Epilepsy surgery and meaningful improvements in quality of life: Results from a randomized controlled trial
Bibliographic record
Abstract
OBJECTIVE: We examine improvement and worsening in quality of life (QOL) in terms of proportions achieving minimum clinically important change (MCID), and factors related to MCID, in patients with temporal lobe epilepsy randomized to medical or surgical treatment. METHODS: Eighty patients with temporal lobe epilepsy randomized to surgical (n(1) = 40) or medical (n(2) = 40) therapy were followed for 12 months, reporting QOL at baseline, and at 6 and 12 months. Previously established thresholds for MCID across various general and epilepsy-specific QOL instruments were used to determine meaningful improvement (positive MCID) or worsening (negative MCID). Generalized linear mixed-effects models were used to compare MCID in both groups. RESULTS: At 6 months, 56.0% of patients in the surgical group achieved positive MCID on the Quality of Life in Epilepsy (QOLIE)-89, as compared to 11.0% of those in the medical group (p < 0.001). On the QOLIE-31, 62.0% of the surgical group and 17.0% of the medical group achieved positive MCID (p < 0.001). Substantially more medically treated patients exhibited clinically significant worsening in QOL, as compared with those surgically treated. The respective medical versus surgical proportions with worsening were 36.67% versus 13.8% in QOLIE31, 20% versus 15% in Health Utility Index-III (HUI-III), and 30% versus 19% in Short Form-36 (SF-36) Mental Composite Score (MCS). The number of patients who need to undergo surgery for one additional person to have a meaningful improvement in the QOLIE-31 is two (number needed to treat = 2). The results also favored surgery using the generic HUI-III instrument, but not with the mental of physical function subscales of the SF-36. SIGNIFICANCE: Significantly more patients in the surgical group achieved meaningful improvement in epilepsy-specific measures of QOL at 6 and 12 months compared to those in the medical group. Substantially more patients in the medical therapy group exhibited clinically significant worsening in their QOL assessed with epilepsy-specific and generic instruments. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.024 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".