL TREATMENT ON
THE QUALITY OF LIFE IN PATIENTS WITH
DRUG-RESISTANT EPILEPSY
Author Dragana Mijatović
Mentor Željka Petelin Gadže (mentor)
Mentor Elizabeta Dadić-Hero (komentor)
Committee member Marina Letica-Crepulja (predsjednik povjerenstva)
Committee member Mario Šekerija (član povjerenstva)
Committee member Vladimira Vuletić (član povjerenstva)
Granter University of Rijeka Faculty of Medicine Rijeka
Defense date and country 2023-11-24, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Neurology
Universal decimal classification (UDC ) 616 - Pathology. Clinical medicine
Abstract Uvod: Kvaliteta života može se promatrati s psihološkog, socijalnog, radnog i tjelesnog aspekta. U oboljelih od epilepsije kvaliteta života može biti narušena u svim navedenim aspektima, kako zbog težine i učestalosti epileptičnih napadaja tako i zbog primjene i nuspojava antiepileptika. Farmakorezistentna epilepsija predstavlja oblik epilepsije u kojoj uz najmanje dva optimalno odabrana antiepileptika, a redovito uzimana u primjerenoj dozi, nije došlo do potpunog prestanka epileptičnih napadaja kod bolesnika. Procjenjuje se da je 30 – 40 % bolesnika oboljelih od epilepsije rezistentno na farmakoterapiju te da je nezadovoljavajuće liječeno, zbog čega je kvaliteta života u ovih bolesnika znatno narušena. Resektivno ili minimalno invazivno neurokirurško liječenje metode su odabira liječenja bolesnika s farmakorezistentnom epilepsijom. Cilj istraživanja: Procijeniti uspješnost neurokirurškog liječenja i kvalitetu života bolesnika s farmakorezistentnom epilepsijom prije i godinu dana nakon neurokirurškog liječenja. Ispitanici i metode: Istraživanje je provedeno u Referentnom centru Ministarstva zdravstva Republike Hrvatske za epilepsiju Klinike za neurologiju KBC Zagreb od veljače 2015. do veljače 2020. godine. U istraživanje je uključeno 96-ero bolesnika s farmakorezistentnom epilepsijom kod kojih je ispitana kvaliteta života prije i godinu dana nakon neurokirurškog liječenja korištenjem upitnika „Kvaliteta života s epilepsijom“ (QOLIE-31), validirana hrvatska 1.0 verzija i upitnika za procjenu stupnja depresivnosti „Beckov Inventar Depresije I“ (BDI-I), validirana hrvatska verzija. Rezultati: Od 96 bolesnika s farmakorezistetnom epilepsijom godinu dana nakon neurokirurškog liječenja 46-ero (47,9 %) bolesnika nije imalo epileptične napadaje, odnosno bilo je seizure free. Srednja vrijednost ukupnog broja epileptičnih napadaja mjesečno prije neurokirurškog liječenja bila je 30,7 ( 49,1), a godinu dana nakon neurokirurškog liječenja znano manja, 13,3 ( 32,2). Smanjenje broja učestalosti epileptičnih napadaja godinu dana nakon neurokirurškog liječenja statistički je značajno utjecalo (p < 0,05) na doživljaj bolje kvalitete života bolesnika u 5 kategorija QOLIE-31: zabrinutost zbog napadaja, ukupna kvaliteta života, kognitivno funkcioniranje, učinak lijekova i socijalno funkcioniranje. Utjecalo je i na ukupni zbroj QOLIE-31 te BDI-I. Wilcoxonov test ekvivalentnih parova pokazao je da je broj korištenih antiepileptika godinu dana nakon neurokirurškog liječenja značajno manji (p = 0,0007). Zaključak: Na temelju istraživanja može se zaključiti da je neurokirurško liječenje u oboljelih od farmakorezistetne epilepsije izuzetno učinkovito, što ukazuje na potrebu što ranijeg postavljanja dijagnoze farmakorezistentne epilepsije te indikacije za neurokirurško liječenje. Godinu dana nakon neurokirurškog liječenja bolesnika s farmakorezistentnom epilepsijom znatno se smanjuje broj epileptičnih napadaja i broj ranije korištenih antiepileptika ili potpuno prestaju epileptični napadaji kod bolesnika čime se znatno poboljšava ukupna kvaliteta njihovog života.
Abstract (english) Background: The quality of life can be observed from the psychological, social, work and physical aspects. In patients with epilepsy, the quality od life can be imparied in all the above mentioned aspects, both due to the severity and frequency of epileptic seizures, and due to the use and side effects of antiepileptic drugs. Drug-resistant epilepsy is a form of epilepsy in which with at least two optimally selected and regularly taken antiepileptics, at an appropriate dose, the complete release of epileptic seizures has not occurred. It is estimated that 30 – 40 % of epilepsy patients have been resistant to pharmacotherapy and are unsatisfactorily treated, for which the quality of life in these patients is significantly impaired. Resective neurosurgical treatment or minimally invasive neurosurgical treatment are methods of choice for the treatment of patients with drug-resistant epilepsy. Objectives: The aim of this study was to examine the impact of neurosurgical treatment and the quality of life in patients with drug-resistant epilepsy before and one year after neurosurgical treatment.
Patients and Methods: The research was performed at the Referral Centre for Epilepsy, Department of Neurology, University Hospital Centre Zagreb from February 2015 to February 2020. The study included 96 patients with drug-resistant epilepsy who were examined for the quality of life before and one year after neurosurgical treatment, using the form questionnaire "Quality of life in epilepsy" (QOILE-31) validated Croatian 1.0 version and the questionnaire to assess the degree of depression "Beck Depression Inventory I" (BDI I) validated Croatian version.
Results: Out of 96 patients with drug-resistant epilepsy one year after neurosurgical treatment, 46 (47.9 %) patients remained without epileptic seizures, ie „seizure free“. The mean value of the total number of seizures per month before neurosurgical treatment was 30.7 ( 49.1), and one year after neurosurgical treatment it was significantly lower, 13.3 ( 32.2). The decrease in the frequency of epileptic seizures one year after neurosurgical treatment had a statistically significant effect (p<0.05) ) on the experience of a better quality of life in 5 categories of QOLIE-31: seizure worry, overall quality of life, cognitive functioning, medication effects and social functioning. It also affected the total score QOLIE-31 and in BDI-I. Wilcoxon equivalent pair test showed that the number of antiepileptic drugs used was one year after neurosurgical treatment significantly lower (p 0.0007).
Conclusion: Based on the research, it can be concluded that neurosurgical treatment in patients with drug-resistant epilepsy is extremely effective, which points to the need for early diagnosis of drug-resistant epilepsy, and indications for neurosurgical treatment. One year after neurosurgical treatment of patients with drug-resistant epilepsy the number of epileptic seizures and the number od previously used antiepileptic drugs are significantly reduced, or the patients are completly seizure free from epileptic seizures, which significantly improves their overall quality of life.
Keywords
farmakorezistentna epilepsija
kvaliteta života
neurokirurško liječenje
Keywords (english)
drug-resistant epilepsy
neurosurgical procedure
quality of life
Language croatian
URN:NBN urn:nbn:hr:184:347751
Promotion 2024
Study programme Title: Biomedicine Postgraduate (doctoral) study programme Study programme type: university Study level: postgraduate Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
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Created on 2024-01-11 07:31:37